Spontaneous Perforation of Meckel's Diverticulum in a Young Adult Male: A Case Report and Review of the Literature

Abstract

Meckel's diverticulum, a congenital defect that affects about 2% of the population, is a remnant of the embryologic vitelline duct. Perforated Meckel's diverticulum, a rare consequence of an already rare disease process, frequently presents and is diagnosed as a perforated appendix. We report a case of a 28-year-old male who presented with a two-day history of right-sided lower abdominal pain associated with nausea. The abdominal examination revealed a soft, nondistended abdomen with tenderness in the right iliac fossa. A CT scan of the abdomen showed a normal appendix and inflammation of Meckel's diverticulum without any signs of perforation. Bowel exploration through a small midline incision indicated the presence of a highly inflamed Meckel's diverticulum with localized perforation 75 cm from the ileocecal valve. A resection of 15 cm of the small bowel and an end-to-end primary anastomosis were performed. The patient had an uncomplicated recovery and was discharged after a five-day admission to a surgical ward. This case report illustrates the significance of keeping Meckel's diverticulum as a differential diagnosis in all the patients who present with an acute abdomen.

Keywords: acute abdomen; appendicitis; congenital anomaly; meckel´s diverticulum; perforation.

Figure 1. A coronal cut section of the CT abdomen and pelvis reveals an inflammatory condition and central calcification within a hollow viscus.

Figure 2. A sagittal cut section of the CT abdomen and pelvis demonstrates a perforated Meckel's diverticulum.

Figure 3. Histopathology image of the specimen.