Perforated Meckel's diverticulum in a neonate

Abstract

Meckel's diverticulum (MD) is a true diverticulum in the small intestine due to an incomplete obliteration of the vitelline duct. It is commonly located within two feet from the ileocecal valve and occurs in approximately two percent of the population before the age of two years. Meckel's diverticulum is often clinically silent but when symptomatic (4%), it could present with gastrointestinal bleeding, bowel obstruction, perforation or diverticulitis. A 1900g male infant was born at 31 weeks and six days. He was placed on CPAP for poor respiratory effort, and was transported to our intensive care unit immediately after delivery. By day of life three, he had failed to pass meconium and developed signs of intestinal perforation prompting surgical exploration. A perforated Meckel's diverticulum was discovered and he underwent a small bowel resection with primary anastomosis. Histopathology study of resected bowel showed a small intestine with focal mural necrosis and perforation, and marked serositis with abundant acute on chronic inflammation. We present a case of a neonatal symptomatic MD in a preterm infant with failure to pass meconium without obstruction on imaging, and an extensive literature review on this topic in the last 40 years. The literature review and our case show that it can be safe to perform primary anastomosis after resection for perforated MD in the neonatal population, even in those of low birth weight.