English

Abstract

Perforation of a Meckel's diverticulum is a rare complication. This case report is about a 9yr old child who presented to our emergency department with diffuse abdominal pain, vomiting and fever. He had leucocytosis and free fluid in the peritoneal cavity on USG. Erect x-ray abdomen shows gas under the diaphragm. A perforated appendix or a bowel perforation was suspected and a diagnosis of a ruptured MD was finally made by laparotomy. INTRODUCTION: MD is a true intestinal diverticulum that results from the failure of the vitelline duct (omphalomesenteric duct) to obliterate during the 5 th week of fetal development 1 . MD is the most common congenital abnormality occurring in about 2% of the population. Meckel diverticulum is typically lined by ileal mucosa, but other tissue types are also found with varying frequency. The heterotopic mucosa is most commonly gastric (present in 50% of all MD's) and pancreatic mucosa is encountered in about 5% of diverticula; less commonly, these diverticula may harbour colonic mucosa 2 . This is important because peptic ulceration of this or adjacent mucosa can lead to painless bleeding, perforation, or both. CASE PRESENTATION: A 9 year old, previously healthy child, presented at the emergency room of Dept. of Surgery, AIMS, Bellur, with abdominal pain, that started in the left iliac fossa 24 hrs ago and progressed to be diffuse, accompanied with vomiting and high grade fever. Physical examination showed the patient to be pale and febrile (body temperature of 102 F) with diffuse tenderness along with rebound tenderness in the right iliac fossa. Guarding was noted in all the quadrants. Laboratory tests showed anemia (10.0g %) with leukocytosis (13000cells/cu mm) accompanied with polymorphonuclear predominance (89%) and normal blood biochemistry analysis. Erect X-ray abdomen showed gas under the diaphragm. USG abdomen revealed echogenic free fluid in the peritoneal cavity with few septations in the RIF-? Pyoperitoneum. These findings led to the diagnosis of a bowel perforation. A laparotomy incision made and pyoperitoneum confirmed. Appendix was inflamed and the bowel inspected. A perforated MD found and resection anastomosis of ileum along with appendectomy done. The patient recovered uneventfully and 7 days later was discharged in a fine condition. Histopathological examination showed Meckel's diverticulitis with ectopic gastric tissue forming an adenoma.