NSAID-Associated Perforation of a Meckels Diverticulum: A Case Report

Abstract

Meckels diverticulum is the most frequent congenital malformation of the gastrointestinal tract. The most common ectopic tissue within a Meckels is heterotopic gastric mucosa, with bleeding being the most common presentation. However, perforation of a Meckels diverticulum is a rare presentation. NSAID-associated Meckels perforation has been suggested, however has not been documented in the literature. We present a case of a 17-year-old female with acute abdominal pain and tenderness following a 24-hour history of excessive ingestion of NSAIDS for pain related to tooth extraction. Chest radiograph demonstrated free intra-abdominal air and she was subsequently taken for exploratory laparotomy. A perforated Meckels diverticulum was isolated and resected. Though NSAID-associated bleeding of heterotopic gastric mucosa has been described, and perforation of the Meckels diverticulum has been suggested, no clear association between heterotopic gastric mucosa and perforation exists. On the other hand, the relationship between NSAIDS and gastric ulcer perforation is well documented. A similar mechanism may also play a role in NSAID-associated Meckels perforation. With how common NSAID use is, we believe it is important to document NSAID-associated perforation of a Meckels diverticulum.

Keywords: Meckels diverticulum; NSAIDS; Perforation; Heterotopic gastric mucosa.

Figure 1.

Chest radiograph demonstrating free intra-abdominal air below the diaphragm. (Black arrows demonstrate the air below the diaphragm).