Successful Conservative Management of Acute Microperforation in a Diverticulum Within a Meckel's Diverticulum: A Case...

Meckel's diverticulum is a common congenital gastrointestinal anomaly that can lead to various complications. This case report presents a rare instance of microperforation of a diverticulum within Meckel's diverticulum. A 31-year-old male presented with a two-day history of progressively worsening, intermittent right lower quadrant pain and fever. The patient reported dull pain that migrated from the epigastric region to the right lower quadrant over the course of two days. The pain was exacerbated by movement. Blood tests revealed WBC 13,900/μL and CRP 5.30 mg/dL. Given the patient's characteristic clinical presentation suggestive of appendicitis, an initial ultrasound examination was performed. However, the ultrasound failed to reveal findings typical of appendicitis. Considering the possibility of conditions mimicking appendicitis, a contrast-enhanced computed tomography (CT) scan was subsequently conducted. The CT scan revealed a blind-ending intestinal structure branching from the jejunum, surrounded by fat stranding and free air. These findings were suggestive of a microperforation of a diverticulum within Meckel's diverticulum. The patient was initially managed conservatively with bowel rest and antibiotic therapy, resulting in significant symptom improvement. Subsequent laparoscopic resection confirmed the presence of a diverticulum within Meckel's diverticulum. This case highlights the diversity of Meckel's diverticulum complications and demonstrates the potential for successful conservative management in select cases of microperforation of diverticulum within a Meckel's diverticulum.