Meckel's diverticulum with small bowel obstruction presenting as appendicitis in a pediatric patient

S Sameer Mohiuddin, Adolfo Gonzalez, Cynthia Corpron
JSLS: Journal of the Society of Laparoendoscopic Surgeons 2011, 15 (4): 558-61

BACKGROUND: Meckel's diverticulum is a congenital anomaly resulting from incomplete obliteration of the omphalomesenteric duct. The incidence ranges from 0.3% to 2.5% with most patients being asymptomatic. In some cases, complications involving a Meckel's diverticulum may mimic other disease processes and obscure the clinical picture.

METHODS: This case presents an 8-year-old male with abdominal pain, nausea, and vomiting and an examination resembling appendicitis.

RESULTS: A CT scan revealed findings consistent with appendicitis with dilated loops of small bowel. During laparoscopic appendectomy, the appendix appeared unimpressive, and an inflamed Meckel's diverticulum was found with an adhesive band creating an internal hernia with small bowel obstruction. The diverticulum was resected after the appendix was removed.

CONCLUSION: The incidence of an internal hernia with a Meckel's diverticulum is rare. A diseased Meckel's diverticulum can be overlooked in many cases, especially in those resembling appendicitis. It is recommended that the small bowel be assessed in all appendectomy cases for a pathological Meckel's diverticulum.

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