A case report of coexistence of acute appendicitis and Meckel's diverticulitis causing generalized acute peritonitis

The coexistence of appendicitis and Meckel's diverticulitis is a rare condition that can lead to acute peritonitis. It is difficult to diagnose preoperatively and requires emergency surgical intervention. We report a case presenting with both lesions.

A 43-year-old female patient was admitted with generalized peritoneal irritation syndrome, developing in a febrile context and associated with a biological inflammatory syndrome. Computed tomography revealed signs of peritonitis and an inflamed appendix. Laparoscopy, converted to laparotomy, revealed coexisting appendicitis and Meckel's diverticulitis, which were responsible for generalized peritonitis. An appendectomy and ileal resection to remove the Meckel's diverticulum were performed, with end-to-end ileoileal anastomosis and cleaning of the peritoneal cavity. The postoperative course was uneventful. Pathological examination showed no malignant degeneration in the surgical specimens.

The coexistence of appendicular inflammation and a Meckel's diverticulum is a rare cause of acute peritonitis. We report a case in which the aetiology appears to be appendicular inflammation that spread to Meckel's diverticulum, facilitated by an anatomical defect in the parietal attachment of the right colon. There is no consensus on the surgical approach to non-inflammatory Meckel's diverticula in the context of appendicitis, but surgical intervention is indisputable in cases of dual inflammation. An appendectomy and diverticulectomy were performed, with a systematic pathological examination to look for signs of malignancy.

The diagnostic and therapeutic urgency of this condition remains a challenge, particularly because the coexistence of these lesions should be considered when a typical picture of acute appendicitis is encountered.