Sonographic Detection of a Torsed Meckel's Diverticulum Misinterpreted as Acute Appendicitis

Abstract

A 38-year-old female presented to the emergency department (ED) with acute-onset right lower quadrant abdominal pain following two days of nausea and vomiting. Physical examination revealed right lower quadrant tenderness to palpation, rebound tenderness, and guarding. Point-of-care ultrasound (POCUS) of the right lower abdomen was performed and interpreted as probable appendicitis. However, upon laparoscopic examination of the abdomen, a benign-appearing appendix was visualized. Further investigation revealed the source of the patient's pain to be a torsed Meckel's diverticulum. Although rare, a torsed and inflamed Meckel's diverticulum can be visualized by POCUS in the ED without the need for further imaging or delay.

Image

Frame A is a short-axis view of a point-of-care ultrasound showing an edematous, non-compressible tubular structure in the right lower quadrant of the abdomen with adjacent normal-appearing, compressible loops of small bowel. Clearly visible is the “gut signature” associated with the different layers of the bowel wall; serosa (echogenic), muscularis externa (hypoechoic), submucosa (echogenic), muscularis mucosa (hypoechoic), and mucosa (echogenic). This structure is circled in Frame B.