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Spontaneous perforation of Meckel's diverticulum: a case report and review of literature.

Farah RH, Avala P, Khaiz D, Bensardi F, Elhattabi K, Lefriyekh R, Berrada S, Fadil A, Zerouali NO - Pan Afr Med J (2015)

Bottom Line: We report a case of 26 year-old male, who presented since 5 days worsening abdominal pain predominantly in the right iliac fossa associated with high grade fever.Heterotopic mucosa of diverticulitis was confirmed on histopathology.The patient made an uneventful recovery postoperatively and ileostomy reconstruction was done two months later.

View Article: PubMed Central - PubMed

Affiliation: Service des Urgences de Chirurgie Viscérale, Pavillon 35, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Morocco.

ABSTRACT
Meckel's diverticulum is the commonest congenital abnormality of the gastrointestinal tract. Hemorrhage, obstruction and inflammation are the three main categories of complications resulting from Meckel's diverticulum. Spontaneously perforation of Meckel's diverticulum is very rare and mimics acute appendicitis. We report a case of 26 year-old male, who presented since 5 days worsening abdominal pain predominantly in the right iliac fossa associated with high grade fever. On physical examination his abdomen was distended with guarding and rigidity. A provisional diagnosis of appendiculaire peritonitis was made. Our patient had an emergency laparotomy, where a perforated Meckel's diverticulum and advanced peritonitis were discovered. A diverticulectomy with ileostomy were performed. Heterotopic mucosa of diverticulitis was confirmed on histopathology. The patient made an uneventful recovery postoperatively and ileostomy reconstruction was done two months later. This case report is an interesting and unusual case of Meckel's diverticulum complications and highlights the importance of considering Meckel's diverticulum as a differential diagnosis in every patient presenting with acute abdomen.

No MeSH data available.


Related in: MedlinePlus

Peroperative view of the perforated the Meckel's diverticulum before excision.
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Figure 0001: Peroperative view of the perforated the Meckel's diverticulum before excision.

Mentions: A 26-year-old male, who presented 5 days ago, a history worsening abdominal pain associated with fever and vomiting. On his admission, patient was toxic, but his vital signs were within normal range. A physical examination demonstrated abdomen was distended with guarding and rigidity. His blood analysis revealed slight elevated blood count, his white blood cells (WBC) were 11,220/µl (normal values 4.6 to 10.2 × 103/mL) and 74% of them were neutrophils (normal values 40 to 75%). The rest of the routine preoperative blood tests and his erect chest and abdominal X-rays were unremarkable. A provisional diagnosis of appendicular peritonitis was made and initial management included intravenous fluid resuscitation and antibiotic coverage. No other examinations were performed and, after our patient gave his written consent, he was taken to the operating theatre and under general anesthesia; a lower umbilical median incision was performed. A normal appearing appendix was identified, which did not have any remarkable sign of inflammation that could explain the contraction and the peritoneal irritation. During the operation, some serous peritoneal fluid was observed between the small intestine loops and Douglas pouch. An examination of the small bowel revealed an inflamed and perforated MD at 75cm proximal to the ileocecal valve (Figure 1). The Meckel's diverticulum was perforated at its base (Figure 2). A Meckel's diverticulectomy & ileostomy were performed. Abundant peritoneal toilet was done with normal saline solution and drainage of douglas pouche by salem's tube. Heterotopic mucosa of diverticulitis was confirmed on histopathology. The patient made an uneventful recovery postoperatively and ileostomy reconstruction was done two months later. Clinical follow up over the next one year was unremarkable


Spontaneous perforation of Meckel's diverticulum: a case report and review of literature.

Farah RH, Avala P, Khaiz D, Bensardi F, Elhattabi K, Lefriyekh R, Berrada S, Fadil A, Zerouali NO - Pan Afr Med J (2015)

Peroperative view of the perforated the Meckel's diverticulum before excision.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4491457&req=5

Figure 0001: Peroperative view of the perforated the Meckel's diverticulum before excision.
Mentions: A 26-year-old male, who presented 5 days ago, a history worsening abdominal pain associated with fever and vomiting. On his admission, patient was toxic, but his vital signs were within normal range. A physical examination demonstrated abdomen was distended with guarding and rigidity. His blood analysis revealed slight elevated blood count, his white blood cells (WBC) were 11,220/µl (normal values 4.6 to 10.2 × 103/mL) and 74% of them were neutrophils (normal values 40 to 75%). The rest of the routine preoperative blood tests and his erect chest and abdominal X-rays were unremarkable. A provisional diagnosis of appendicular peritonitis was made and initial management included intravenous fluid resuscitation and antibiotic coverage. No other examinations were performed and, after our patient gave his written consent, he was taken to the operating theatre and under general anesthesia; a lower umbilical median incision was performed. A normal appearing appendix was identified, which did not have any remarkable sign of inflammation that could explain the contraction and the peritoneal irritation. During the operation, some serous peritoneal fluid was observed between the small intestine loops and Douglas pouch. An examination of the small bowel revealed an inflamed and perforated MD at 75cm proximal to the ileocecal valve (Figure 1). The Meckel's diverticulum was perforated at its base (Figure 2). A Meckel's diverticulectomy & ileostomy were performed. Abundant peritoneal toilet was done with normal saline solution and drainage of douglas pouche by salem's tube. Heterotopic mucosa of diverticulitis was confirmed on histopathology. The patient made an uneventful recovery postoperatively and ileostomy reconstruction was done two months later. Clinical follow up over the next one year was unremarkable

Bottom Line: We report a case of 26 year-old male, who presented since 5 days worsening abdominal pain predominantly in the right iliac fossa associated with high grade fever.Heterotopic mucosa of diverticulitis was confirmed on histopathology.The patient made an uneventful recovery postoperatively and ileostomy reconstruction was done two months later.

View Article: PubMed Central - PubMed

Affiliation: Service des Urgences de Chirurgie Viscérale, Pavillon 35, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Morocco.

ABSTRACT
Meckel's diverticulum is the commonest congenital abnormality of the gastrointestinal tract. Hemorrhage, obstruction and inflammation are the three main categories of complications resulting from Meckel's diverticulum. Spontaneously perforation of Meckel's diverticulum is very rare and mimics acute appendicitis. We report a case of 26 year-old male, who presented since 5 days worsening abdominal pain predominantly in the right iliac fossa associated with high grade fever. On physical examination his abdomen was distended with guarding and rigidity. A provisional diagnosis of appendiculaire peritonitis was made. Our patient had an emergency laparotomy, where a perforated Meckel's diverticulum and advanced peritonitis were discovered. A diverticulectomy with ileostomy were performed. Heterotopic mucosa of diverticulitis was confirmed on histopathology. The patient made an uneventful recovery postoperatively and ileostomy reconstruction was done two months later. This case report is an interesting and unusual case of Meckel's diverticulum complications and highlights the importance of considering Meckel's diverticulum as a differential diagnosis in every patient presenting with acute abdomen.

No MeSH data available.


Related in: MedlinePlus