Spontaneous Perforation of Meckel's Diverticulum in a 37-Year-Old Woman: A Case Report

Meckel's diverticulum (MD), the most common congenital abnormality of the gastrointestinal (GI) tract, typically presents in an asymptomatic manner. However, peritonitis occurring as a result of ruptured MD is extremely rare in adults, and this may make diagnosis even more challenging. This presentation can often imitate other acute GI emergencies like appendicitis or even some gynecological conditions.

We report an unusual case of a 37-year-old female patient presenting with lower abdominal pain radiating to the right iliac fossa for three days, progressing to generalized abdominal pain along with signs of peritonitis. On exploratory laparotomy, findings included a severely congested and edematous MD with a large 1 cm perforation, as well as a mass of hard tissue within its wall. Segmental enterectomy with primary end-to-end anastomosis and an appendectomy was performed.

The differential diagnosis of ruptured MD should never be overlooked in adult patients presenting with acute abdominal pain and generalized peritonitis, even though it is very rare. Diagnosis of this disease preoperatively is extremely complex due to the fact that radiological findings are usually not specific and may imitate other acute abdominal or gynecological emergencies. For this reason, immediate surgical intervention is crucial to prevent complications such as widespread sepsis and chronic illness.

This case emphasizes the importance of keeping the differential of ruptured MD under consideration when dealing with adults presenting with acute abdominal pain, even if a gynecological cause is initially suspected. Thus, early detection and immediate surgical intervention are key factors for more positive patient outcomes.