Perforated Meckel's diverticulum

Case contributed by Dr Eric F Greif


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

Patient Data

Age: 9 months
Gender: Male

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

Findings are consistent with bowel perforation. There are 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 are consistent with constipation.

Feeding tube with tip in the stomach.


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

Case Discussion

A 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 a significant amount of pneumoperitoneum, it remains a differential diagnosis. Laparotomy was performed and a perforated Meckel's diverticulum was identified.

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Case information

rID: 34130
Published: 1st Apr 2015
Last edited: 4th Jul 2020
Inclusion in quiz mode: Included

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