Ileoileal intussusception due to Meckel diverticulum

Case contributed by Yaïr Glick
Diagnosis certain

Presentation

Colicky abdominal pain, vomiting.

Patient Data

Age: 11 years
Gender: Male

Grossly dilated small bowel loop in right-central abdomen.

The L3-L4 disc space is substantially narrowed.

Small amount of oral contrast material in duodenum and proximal jejunum.
Large ileoileal intussusception in the center of the abdomen measuring 10.3 x 9.9 cm, with a long intussusceptum.
Prominent, non-enlarged mesenteric lymph nodes.

Markedly narrowed L3-L4 disc space, with irregular surfaces of bordering endplates.

Incidental circumaortic left renal vein.

The first photo shows the intussusception and the second shows the Meckel diverticulum (pointing inferiorly) after manual reduction of the intussuception.

Case Discussion

History of three episodes of intussusception around age 3 years - the first two were successfully reduced by air enema and the third reduced spontaneously.
Presented with severe, colicky abdominal pain and several bouts of vomiting.
CBC remarkable for leukocytosis with neutrophilia.
Abdominal x-ray showed a single grossly dilated small bowel loop and CT showed an impressive ileoileal intussusception, which the on-call radiologist suspected contains a Meckel diverticulum. The suspicion was verified at surgery, where it took the surgeon approximately 15 minutes to manually reduce the intussusception. Since the diverticulum had a wide base, wedge resection was performed.

Histopathology report:
Macroscopic description
A necrotic appearing bowel segment was received, measuring 4 x 3.5 x 2.2 cm.

Microscopic description
Partial small bowel resection: histological findings compatible with Meckel's diverticulum. In addition, fresh hemorrhages.

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