Abstract
IntroductionThis is the first reported case of perforation and haemorrhage of a Meckel's diverticulum leading to the incidental finding of a gastrointestinal stromal tumour within the diverticulum. Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract, however, when symptomatic, it is often misdiagnosed at presentation. Common complications presenting in adults include bleeding, obstruction, diverticulitis and perforation. Tumours within a Meckel's diverticulum are a rare but recognised complication. We discuss the management of a gastrointestinal tumour within the diverticulum.Case presentationA 59-year-old Caucasian man presented with acute right iliac fossa pain with localized peritonism. At surgery, he was found to have a perforated and haemorrhagic Meckel's diverticulum, associated with a gastrointestinal stromal tumour within the apex of the diverticulum. The absence of necrosis and a low mitotic rate indicated primary resection with subsequent computed tomography surveillance to be the most appropriate management strategy.ConclusionWe report a unique triad of complications associated with the presentation of a Meckel's diverticulum. This article reviews this common congenital abnormality and discusses the management of a gastrointestinal tumour. Meckel's diverticulum will mimic other intra-abdominal pathologies in presentation and should therefore often be considered as a differential diagnosis.
Highlights
This is the first reported case of perforation and haemorrhage of a Meckel’s diverticulum leading to the incidental finding of a gastrointestinal stromal tumour within the diverticulum
Meckel’s diverticulum is the most common congenital abnormality of the gastrointestinal tract, when symptomatic, it is often misdiagnosed at presentation
Common complications presenting in adults include bleeding, obstruction, diverticulitis and perforation
Summary
Since 1978, there have been approximately 10 reported cases of tumour-associated perforation of a Meckel’s diverticulum, only two of these were histologically classified as GISTs [7,13]. Our case is the first reported patient with perforation of a Meckel’s diverticulum with frank intra-abdominal haemorrhage that led to the incidental discovery of the separate pathology of GIST within the diverticulum. Meckel’s diverticulum can mimic other intra-abdominal pathologies in presentation and should be considered as a differential diagnosis. The case reported by us has a low risk of recurrence based on a maximum diameter of 4.5 cm, a low mitotic count of less than one mitotic figure in 10 × 40 high powered fields, and no evidence of necrosis. NB summarized the case and helped substantially with the drafting and critiquing of the original manuscript.
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