Meckel's diverticulum perforated by a foreign body: a rare cause of abdominal pain

Perforation of small bowel due to ingested fish bone is rare, the most common site is ileum and occasionally, it can involve the appendix and/or Meckel diverticulum. We report six patients who, developed bowel perforation after fish bone ingestion, four of them found to have rent in the ileum and two through Meckel’s diverticulum and presented with abdominal pain and localized peritonitis. All underwent surgical exploration and removal of the fish bone and closure of the small intestine/excision of the diverticulum. Foreign body ingestion should be kept in mind in suspicious cases, and laparoscopy is very important to diagnose such rare cases as they may commonly be missed by imaging.

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Meckel’s diverticulum with intraperitoneal hemorrhage in a child detected with screening laparoscopy: a case report

Surgical Case Reports ◽

10.1186/s40792-021-01347-9 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Kazuki Wakizaka ◽

Lee Wee Khor ◽

Kazuya Annen ◽

Tsuyoshi Fukushima ◽

Mitsuko Furuya ◽

...

Keyword(s):

Abdominal Pain ◽

Gastric Mucosa ◽

Meckel’S Diverticulum ◽

Lower Abdominal Pain ◽

Abdominal Distension ◽

Small Bowel Resection ◽

Massive Bleeding ◽

Meckel's Diverticulum ◽

Ectopic Gastric Mucosa ◽

Intraperitoneal Hemorrhage

Abstract Background The most common presentation of symptomatic Meckel’s diverticulum (MD) are intestinal obstruction, gastrointestinal hemorrhage, and inflammation of the MD with or without perforation. Intraperitoneal hemorrhage because of MD is extremely rare. We report a case of MD with intraperitoneal hemorrhage in a child detected with screening laparoscopy. Case presentation An 11-year-old girl presented to another hospital with lower abdominal pain and vomiting that lasted for 2 days. Acute appendicitis was suspected, and she was referred to our department. Abdominal enhanced computed tomography showed an abscess in the lower abdomen with ascites in the pelvis. She was diagnosed with a localized intra-abdominal abscess and the decision was made to treat with antibiotics. However, her abdominal pain worsened, with abdominal distension, tenderness and guarding. She was diagnosed with panperitonitis and the decision was made for surgery 5 h after admission. During surgery, laparoscopic observation from the umbilical region revealed 200 ml of fresh blood throughout the peritoneal cavity, originating from the mesentery of the ileum. MD was observed with bleeding from the surrounding mesentery. Small bowel resection was performed, and the patient was discharged on the 5th postoperative day. Pathological findings revealed an MD containing ectopic gastric mucosa and small intestinal ulcer perforation at the base of the MD. Conclusions We report an extremely rare case of an MD with intraperitoneal hemorrhage in a child. In pediatric cases, it is possible that perforation with ectopic gastric mucosa may cause massive bleeding because of rupture of the surrounding mesenteric blood vessels.

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Lupus Enteritis, a Severe and Potentially Fatal Complication of Systemic Lupus Erythematosus

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqz113.066 ◽

2019 ◽

Vol 152 (Supplement_1) ◽

pp. S64-S64 ◽

Cited By ~ 1

Author(s):

Hany Meawad ◽

Andrew Kobalka ◽

Yaseen Alastal ◽

Brooke Koltz

Keyword(s):

Systemic Lupus Erythematosus ◽

Abdominal Pain ◽

Lupus Erythematosus ◽

Clinical Symptoms ◽

Meckel’S Diverticulum ◽

Severe Abdominal Pain ◽

Meckel's Diverticulum ◽

Systemic Lupus ◽

Gi Symptoms ◽

Lupus Enteritis

Abstract Objectives Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease that can show wide manifestations in many organs. The gastrointestinal tract (GI) is commonly affected in SLE; symptoms are often related to the side effect of medications or to infections. One rare GI complication of SLE is lupus enteritis, a complex of manifestations including intestinal vasculitis and enteric ischemia, which presents with vague symptoms of severe abdominal pain, nausea, vomiting, and diarrhea. Methods We present the case of a 25-year-old female who was admitted to the hospital with complaints of abdominal pain, vomiting, diarrhea, and a history of SLE. Complicating the patient’s clinical picture and diagnosis was gastrointestinal bleeding requiring multiple blood product transfusions secondary to bleeding Meckel’s diverticulum, lupus flare, and positive stool culture for campylobacter antigen. Repeated upper and lower GI endoscopies with biopsy failed to identify the exact cause of bleeding and GI symptoms; the patient underwent exploratory laparotomy with right hemicolectomy to control bleeding. Microscopic examination revealed marked small vessel acute vasculitis consistent with lupus enteritis, ischemic enteritis, and Meckel’s diverticulum with gastric heterotopia. Results Our patient was subsequently aggressively treated; however, she developed further associated complications and died. Conclusion The pathologic diagnosis of lupus enteritis is challenging due to the nonspecific clinical symptoms and paucity of pathologic findings on most biopsy specimens. Lupus enteritis must be considered in the differential diagnosis of severe abdominal pain in lupus patients to aid in early diagnosis and treatment as this condition could be severe and potentially fatal.

