A Case of Perforated Meckel's Diverticulm with True Eneterolith Presenting with Acute Abdomen

Abstract

A 39-year-old man presented with epigastralgia and vomiting. We diagnosed the case as acute gastroenteritis and initiated conservative therapy, however, his symptoms became worse. An abdominal CT scan conducted on the 2^nd hospital day revealed a suspected diagnosis of perforation of Meckel's diverticulum associated with enterolith and so we performed an emergency operation. Laparoscopic observation of the peritoneal cavity showed collection of cloudy ascites and adhesions of the small intestine to the surrounding tissues. After dissection of the adhesions, the small bowel was mobilized outside of the body, when we confirmed a perforated diverticulum on the antimesenteric side of the small bowel locating about 100 cm proximal to the ileocecal valve. It appeared to be the Meckel's diverticulum. As the diverticulum was 4 cm in diameter and inflammation was also found to have infiltrated into the small intestine, we performed partial resection of the small intestine including the diverticulum. Histopathology revealed that ectopic tissues were absent in the diverticulum membrane but two enteroliths about 2 cm in diameter were present within the resected diverticulum. As a result of components analysis of the enteroliths, they were found to be calcium oxalate calculus Since perforated Meckel's diverticulum associated with true enteroliths has rarely been reported, we present our case with some bibliographic comments.