3226 Complications of Meckel's Diverticulum from Helicobacter pylori

Abstract

INTRODUCTION: Meckel's diverticulum is a disease most prevalent in children. It is rare for it to present in adulthood, especially with complications. Below is a unique case of Helicobacter Pylori (H. Pylori) causing an abdominal abscess which led to the discovery of an adult male's Meckel's diverticulum. CASE DESCRIPTION/METHODS: A 26-year-old male with no past medical history presented to the emergency room complaining of intermittent midline abdominal pain in the lower quadrant for the past two weeks, with associated decrease in appetite, fever, nausea, and vomiting that started two days prior to arrival. The pain was worsened with eating and ambulation, and improved when lying down. One week ago he was in the emergency room for similar symptoms and was discharged home with given intravenous fluids, omeprazole, ranitidine, calcium carbonate and then subsequently discharged home. His pain did not improve, so three days later he went to his primary care physician's office where outpatient CT was ordered and patient was prescribed azithromycin, ciprofloxacin, and tramadol. Primary care physician contacted patient after obtaining CT scan results, and instructed him to immediately go to the emergency room. In the emergency room physical exam was significant for periumbilical and suprapubic tenderness with palpation and mild guarding. The CT scan showed a complex multiloculated 5 cm abscess in the mesentery of the midline lower abdomen. Patient was admitted and started on ceftriaxone and metronidazole. Surgery evaluated the patient and recommended laparoscopic exploration. During the procedure the perforated small bowel was resected and mesenteric abscess was suctioned. While in the hospital patient complained of a history of dyspepsia for the past three years which worsened 1-2 hours postprandially. This prompted him to be tested for H. Pylori IgG antibody and stool antigen. Serum IgG antibody was positive and stool antigen was negative. Ciprofloxacin and flagyl were continued, and he was also treated for H. Pylori with metronidazole prior to being discharged home. Etiology of patient's abdominal pain was determined to be a complicated H. Pylori infection and transmural perforation followed by auto seclusion via the mesentery. DISCUSSION: This case presents with unusual etiology for a diagnosis that is uncommonly discovered in adults. It highlights the importance of getting a thorough history with supportive diagnostic labs and imaging while maintaining a wide differential diagnosis during the initial workup.