Perforated Meckel's Diverticulum in an Adult

Meckel's Diverticulum Enterolith: A Rare Cause of Perforation and Small Bowel Obstruction Presenting as Acute Abdomen

Meckel’s diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. MD enteroliths are an uncommon entity that could rarely present with complications.

We, herein, present a case of a 56-year-old man who presented with severe abdominal pain. Preoperative CT showed an inflamed structure with central calcification connected to distal ileum lumen with an air pouch associated with small bowel obstruction. Upon laparotomy, a perforated MD was found with phlegmon formation. He underwent resection of the loops containing MD with end-to-end anastomosis. 

This highlights the importance of radiological imaging in preoperative diagnosis of these conditions which should be kept in mind if we find a calcified lesion in an inflamed diverticulum around the midline region.

MECKEL'S DIVERTICULITIS: A CASE FROM URGENT SURGERY. CLINICAL CASE

Background. Meckel's diverticulum is an ileal diverticulum, formed as a result of incomplete reduction of the yolk duct, occurs on average in 2% of the population. Up to 25% of cases of this pathology are symptomatic or have complications (up to 16%), while more often it manifests in children under 2 years of age. Destructive diverticulitis is the least common complication of Meckel's diverticulum, requiring urgent surgical intervention.Clinical case. A 28-year-old patient with a clinical picture of acute appendicitis came to the emergency room. Intraoperatively, destructive diverticulitis and widespread fibrinous-purulent peritonitis were identified. Conversion to a laparotomic approach and expansion of the volume of the main stage of the operation to appendectomy, segmental resection of the ileum were performed. The postoperative period was uneventful. The patient received complex conservative therapy, was discharged on the 10th day in a satisfactory condition.Conclusion. Destructive diverticulitis requires the surgeon to be vigilant in conducting a diagnostic search in the clinical picture of acute appendicitis in adult patients. If a correct intraoperative diagnosis is established, a radical and least traumatic operation should be selected from a rational approach (if necessary, it should be converted to a laparotomic one). It is necessary to emphasize the importance of an individual approach in choosing intraoperative tactics and planning perioperative complex therapy

Subacute Meckel's diverticulum perforation

Meckel's diverticulum is the most common intestinal congenital defect, its prevalence is 0.2%-4.0% and it occurs more commonly in children younger than 2-year old with intestinal bleeding and abdominal pain. Perforation in the elderly is very rare with no more than 35 articles reported worldwide. Here we report the case of a 62-year-old man who was admitted to hospital with a history of acute abdominal pain with a 20-day onset. The patient was treated with laparotomy and 30 cm ileal resection was performed for an 8×5 cm perforated ileum tumour at 50 from ileocecal valve with a side-to-side mechanical anastomosis for reconstruction. Having morbidity Clavien-Dindo scale I in postsurgical and good outcome in 6-month follow-up. Meckel's diverticulum is an infrequent pathology in paediatric and even rarer in adult population, however, it is always important to keep in mind how to act when is seen either as a finding or as a complication.