Meckel's diverticulitis: a rare entity of Meckel's diverticulum

Abstract

Meckel's diverticulum is the most common congenital abnormality of the small intestine that results from incomplete closure of the vitelline (omphalo-mesenteric) duct. This true diverticulum, ~2 ft from the ileocecal valve commonly found on the anti-mesenteric border of the ileum, is benign and majority asymptomatic. Diagnosis challenges arise when it became inflamed or presented in following ways, for example, haemorrhage (caused by ectopic pepsin-and hydrochloric acid-secreting gastric mucosa), intestinal obstruction (secondary to intussusception or volvulus) or the presence of diverticulum in the hernia sac (Littre's hernia). We report a case of a 59-year-old male who was admitted under the surgical service at Blackpool Victoria Hospital with suspected appendicitis that turned out to be a Meckel's diverticulitis, a rare presentation of an acute abdomen. We discuss the issues involved in his investigation and management as well as perform a literature review comparing different surgical approaches.

Figure 1:

Normal erect chest X-ray. No air under the diaphragm.

Figure 2:

CT abdomen and pelvis (a) transverse; (b) frontal (coronal); and (c) sagittal view. An arrow indicates a blind ending sac at mid-ileal loop.

Figure 3:

Intraoperative findings: broad based Meckel's diverticulum with oedematous adjacent small bowel (ileum).

Figure 4:

Histology: small bowel histology showing margin of resection with prominent submucosa oedema and mild inflammation.