Laparoscopic Management of Perforated Meckel's Diverticulitis in Pregnancy

Abstract

A 39-year-old woman gravida 3 para 2, presented to the emergency room at 19+6 weeks gestation with epigastric pain and nausea. A 4-cm right ovarian cyst was reported on magnetic resonance imaging, and a cyst torsion was suspected. Laparoscopy was performed, with an open transumbilical port established by and a retractor-and-glove system used as previously reported [1]. The cyst was not torted, however, a segment of swollen small intestine was adherent to anterior abdominal wall above the gravid uterus, with surrounding pus and fibrin. This was consistent with the site of abdominal pain (Fig. 1). On further inspection a small bowel perforation was noted in a diverticulum following laparoscopic adhesiolysis (Fig. 2A). The small bowel was delivered through the umbilical wound, with wide-based Meckel's diverticulitis (MD) noted at 40 cm proximal to the ileocecal valve (Fig. 2B, white arrow). An uncomplicated diverticulectomy was performed, and the patient recovered uneventfully. Fig. 2(A) An outpouching of the small intestine was noted after adhesiolysis. (B) By pulling out the related segments of small bowels through the umbilical wound, a perforated Meckel's diverticulitis was noted at 40 cm proximal to the ileocecal valve. White arrow indicates the Meckel's diverticulum. View Large Image Figure Viewer Download Hi-res image