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Unusual Presentation of Meckel’s Diverticulum: Gangrene due to Axial Torsion

Case Reports in Emergency Medicine ◽

10.1155/2015/571847 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Ahmet Rencuzogullari ◽

Kubilay Dalci ◽

Orcun Yalav

Keyword(s):

Congenital Anomaly ◽

Abdominal Pain ◽

Small Bowel ◽

Preoperative Diagnosis ◽

Iliac Fossa ◽

Meckel’S Diverticulum ◽

Meckel's Diverticulum ◽

Life Threatening ◽

Operative Findings ◽

The Right

Meckel’s diverticulum is the most common congenital anomaly of the small bowel. The majority of cases are asymptomatic; however, life-threatening complications can also take place. We present a case of a 37-year-old male who was admitted with symptoms of acute, severe abdominal pain in the right iliac fossa. The patient was operated on with the preoperative diagnosis of acute appendicitis but the operative findings were consistent with torted Meckel’s diverticulum due to presence of mesodiverticular band and he was treated successfully with surgical resection.

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Perforation of Meckel's diverticulum by foreign body

The American Journal of Surgery ◽

10.1016/0002-9610(57)90602-5 ◽

1957 ◽

Vol 94 (4) ◽

pp. 666-668 ◽

Cited By ~ 2

Author(s):

Walter R. Gillette ◽

Paul E. Zoltowski

Keyword(s):

Foreign Body ◽

Meckel’S Diverticulum ◽

Meckel's Diverticulum

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Concurrent intestinal malrotation and Meckel's diverticulum presenting as acute intestinal obstruction in an adult

International Surgery Journal ◽

10.18203/2349-2902.isj20212288 ◽

2021 ◽

Vol 8 (6) ◽

pp. 1904

Author(s):

Aishwarya Emerald Manohar ◽

M. S. Kalyan Kumar ◽

V. Vijayalakshmi ◽

R. Kannan

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Intestinal Obstruction ◽

Meckel’S Diverticulum ◽

Postoperative Recovery ◽

Meckel's Diverticulum ◽

Intestinal Malrotation ◽

Emergency Laparotomy ◽

Meckel’S Diverticulitis ◽

Subacute Intestinal Obstruction

Intestinal malrotation is the partial or complete failure of rotation of midgut around the superior mesenteric artery, while Meckel’s diverticulum is the remnant of vitellointestinal duct and concurrence of these congenital abnormalities in an adult is considered a rarity. Till date only 3 cases of concurrent intestinal malrotation and Meckel's diverticulum have been reported. We report a 18 years male who presented with a 3 day history of abdominal pain, bilious vomiting, obstipation and chronic abdominal pain on and off since 3 years of age. During the last episode which occurred 1 year back, he was diagnosed with intestinal malrotation with subacute intestinal obstruction and was treated conservatively. Examination revealed the presence of signs of peritonitis. After resuscitation, CECT abdomen was taken which showed dilated small bowel loops in the subhepatic region associated with malrotation. Emergency laparotomy revealed a Ladd's band below which the gangrenous small bowel loops 150 cm from the duodenojejunal (flexure until 5 cm proximal to the ileocecal junction) were found herniating into the subhepatic region with a Meckel’s diverticulum and a right sided DJ flexure. We proceeded with the band release and resection of gangrenous bowel followed by proximal jejunostomy with distal ileostomy. HPE was consistent with Meckel’s diverticulitis without any ectopic gastric or pancreatic mucosa. Ostomy reversal was done after 8 weeks. Patient had an uneventful postoperative recovery during both the admissions and he is on regular follow-up now.

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A Rare Cause of Abdominal Pain in Adults: Meckel’s Diverticulitis

Case Reports in Gastroenterology ◽

10.1159/000494752 ◽

2018 ◽

Vol 12 (3) ◽

pp. 709-714 ◽

Cited By ~ 3

Author(s):

Usman Pirzada ◽

Hassan Tariq ◽

Sara Azam ◽

Kishore Kumar ◽

Anil Dev

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Meckel’S Diverticulum ◽

Meckel's Diverticulum ◽

Emergency Laparotomy ◽

Contrast Enhanced ◽

Meckel’S Diverticulitis ◽

The Right ◽

Enhanced Computed Tomography

A 42-year-old man presented to the emergency room with complaints of periumbilical abdominal pain. A contrast-enhanced computed tomography revealed mucosal thickening in the small bowel of the right abdomen. There was a fairly large small bowel diverticulum associated with this segment. Findings were suggestive of small bowel diverticulitis or possibly focal enteritis. A Meckel’s diverticulum scan was diagnostic of Meckel’s diverticulum. The patient was then immediately taken to the operating room for emergency laparotomy and was intra-operatively found to have a thickened Meckel’s diverticulitis with adjacent small bowel obstruction. Meckel’s diverticulectomy was performed in continuity with the adjacent inflamed small bowel. The patient had a stable postoperative course without any complications and was discharged within 10 days. At the 3-month follow-up, the patient was well and remained asymptomatic.

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