A Preoperatively Diagnosed Case of Perforated Meckel’s Diverticulum

Abstract

Perforation of Meckel’s diverticulum is relatively rare and difficult to diagnose preoperatively. In this report, we describe a pediatric case of perforation of Meckel’s diverticulum that was preoperatively diagnosed. The patient was an 8-month-old boy. He was referred to our department with a complaint of melena. An abdominal contrast-enhanced CT scan revealed a luminal structure with a blind end continuous from the small intestine and a small amount of intramesenteric gas around the lumen. We started conservative treatment with a diagnosis of Meckel’s diverticulum hemorrhage and intramesenteric perforation. After admission, persistent fever, abdominal distention, and enhanced inflammatory responses were observed, and emergency surgery was performed with a diagnosis of perforated peritonitis. The abdomen was opened through a longitudinal umbilical incision and observed laparoscopically, but it was difficult to identify the site of perforation, so the skin incision was extended by 20 mm, and the patient underwent laparotomy. A diverticulum was observed on the contralateral side of the mesentery of the ileum 30 cm orally from Bauhin’s valve, and the middle portion was perforated. The diseased intestinal tract including the diverticulum was resected, and an end-to-end anastomosis was performed. Histopathological examination revealed gastric mucosal tissue as well as small intestinal mucosa in the diverticular lumen. The postoperative course was good. Preoperative diagnosis of this disease allowed us to perform a minimally invasive procedure and achieve a good outcome.