Presentation
One week of right lower abdominal pain accompanied by fever of 38.7 °C, nausea, and vomiting. No relevant medical or surgical history.
Patient Data
Patient had a normotensive tachycardia of 108 bpm. Localized tenderness in the right iliac fossa without peritoneal reaction.
Blood tests revealed leukocytosis of 13,000/mm³ and C-reactive protein of 73 mg/dL. Other tests within normal range.
Axial and sagittal CT scans revealed a well-defined fluid collection of approximately 5 x 4 cm with contrast enhancement and mesenteric reaction related to the terminal ileum. These findings suggest Meckel's diverticulitis with intraperitoneal abscess. The appendix was normal.
Case Discussion
Meckel’s diverticulum is a frequent asymptomatic congenital anatomic abnormality of the small intestine. It constitutes approximately 2% of the general population; therefore, clinical diagnosis is rarely possible preoperatively. Most patients with this anomaly present with complications, such as bleeding, inflammation, and perforation, with an estimated risk of approximately 4%.
The intraperitoneal abscess is an unusual complication associated with diverticulum perforation. Our patient was misdiagnosed with appendicitis; however, an abdominal CT scan revealed a normal appendix and an intraperitoneal abscess related to the terminal ileum. The patient was managed with ultrasound-guided aspiration and antibiotics, with good remission after 7 days.
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