An Unusual Case of a Perforated Meckel's Diverticulum

Abstract

Background: Meckel's diverticulum, the most common congenital anomaly of the gastrointestinal tract, typically presents in children with gastrointestinal bleeding. Case Presentation. An 11-year-old Caucasian male presented with a 6 week history of abdominal pain, vomiting, and diarrhea. He was found to have iron deficiency anemia, markedly elevated serum and fecal inflammatory markers, and imaging showing a contained bowel perforation. He was evaluated for infectious etiologies and later underwent extensive testing for inflammatory bowel disease. Ultimately, he was found to have a Meckel's diverticulum, which was successfully resected and led to resolution of his gastrointestinal complaints.

Conclusions: This case report highlights one of the more rare presentations in children, which is intestinal perforation. Symptoms of a Meckel's diverticulum can overlap with those of inflammatory bowel disease, as demonstrated by our patient. Clinicians should be familiar with criteria to establish diagnosis of inflammatory bowel disease, and if diagnosis isn't fully supported by testing, they should expand the differential and consider Meckel's diverticulum.

Figure 1

CT of abdomen and pelvis with intravenous and oral contrast showed severe wall thickening (black arrow) of the ascending colon with adjoining phlegmon (white arrow), and small amount of adjacent free air suggesting contained perforation (dotted white arrow).

Figure 2

Magnetic resonance enterography performed with intravenous contrast showed short segment of ileal inflammation with wall thickening and enhancement (white arrow).

Figure 3

A technetium 99 m pertechnetate scan showed increased focal uptake in the right lower quadrant consistent with Meckel's diverticulum with ectopic stomach mucosa (black arrow).