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Perforated Meckel Diverticulum Caused by Vegetal Food Entrapment: A Rare Case Report and Literature Review
Odile Sorg1, Xenofon Papazarkadas1, Michaël Racine1
1Department of Surgery, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
Abstract:
BACKGROUND Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract. It results from incomplete obliteration of the vitelline duct, leading to the formation of a true diverticulum of the small intestine, and is often clinically silent. However, complications can occur, including gastrointestinal bleeding, bowel obstruction, Meckel's diverticulitis, or perforation. CASE REPORT We present the case of a 62-year-old male patient in good health, with no prior history of surgery, who presented with abdominal pain in the right iliac fossa and elevated C-reactive protein levels. An abdominal ultrasound showed signs of acute appendicitis. During surgical laparoscopic exploration, which was converted to a median laparotomy, an inflamed perforated Meckel diverticulum caused by a foreign body was discovered. Due to the inflammation, a segmental small bowel resection with an ileo-ileal latero-lateral anastomosis was performed. CONCLUSIONS The surgical management of Meckel diverticulum depends on several factors, including the presence of inflammation, perforation, infection, and the size of the diverticulum. Diverticulectomy, which can be easily performed laparoscopically, typically has a lower complication rate. Nevertheless, in cases of bleeding or severe inflammation, a small bowel resection may be needed to ensure that all heterotopic mucosa is removed. This report highlights a rare case of perforation caused by a foreign body of vegetal origin.
Insights
A perforated Meckel diverticulum, a rare congenital anomaly, can be caused by a foreign body. Surgical intervention, such as small bowel resection, may be necessary for severe inflammation or perforation.
Area of Science:
- Gastroenterology
- Surgical Pathology
Background:
- Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract, arising from incomplete obliteration of the vitelline duct.
- While often asymptomatic, it can lead to serious complications like bleeding, obstruction, diverticulitis, or perforation.
Purpose of the Study:
- To report a rare case of Meckel diverticulum perforation caused by a foreign body.
- To discuss the surgical management of complicated Meckel diverticulum.
Main Methods:
- Case report of a 62-year-old male presenting with abdominal pain and elevated inflammatory markers.
- Diagnostic workup included abdominal ultrasound, followed by laparoscopic exploration converted to laparotomy.
- Surgical management involved segmental small bowel resection and ileo-ileal anastomosis.
Main Results:
- An inflamed, perforated Meckel diverticulum containing a foreign body was identified as the cause of symptoms.
- The patient underwent successful small bowel resection and anastomosis.
Conclusions:
- Surgical approach for Meckel diverticulum is tailored to factors like inflammation, perforation, and size.
- While diverticulectomy is common, small bowel resection may be required for severe cases to ensure removal of all ectopic mucosa.
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