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Perforated Meckel's diverticulitis complicating active Crohn's ileitis: a case report.

Schwenter F, Gervaz P, de Saussure P, McKee T, Morel P - J Med Case Rep (2009)

Bottom Line: Laparoscopy was performed and revealed, in addition to extensive ileitis, a 3 x 3 cm abscess in connection with perforated Meckel's diverticulitis.It was therefore possible to avoid ileocaecal resection by only performing Meckel's diverticulectomy; pathological examination of the surgical specimen revealed the presence of transmural inflammation with granulomas and perforation of the diverticulum at its extremity.Crohn's disease of the ileum may be responsible for Meckel's diverticulitis and cause perforation which, in this case, proved to be a blessing in disguise and spared the patient an extensive small bowel resection.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, University Hospital and Medical School Geneva, 1211 Geneva 14, Switzerland. frank.schwenter@hcuge.ch.

ABSTRACT

Introduction: In Crohn's disease, the extension of active terminal ileitis into a Meckel's diverticulum is possible, but usually has no impact on clinical decision-making. We describe an original surgical approach in a young woman presenting with a combination of perforated Meckel's diverticulitis and active Crohn's ileitis.

Case presentation: We report the case of a 22-year-old woman with Crohn's disease, who was admitted for abdominal pain, fever and diarrhoea. CT scan demonstrated active inflammation of the terminal ileum, as well as a fluid collection in the right iliac fossa, suggesting intestinal perforation. Laparoscopy was performed and revealed, in addition to extensive ileitis, a 3 x 3 cm abscess in connection with perforated Meckel's diverticulitis. It was therefore possible to avoid ileocaecal resection by only performing Meckel's diverticulectomy; pathological examination of the surgical specimen revealed the presence of transmural inflammation with granulomas and perforation of the diverticulum at its extremity.

Conclusion: Crohn's disease of the ileum may be responsible for Meckel's diverticulitis and cause perforation which, in this case, proved to be a blessing in disguise and spared the patient an extensive small bowel resection.

No MeSH data available.


Related in: MedlinePlus

Preoperative Computed Tomography scanner showing a 3 × 3 cm abscess in right iliac fossa (arrow) as well as extensive inflammation of the terminal ileum (*).
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Figure 1: Preoperative Computed Tomography scanner showing a 3 × 3 cm abscess in right iliac fossa (arrow) as well as extensive inflammation of the terminal ileum (*).

Mentions: A 22-year-old Caucasian woman was admitted because of severe abdominal pain, fever and diarrhoea. She had been diagnosed with Crohn's disease 2 months before, and a computed tomography (CT) scan demonstrated active inflammation of the terminal ileum, as well as a 3 × 3 cm abscess in the right iliac fossa (Figure 1). The initial management was conservative, with metronidazole 500 mg TID, ciprofloxacin 500 mg twice daily (BD), azathioprine 150 mg once daily (OD) and percutaneous CT scan-guided drainage of the abscess. This proved unsuccessful and surgery was considered following the development of persistent purulent drainage from the drain orifice.


Perforated Meckel's diverticulitis complicating active Crohn's ileitis: a case report.

Schwenter F, Gervaz P, de Saussure P, McKee T, Morel P - J Med Case Rep (2009)

Preoperative Computed Tomography scanner showing a 3 × 3 cm abscess in right iliac fossa (arrow) as well as extensive inflammation of the terminal ileum (*).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2630308&req=5

Figure 1: Preoperative Computed Tomography scanner showing a 3 × 3 cm abscess in right iliac fossa (arrow) as well as extensive inflammation of the terminal ileum (*).
Mentions: A 22-year-old Caucasian woman was admitted because of severe abdominal pain, fever and diarrhoea. She had been diagnosed with Crohn's disease 2 months before, and a computed tomography (CT) scan demonstrated active inflammation of the terminal ileum, as well as a 3 × 3 cm abscess in the right iliac fossa (Figure 1). The initial management was conservative, with metronidazole 500 mg TID, ciprofloxacin 500 mg twice daily (BD), azathioprine 150 mg once daily (OD) and percutaneous CT scan-guided drainage of the abscess. This proved unsuccessful and surgery was considered following the development of persistent purulent drainage from the drain orifice.

Bottom Line: Laparoscopy was performed and revealed, in addition to extensive ileitis, a 3 x 3 cm abscess in connection with perforated Meckel's diverticulitis.It was therefore possible to avoid ileocaecal resection by only performing Meckel's diverticulectomy; pathological examination of the surgical specimen revealed the presence of transmural inflammation with granulomas and perforation of the diverticulum at its extremity.Crohn's disease of the ileum may be responsible for Meckel's diverticulitis and cause perforation which, in this case, proved to be a blessing in disguise and spared the patient an extensive small bowel resection.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, University Hospital and Medical School Geneva, 1211 Geneva 14, Switzerland. frank.schwenter@hcuge.ch.

ABSTRACT

Introduction: In Crohn's disease, the extension of active terminal ileitis into a Meckel's diverticulum is possible, but usually has no impact on clinical decision-making. We describe an original surgical approach in a young woman presenting with a combination of perforated Meckel's diverticulitis and active Crohn's ileitis.

Case presentation: We report the case of a 22-year-old woman with Crohn's disease, who was admitted for abdominal pain, fever and diarrhoea. CT scan demonstrated active inflammation of the terminal ileum, as well as a fluid collection in the right iliac fossa, suggesting intestinal perforation. Laparoscopy was performed and revealed, in addition to extensive ileitis, a 3 x 3 cm abscess in connection with perforated Meckel's diverticulitis. It was therefore possible to avoid ileocaecal resection by only performing Meckel's diverticulectomy; pathological examination of the surgical specimen revealed the presence of transmural inflammation with granulomas and perforation of the diverticulum at its extremity.

Conclusion: Crohn's disease of the ileum may be responsible for Meckel's diverticulitis and cause perforation which, in this case, proved to be a blessing in disguise and spared the patient an extensive small bowel resection.

No MeSH data available.


Related in: MedlinePlus