Meckel diverticulitis with small bowel obstruction

Case contributed by Dr Abdullah Alqudah

Presentation

Negative appendicectomy 45 days earlier. Now presenting with severe right lower quadrant pain and abdominal distention.

Patient Data

Age: 30 year old
Gender: Male

Upright and supine frontal x-rays showing multiple air-fluid levels and dilated small bowel loops, suggestive of small intestinal obstruction.

Evidence of surgery with subcutaneous fat stranding noted in the right lower abdominal wall. The small bowel loops are dilated and fluid filled with a transition zone noted in the terminal ileum.

There is blind ending tubular structure arising from the distal ilium. This structure shows wall enhancement with significant surrounding fatty stranding seen, concerning for an inflamed Meckel's diverticulum.

Small amount of free fluid is present, with fatty stranding, regional lymph nodes and peripherally enhancing small collection and foci of gas noted at the appendicular stump. The large bowel is collapsed.
 

Case Discussion

This patient presented 45 days ago to the emergency department with severe right lower quadrant pain, the suspicion of acute appendicitis was high so he underwent appendectomy and the appendix was surprisingly not inflamed.

He then presented with acute right lower quadrant abdominal pain and abdominal distention. Initial abdominal x-ray showed signs of intestinal obstruction. Complicated inflammation of the appendiceal stump was suspected.  The patient underwent this CT scan and an inflamed blind ending tubular structure arising from the terminal ileum (rather than the cecum) was found suggestive of Meckel's diverticulitis.

The patient underwent surgery to relieve the obstruction and inflamed Meckel's diverticulum was found.

PlayAdd to Share

Case information

rID: 50004
Case created: 14th Dec 2016
Last edited: 28th Jun 2017
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.