Perforated Meckel's diverticulum

Case contributed by Dr Eric F Greif

Presentation

5 episodes of non bilious emesis with abdominal distention, lethargy, decreased oral intake and excessive crying.

Patient Data

Age: 9 months old
Gender: Male
X-ray

There is evidence for pneumoperitoneum with air outlining the bowel wall on supine frontal view (Riglers sign) and air above the liver on left decubitus view. 

Findings consistent with bowel perforation. There is a small amounts of contrast between the stomach and the transverse colon. It is unclear where the origin of the bowel perforation is. There appears to be a blind ended fluid filled tubular structure in the mid pelvis which may represent an abnormal appendix or Meckel's diverticulum.

Diffuse thickening of the wall of small bowel, consistent with enteritis. Findings consistent with constipation.

Feeding tube with tip in the stomach.

Photo

Partial small bowel resection with Meckel's diverticulum containing gastric mucosa. There is a focal ulceration and perforation of the Meckel's diverticulum.

Case Discussion

9 month old male presented with an acute abdomen and was found to have free air on abdominal radiographs and CT. The source of the free air was unable to be found on imaging, but a possibility that it may have originated from a blind ended fluid structure in the pelvis. This structure was thought to be an abnormal appendix or Meckel's diverticulum, although a ruptured appendix typically does not cause significant amount of pneumoperitoneum, it is still in the differential diagnosis. Laparotomy was performed and a perforated Meckel's diverticulum was found.

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Case information

rID: 34130
Case created: 5th Feb 2015
Last edited: 31st May 2017
Inclusion in quiz mode: Included

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