267 Perforated Meckels diverticulitis; a cautionary tale highlighting the importance of accurate vetting information in the selection and interpretation of radiological investigations

Abstract

Abstract Background Failure of the vitelline duct involution process during the 7th week of gestation gives rise to the most common congenital anomaly of the GI tract; Meckel’s diverticulum. Clinical presentation is extremely variable. We present an unusual case of a perforated Meckel’s diverticulitis and a cautionary tale highlighting the importance of accurate clinical information when requesting radiological investigations. Case report An 18 year old gentleman presented acutely with 24 hours of rectal pain and associated fever. There were no urinary or penile symptoms. Examination revealed lower abdominal tenderness. Rectal and prostatic examination were normal. Abdominal ultrasound revealed a dilated appendix with surrounding free fluid. Diagnostic laparoscopy revealed pus in the right iliac fossa with a submerged and mildly injected appendix. A separate cause was sought – a perforated small bowel diverticulum was found in a 600mL pelvic collection. The procedure was converted to a Laparotomy with small bowel resection and side-side anastomosis plus appendicectomy and washout. Post-operative histology revealed a perforated Meckel’s diverticulitis. Discussion This unusual case highlights the importance of using the correct radiological investigation at the correct time for the correct clinical query. Clinical information supplied to radiologists, particularly ultrasonographer's, drastically alters the extent of examination and interpretation of imaging. Conclusion Providing accurate clinical information to Radiologists is key for accurate interpretation of imaging. Inaccurate information impacts the ability to arrive at the correct diagnosis, give the correct treatment and, in a surgical setting, complete the correct consent process for the patient.