Meckel's Diverticulum: Role of Small Bowel Exploration in Patient Presenting with Abdominal Pain

Abstract

A 37-year-old woman with a history of endometriosis presented with ongoing pelvic pain. She had undergone multiple previous surgeries at an outside facility for evaluation and treatment including total hysterectomy, bilateral salpingo-oophorectomy, sigmoid diverticulectomy, and excision of pelvic and abdominal wall endometriosis. She continued to experience severe dyspareunia, constipation, and right periumbilical pain that radiated to her right flank. Preoperative magnetic resonance imaging showed areas concerning deep infiltrating endometriosis with no evidence of diverticulum. Repeat surgical exploration and possible excision of endometriosis were recommended. Intraoperatively, the pelvic peritoneum visually and histologically revealed fibrosis with no evidence of endometriosis. Laparoscopic inspection of the small intestine revealed a 2.5 cm Meckel's diverticulum (MD) (Fig. 1). Given the patient's abdominal pain, visualization of MD, and no significant pelvic pathology, a decision was made to perform thorough exploration of the small bowel via a minilaparotomy at the umbilicus. MD was resected using a stapling device (Fig. 2). Postoperatively, the patient reported complete resolution of periumbilical pain and improvement in constipation. These improvements persisted at the time of last follow-up (7 months postoperatively). Lack of sexual activity prevented assessment of changes in dyspareunia.