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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

Histology of resected Meckel's diverticulum: (A) active chronic transmural inflammation with micro-abscesses and granulomas (×40); (B) enlarged view (×400) of a giant cell granuloma.
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Figure 3: Histology of resected Meckel's diverticulum: (A) active chronic transmural inflammation with micro-abscesses and granulomas (×40); (B) enlarged view (×400) of a giant cell granuloma.

Mentions: Laparoscopy was performed, and revealed features typical of extensive small bowel Crohn's disease, involving the last 80 cm of the ileum, as well as a fistulising 3 × 3 cm abscess adherent to the anterior abdominal wall. The origin of the abscess proved to be a perforated Meckel's diverticulum (Figure 2). A conservative surgical option was preferred in order to avoid an extensive bowel resection, and Meckel's diverticulectomy was performed using an endoGIA stapler fired at the base of the diverticulum. Pathological examination of the surgical specimen revealed the presence of an active transmural inflammation with granulomas and perforation of the diverticulum at its extremity (Figure 3).


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)

Histology of resected Meckel's diverticulum: (A) active chronic transmural inflammation with micro-abscesses and granulomas (×40); (B) enlarged view (×400) of a giant cell granuloma.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Histology of resected Meckel's diverticulum: (A) active chronic transmural inflammation with micro-abscesses and granulomas (×40); (B) enlarged view (×400) of a giant cell granuloma.
Mentions: Laparoscopy was performed, and revealed features typical of extensive small bowel Crohn's disease, involving the last 80 cm of the ileum, as well as a fistulising 3 × 3 cm abscess adherent to the anterior abdominal wall. The origin of the abscess proved to be a perforated Meckel's diverticulum (Figure 2). A conservative surgical option was preferred in order to avoid an extensive bowel resection, and Meckel's diverticulectomy was performed using an endoGIA stapler fired at the base of the diverticulum. Pathological examination of the surgical specimen revealed the presence of an active transmural inflammation with granulomas and perforation of the diverticulum at its extremity (Figure 3).

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