Abstract and Introduction
Abstract
Introduction Meckel's diverticulum is the commonest congenital abnormality of the gastrointestinal tract. Most of them are asymptomatic but can rarely present with forms of complications such as bleeding, obstruction, diverticulitis, intussusception and neoplasm. Patients with a perforation of Meckel's diverticulum by a foreign body are rare and may present with right iliac fossa pain, which mimics acute appendicitis.
Case presentation A 64-year-old Greek man presented with an eight-hour history of right iliac fossa pain. On examination, our patient had tenderness in his right iliac fossa. A provisional diagnosis of acute appendicitis was made. He was taken to theatre with the option of an appendicectomy. His appendix was found to have an about normal appearance. An inflamed Meckel's diverticulum that had been perforated by a fish bone was found to be the cause of the abdominal pain. A Meckel's diverticulectomy was performed. Our patient made an uneventful recovery and was discharged after two days.
Conclusions Complications of Meckel's diverticulum can be difficult to diagnose and early recognition and timely operative intervention must occur in order to provide the best outcome for these patients. This is an interesting and unusual case of perforation of Meckel's diverticulum that highlights the importance of considering Meckel's diverticulum as a differential diagnosis in every patient presenting with acute abdomen.
Introduction
Meckel's diverticulum is the most prevalent congenital anomaly of the gastrointestinal tract, affecting approximately 2% of the general population. A 3:2 male to female ratio has been reported. Meckel's diverticula are designated true diverticula because their walls contain all of the layers found in normal intestine. Their location varies among individual patients, but they are usually found in the ileum within 100cm of the ileocecal valve. Approximately 60% of Meckel's diverticula contain heterotopic mucosa, of which over 60% consist of gastric mucosa. Other heterotopic tissues include pancreatic tissue, which is found in 6% of cases, jejunal, duodenal mucosa or Brunner's glands, with every one of this type found in 2% of cases, and pancreatic islets, colonic mucosa, endometriosis and hepatobiliary tissue, which are found in smaller percentages. A commonly quoted 'rule of twos' also applies: 2% of the population have the anomaly, it is approximately 2 inches in length, it is usually found within 2 feet proximal to the ileocecal valve, it is often found in children under two years of age, it contains two types of common ectopic tissue (gastric and pancreatic) and it affects males twice as often as females.
The overall lifetime complication rate is approximately 4%. The most common presentation associated with symptomatic Meckel's diverticula is bleeding, followed by intestinal obstruction, diverticulitis, intussusceptions and neoplasm. However, perforation is very rarely seen and, in a review, was reported as being responsible for 0.5% of symptomatic diverticula. This is an interesting and unusual case of perforation of Meckel's diverticulum mimicking acute appendicitis, a very rare complication caused by a fish bone. To the best of the authors' knowledge, this is the first reported case of perforation of Meckel's diverticulum by a fish bone in Greece and from an extensive review of the literature, such an unusual complication of Meckel's diverticulum has rarely been reported.