Presentation
Abdominal pain and hypotensive. Peritonitic?
Patient Data
A 55 x 49 mm saccular lesion is demonstrated arising from the mid to distal ileum, containing fluid, gas and several rounded calcified lesions. There is surrounding fat stranding and mural thickening of the adjacent ileum. A further 43 x 22 x 50 mm right anterior peritoneal fluid collection is present, containing locules of gas. Trace peritoneal free fluid is present. No peritoneal free gas. The appendix is normal. The liver, spleen, pancreas, adrenals, kidneys, stomach and colon normal. The bladder is collapsed over indwelling catheter. Suspicious osseous lesions. Lumbar spine degenerative changes.
Conclusion:
Saccular lesion with surrounding inflammatory changes arising from the ileum most likely represents Meckel diverticulitis. Focal contained perforation is a less likely possibility. A further fluid and gas collection is present in the right anterior abdomen suggesting perforation.
Case Discussion
Meckel diverticula are said to follow a rule of 2's: 2% of the population, 2% symptomatic, 2 inches long, 2 feet from ICV.
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