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Perforation of the Meckel's diverticulum with a chicken bone: a case report and literature review
Bardia Bidarmaghz1, Hugh McGregor2, Kasra Raufian2
1Department of Surgery, Redcliffe Hospital, Anzac Avenue, Redcliffe, QLD, 4020, Australia. bardiab1985@yahoo.com.
Background:
Meckel's diverticulum (MD) is the most common congenital abnormality of the gastrointestinal (GI) tract. Most of the people remain asymptomatic during their lifetime, but some can develop complications such as inflammation, haemorrhage or obstruction. Perforation of Meckel's diverticulum is very rare, and we present a case of perforation by a chicken bone.
Case Presentation:
A 19-year-old man presented to the emergency department with abdominal pain, and based on examination and laboratory findings, he was diagnosed with appendicitis initially. Meanwhile, a CT scan was requested and a foreign object inside the Meckel's diverticulum was noted, and on further questioning, he mentioned that he had chicken with bones 2 days ago. He was taken to the operating theatre, and during laparotomy, the perforated Meckel's diverticulum was found, and it was resected with primary anastomosis.
Conclusion:
Meckel's diverticulum follows the 'rule of twos', and perforation of it with foreign object is rare. Patients usually present with signs and symptoms of acute abdomen, and appendicitis is the first diagnosis, and the final diagnosis is usually made intraoperatively. Perforation of Meckel's diverticulum should be considered for the patients who present with acute abdomen, and with precise history taking and investigations, preoperative diagnosis can be achieved.
Insights
Perforation of Meckel
Area of Science:
- Gastroenterology and General Surgery
- Congenital gastrointestinal abnormalities
Background:
- Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract.
- While often asymptomatic, MD can lead to complications like inflammation, hemorrhage, or obstruction.
- Perforation of Meckel's diverticulum is an exceptionally rare occurrence.
Purpose of the Study:
- To report a rare case of Meckel's diverticulum perforation caused by a foreign object (chicken bone).
- To highlight the diagnostic challenges and considerations for Meckel's diverticulum perforation presenting as acute abdomen.
Main Methods:
- A 19-year-old male presented with acute abdominal pain, initially suspected as appendicitis.
- Computed tomography (CT) scan revealed a foreign object within the Meckel's diverticulum.
- Surgical exploration (laparotomy) confirmed a perforated Meckel's diverticulum, which was resected with primary anastomosis.
Main Results:
- The patient's Meckel's diverticulum was perforated by a chicken bone, a rare etiology.
- Initial diagnosis was appendicitis, underscoring the potential for misdiagnosis in acute abdominal cases.
- Intraoperative findings confirmed the Meckel's diverticulum perforation as the source of symptoms.
Conclusions:
- Meckel's diverticulum perforation by foreign objects is uncommon, despite MD's prevalence.
- Patients often present with signs mimicking acute appendicitis, leading to delayed diagnosis.
- Considering Meckel's diverticulum in acute abdomen cases and utilizing thorough history and investigations can improve preoperative diagnosis.
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