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Perforated Meckel Diverticulum: A Rare Cause of Acute Abdomen in Children
Saurabh Talathi1, David Kelly2,3, Scott Anderson4
1From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Alabama at Birmingham.
Abstract:
Meckel diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract and the most common cause of gastrointestinal bleeding in children. Although it usually follows the rule of 2's, exceptions to this rule are reported in the literature. Often asymptomatic, MD is commonly an incidental finding during surgical interventions. When symptomatic, the most common presentation of this condition is painless rectal bleeding. A myriad of other nonspecific symptoms are however possible, especially in adults, thus making this diagnosis difficult. Meckel diverticulum has been reported to mimic other abdominal pathologies like appendicitis, inflammatory bowel disease, and pancreatitis to name a few.We report a patient with acute abdomen in whom the more common causes of acute abdomen were ruled out and a diagnosis of MD was established on exploratory laparoscopy, only after he developed perforation. This report emphasizes the need for maintaining a high index of suspicion towards a possibility of a complicated MD in patients presenting with an acute abdomen, once other causes of acute abdomen are ruled out.
Insights
Meckel diverticulum (MD), a common congenital anomaly, often presents as painless rectal bleeding in children. This case highlights the importance of considering complicated MD in acute abdomen diagnoses when other causes are excluded.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Congenital Anomalies
Background:
- Meckel diverticulum (MD) is the most frequent congenital anomaly of the gastrointestinal tract.
- It is the leading cause of gastrointestinal bleeding in pediatric patients.
- MD often remains asymptomatic and is discovered incidentally during surgery.
Observation:
- Symptomatic MD commonly presents with painless rectal bleeding.
- However, nonspecific symptoms, particularly in adults, can complicate diagnosis.
- MD can mimic other abdominal conditions such as appendicitis, inflammatory bowel disease, and pancreatitis.
Findings:
- A case report details a patient with acute abdomen where initial common causes were ruled out.
- The diagnosis of Meckel diverticulum was confirmed via exploratory laparoscopy after perforation occurred.
- This underscores the diagnostic challenges posed by Meckel diverticulum.
Implications:
- Maintaining a high index of suspicion for complicated Meckel diverticulum is crucial in acute abdomen cases.
- Early consideration of MD can prevent diagnostic delays and potential complications.
- This emphasizes the need for thorough differential diagnosis in abdominal emergencies.
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