Chronic Nocturnal Abdominal Pain as the Presentation of Inverted Meckel Diverticulum: A Case Report

The common clinical manifestations of Meckel’s diverticulum include painless lower gastrointestinal bleeding and intestinal obstruction due to intussusception. Intussusception induced by inverted Meckel’s diverticulum has rarely been reported; furthermore, there is no report thus far of chronic nocturnal abdominal pain as a presenting symptom in children with Meckel’s diverticulum. A 4-year-and-10-month-old girl with no significant history of previous illness presented with the sole complaint of chronic nocturnal abdominal pain for 3 months. The patient was reported to be asymptomatic during the day. A provisional diagnosis of chronic ileoileal intussusception was already under consideration in her previous hospital visits elsewhere. Physical examination revealed a soft, non-distended abdomen without tenderness. Imaging studies revealed ileoileal intussusception. Exploratory laparotomy showed ileoileal intussusception induced by an inverted Meckel’s diverticulum with ulceration. The patient underwent successful surgery and made a full recovery. We report this case to remind physicians that Meckel’s diverticulum should be considered in differential diagnosis of children presenting with the isolated symptom of chronic nocturnal abdominal pain.

Inverted Meckel’s diverticulum: a case report

Background Inverted Meckel’s diverticulum refers to the condition in which the diverticulum inverts on itself. The reasons for such an inversion are poorly understood due to the rarity of the condition. We present a case of inverted Meckel’s diverticulum, an uncommon finding, as a cause of recurrent intussusception. Case presentation A 30-year old Indian woman presented with complaints of pain in the central abdomen for 3 days, accompanied with vomiting and loose stools. Computed tomography images were suggestive of intussusception with intestinal obstruction. Intra-operative findings were suggestive of an intussuscepted segment of ileum measuring 10 cm in length, proximal to ileocecal junction. Ileo–ileal anastomosis was performed after appropriate resection. Upon opening the specimen, we were surprised to find an inverted Meckel diverticulum with lipoma at one end causing the intussusception. The patient made an uneventful recovery and was discharged after 5 days. Conclusion The reasons for inversion include abnormal peristalsis around the diverticulum and non-fixity of the diverticulum itself. The inverted diverticulum itself can cause luminal compromise and acts as a lead point for intussusception leading to obstruction. Computed tomography remains the diagnostic tool of choice for identifying intestinal obstruction and intussusception. Although pathological signs, such as lipoma, can be identified, the identification of any inversion will require a proficient radiologist. Inverted Meckel’s diverticulum is a rare condition which is difficult to diagnose preoperatively. Treatment is surgical, whether diagnosed pre-operatively or intra-operatively, and includes segmental resection and anastomosis. This uncommon condition should be noted as one-off differential diagnosis for intussusception and intestinal obstruction.

Inverted Meckel’s diverticulitis manifesting as intussusception: unusual case of intestinal obstruction in adults

Meckel’s diverticulum can manifest with various complications such as obstruction, intussusception, inflammation or diverticulitis, perforation, haemorrhage and fistula, and commonly manifests in children. Adult intussusception due to inverted Meckel’s diverticulum is an uncommon aetiology of intestinal obstruction but should be suspected in individuals. Imaging such as contrast-enhanced computed tomography aids in the diagnosis but it is not confirmatory to diagnose inverted Meckel’s diverticulum as a leading point. Resection of the intussusception segment is the definitive treatment. We present the case of a young man who presented in emergency with complaints of intestinal obstruction and ileo-ileal intussusception was the aetiology of for the same diagnosed on contrast-enhanced computed tomography of the abdomen. On exploration we discovered an inverted Meckel’s diverticulum to be the leading point for intussusception.

Inverted Meckel's diverticulum associated with heterotopic pancreatic tissue causing intestinal obstruction: a case report

Background Meckel’s diverticulum is the most frequent congenital anomaly of the gastrointestinal tract. It can invert or invaginate into the small intestine lumen. It is usually associated with heterotopic tissue elements. Case presentation We present a case of inverted Meckel's diverticulum, clinically and radiologically diagnosed as intestinal obstruction due to intussusceptions. The diagnosis was suspected due to target sign shown on radiological examination. Pathologically, it was inverted Meckel's diverticulum obstructing the lumen in parallel plan mimicking the telescoping appearance, with heterotopic pancreatic tissue formed of exocrine and ductal components only. Conclusions Inverted Meckel’s diverticulum may present by vague symptoms and may simulate other causes of intestinal obstruction.

Intussusception caused by a small intestinal lipoma with ectopic gastric mucosa containing gastric cystica profunda component cells within the inverted Meckel’s diverticulum: a case report

Background Lipomas are the most common cause of intussusception in adults. To our knowledge, however, no cases of lipoma and ectopic gastric mucosa with gastritis cystica profunda (GCP) have been reported. We report a case of intussusception caused by a small intestinal lipoma with ectopic gastric mucosa containing GCP-component cells within the inverted Meckel’s diverticulum. Case presentation A female in her 40s underwent computed tomography for postoperative follow-up of left breast cancer. A tumor, suspected to be a lipoma, was found in the ileum. Since there were no symptoms, the patient underwent regular follow-up. However, gradual enlargement was observed, and surgery was recommended due to the risk of intussusception. After reduction via the Hutchinson technique, laparoscopically assisted partial resection of the small intestine was performed due to suspicion that the tumor was causing intussusception starting from the ileum. Histopathologic examinations revealed proliferation of mature adipose tissue in the subserosal layer, which was diagnosed as lipoma. Furthermore, adipose tissue was found in the stem area and accordingly, we diagnosed lipoma associated with the inverted Meckel’s diverticulum. Moreover, gastric mucosa-like crypt epithelium and proper glandular tissue were identified in the mucosal membrane at the area of onset, and signs of gastric pit dilatation over the submucosa and crypt epithelium hyperplasia were observed. Diagnosis was ectopic gastric mucosa containing GCP component tissue. Conclusions Intussusception in the small intestine complicated with lipoma and ectopic gastric mucosa with GCP within the Meckel’s diverticulum has not been reported, demonstrating the rarity of our case.

Inverted Meckel’s diverticulum: a rare cause of intussusception in children

Invagination of proximal segment of intestine to distal one results in intussusceptions and is a common cause of intestinal obstruction in children. In most of the cases of intussusceptions, the cause is idiopathic in nature; the other causes may be infection, polyp or anatomical abnormalities. Occasionally, Meckel’s diverticulum may cause intussusception and inverted Meckel’s diverticulum leading to intussusceptions is very rare in children. It is difficult to diagnose inversion of Meckel’s diverticulum preoperatively. Here in we report a case of 6 yrs old male child, who was operated for intussusception and found to have inverted Meckel’s diverticulum as lead point.