Meckel's diverticulum causing acute intestinal obstruction: A case series

Perforation of Meckel's diverticulum by an unusual foreign body: A case report and a review of literature

Key Clinical Message

Perforation of Meckel's diverticulum (MD) is rare, particularly by foreign body. High index of suspicion and thorough intraoperative assessment is needed in patients undergoing surgery for acute appendicitis, specifically when appendix appears normal.

Abstract

Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. While often asymptomatic, it can present with several complications. Perforation due to foreign body ingestion is rare but can have severe consequences if late diagnosis occurs. A 13-year-old male, initially suspected of acute appendicitis, was eventually diagnosed with perforation of MD by a wood splinter-like foreign body after intraoperative assessment. Histological analysis revealed ectopic colonic tissue within the MD, a finding whose implications are not well understood, in contrast with the well-established complications associated with ectopic gastric and pancreatic tissues. This case highlights the diagnostic challenges of MD, which can mimic acute appendicitis, emphasizing the need for high suspicion when faced with atypical clinical presentation such as foreign body-induced perforation. Although surgical resection of asymptomatic MD remains controversial, we recommend a case-specific approach based on risk factors to guide decision-making on surgical resection for asymptomatic MD.

Acute intestinal obstruction due to meckel's diverticulum: A case report and literature review

Introduction

and Importance: Meckel's diverticulum is a rare congenital condition often detected incidentally. Meckel's diverticulum, a rare disease, may result in acute intestinal obstruction and is frequently misdiagnosed. This study aims to report a case of acute intestinal obstruction due to Meckel's diverticulum.

Case presentation

A 61-year-old Javanese man was admitted to the emergency room with a history of constipation, nausea, vomiting, and abdominal pain. Physical examination showed abdomen distention, tenderness in the lower quadrant, and hyperactive bowel sound. Rectal examination found that the rectal ampulla was collapsed. A plain abdominal Radiograph showed small bowel dilatation and air-fluid levels. The patient was diagnosed with small bowel obstruction due to suspected left-sided colon cancer and taken up for exploratory laparotomy.

Clinical discussion

On exploration, Meckel's diverticulum measuring 3.5 cm in length and with a 2 cm base was found about 70 cm proximal to the Bauhin valve; the thin part formed a band that entangled the small bowel. Ileo-ileal resection anastomosis was performed.

Clinical discussion

Meckel's diverticulum is an intestinal pouch caused by incomplete obliteration of the vitelline duct during gestation. This condition affects 2 % of the population and is within 2 feet of the Bauhin valve. The mesodiverticular band was found to be the source of the bowel obstruction. Surgical resection is required for complicated diverticulum.

Conclusion

Meckel's diverticulum can be difficult to diagnose and require a higher level of suspicion. Although Meckel's diverticulum is uncommon in adults, it should be considered a cause of small bowel obstruction.

INTESTINAL OBSTRUCTION FROM MECKEL'S DIVERTICULUM IN AN ADULT; UNSUSPECTED BUT FOUND- A CASE REPORT

Introduction

Most cases of Meckel's Diverticulum (MD) are asymptomatic and when symptomatic, preoperative diagnosis of MD maybe a dilemma. Intestinal obstruction is a major complication in the adult population.

Case presentation

We report a case of a 24-year-old female presenting with intestinal obstruction from Meckels Diverticulum.

Conclusion

MD is largely asymptomatic in adults, however may be present and should be included in our array of differential diagnoses.

Acute abdomen due to rupture of a hydatid cyst of the liver: a rare complication - a case report

Hydatid cyst is a parasitic disease that is transmitted from animals to humans caused by the larval stage Echinococcus, especially Echinococcus granulosus. A complication of a hydatid cyst of the liver is its rupture, either traumatic or spontaneously.

Case presentation

A 19-year-old male presented with an acute abdomen for 12 h. After clinical assessment, contrast-enhanced computed tomography showed a rupture of the anterior wall of the hepatic hydatid cyst with intra-abdominal and pelvic dissemination. Exploratory laparotomy was performed with the evacuation of the daughter cyst and peritoneal lavage. The patient recovered well and was discharged with albendazole therapy.

Clinical discussion

Hydatid cyst rupture is a rare but serious complication. Computed tomography has high sensitivity in demonstrating cyst rupture. The patient underwent laparotomy, where disseminated cysts were evacuated, and the anterior wall of the cyst was deroofed, along with the removal of a ruptured laminated membrane. Emergency surgery plus albendazole therapy are recommended protocols for cases like ours.

Conclusions

A patient from an endemic region with acute presentation of right upper quadrant pain can have spontaneously ruptured hydatidosis as a differential diagnosis. Intraperitoneal rupture and dissemination of hydatid cysts of the liver can be life-threatening if intervention is delayed. Immediate surgery is life-saving and prevents complications.