Perforation of Meckel's diverticulum by a fish bone presenting as acute appendicitis: a case report

Abstract

Introduction: Meckel's diverticulum is the commonest congenital abnormality of the gastrointestinal tract. Most of them are asymptomatic but can rarely present with forms of complications such as bleeding, obstruction, diverticulitis, intussusception and neoplasm. Patients with a perforation of Meckel's diverticulum by a foreign body are rare and may present with right iliac fossa pain, which mimics acute appendicitis.

Case presentation: A 64-year-old Greek man presented with an eight-hour history of right iliac fossa pain. On examination, our patient had tenderness in his right iliac fossa. A provisional diagnosis of acute appendicitis was made. He was taken to theatre with the option of an appendicectomy. His appendix was found to have an about normal appearance. An inflamed Meckel's diverticulum that had been perforated by a fish bone was found to be the cause of the abdominal pain. A Meckel's diverticulectomy was performed. Our patient made an uneventful recovery and was discharged after two days.

Conclusions: Complications of Meckel's diverticulum can be difficult to diagnose and early recognition and timely operative intervention must occur in order to provide the best outcome for these patients. This is an interesting and unusual case of perforation of Meckel's diverticulum that highlights the importance of considering Meckel's diverticulum as a differential diagnosis in every patient presenting with acute abdomen.

Figure 1

Meckel’s diverticulum perforated by a fish bone as it was found during surgery.

Figure 2

A view of the fish bone that perforated the Meckel’s diverticulum.

Figure 3

Excising the Meckel’s diverticulum using a GIA 55mm.

Figure 4

The ileum after the excision of the Meckel’s diverticulum.

Figure 5

The anatomical specimen after excision.