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Perforated Meckel's diverticulum in an adult: Case report and literature review
Carlos Eduardo Rey Chaves1, Ingrid Serna1, Laura Romero-Guerra2
1Estudiante de posgrado Cirugía General, Pontificia Universidad Javeriana, Facultad de Medicina, Bogotá, Colombia.
Introduction And Importance:
Meckel's diverticulum (MD) is an unusual clinical condition that occurs in approximately 2-4 %. The complications are more common in children, with a low prevalence in adults, with the main complication in adults being intestinal obstruction followed by diverticulitis with or without perforation.
Case Presentation:
We present a 30-year-old female patient with a history of an appendectomy. She attends the emergency room due to a four-day history of pain in the lower abdominal quadrants, tachycardia, and leukocytosis, with an abdominal CT scan identifying an inflammatory process of the ileum, suggesting a Meckel's diverticulum, urachus remnant, or foreign body. The patient was taken to surgery, and inflammatory adhesions, including a perforated Meckel's diverticulum with necrotic signs and purulent production, were evidenced. Intestinal resection and ileal anastomosis were performed with no complications at 90 days.
Clinical Discussion:
Preoperative diagnosis is difficult in cases with associated inflammatory conditions and is generally made incidentally during surgery and less frequently with CT scans. Surgical management for patients with MD is still controversial and depends on many factors, including symptoms, related complications, characteristics of the diverticulum, and the patient's clinical condition. Currently, no standardized surgical technique exists, and cases should be individualized.
Conclusion:
Meckel's diverticulum perforation is a rare complication in the adult population and remains a diagnostic and surgical challenge, and the final decision must be individualized.
Insights
Meckel
Area of Science:
- Gastroenterology
- Surgical Case Reports
- Abdominal Surgery
Background:
- Meckel's diverticulum (MD) affects 2-4% of the population, with complications more frequent in children.
- Adult complications of MD typically involve intestinal obstruction or diverticulitis, with perforation being rare.
Observation:
- A 30-year-old female presented with acute abdominal pain, tachycardia, and leukocytosis.
- CT scan suggested an ileal inflammatory process; surgery revealed a perforated Meckel's diverticulum with adhesions.
- The patient underwent intestinal resection and ileal anastomosis without postoperative complications.
Findings:
- Preoperative diagnosis of Meckel's diverticulum perforation in adults is challenging, often incidental.
- Surgical management requires individualized approaches due to varying presentations and patient conditions.
Implications:
- Meckel's diverticulum perforation is a rare but significant complication in adults.
- Timely surgical intervention and individualized treatment are crucial for favorable outcomes.
- This case highlights the diagnostic and surgical challenges associated with adult Meckel's diverticulum perforation.
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