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Diverticular disease in a pediatric patient with Crohn's disease mimicking a perforated post-appendectomy appendiceal
Joseph de Nanassy1, David Mack2, Marcos Bettolli3
1Department of Pathology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.
Insights
A rare non-Meckel diverticulum formed in a child
Area of Science:
- Gastroenterology and Pediatric Surgery
Background:
- Crohn disease can cause ileocecal strictures in children.
- Strictures may mimic other surgical emergencies.
Observation:
- A pediatric Crohn disease patient presented with an ileocecal stricture.
- Imaging revealed a cecal diverticulum, initially mistaken for a perforated appendiceal stump.
Findings:
- This is the first reported case of a non-Meckel diverticulum in a pediatric Crohn disease patient.
- Laplace Law explains diverticulum formation at the point of maximal stricture and weakness in the inflamed bowel wall.
- A 9-month interval between diagnosis and surgery facilitated diverticulum development.
Implications:
- This case highlights a rare complication of pediatric Crohn disease.
- Long-term adult follow-up is crucial due to increased risks of diverticular disease and neoplasms in Crohn disease patients.
Abstract:
We present the finding of a diverticulum in the colonic wall of the cecum, arising in the context of ileocecal stricture in a child with Crohn disease mimicking a post-appendectomy perforated appendiceal stump. To our knowledge, a non-Meckel diverticulum in a pediatric patient with Crohn disease has not yet been reported and we examine the mechanics behind it. According to the Laplace Law, the pressure inside a container with curved walls is inversely proportional to its radius. A diverticulum forms at the point of maximum stricture and at the locus of least resistance (weakness) in the bowel wall due to the inflammatory bowel disease. The long-time interval between diagnosis of ileocecal stricture and surgery (9 months) is important to allow the formation of this diverticulum. Continued follow-up in adulthood is warranted due to an increased risk of intestinal diverticular disease and neoplasms in patients with Crohn disease.
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