Abstract
The following is a report on a case of Meckel's diverticulitis which was misdiagnosed as acute appendicitis as the preoperative findings seemed to be typical of this condition.
At operation a blind tube about 6 cms. long was found approximately 40 cms. above the ileo-caecal junction; the walls were thin about the same as those of the ileum at the same level. The posterior wall a little proximal to the centre of the diverticulum showed much pathological change, inflammatory, suppurative and having a perforation about the size of a grain of rice. The mucous membrane was denuded and then was much oedematic with round cell infiltration of the whole wall. Especially remarkable was the fact that the diseased posterior part of the Meckel's divericulum was attached to the serous membrane covering the pancreas; this may be explained by the close proximity of the intestinal canal and pancreas during embryological development.
Operative procedure was as follows; the ileum, as far as 20 cms. from the location of the diverticulum, was removed. Then the cut ends were sewn together by a side anastomosis in the orthodox way. It was important to remove the ileum immediately above and below the diverticulum in order to prevent the possibility of tumor formation in the future, since the diverticulum was an abnormal embryological structure.
The rest of the ileum was found to be healthy, but a little above and to inner side of McBurney's point some local peritonitis and a little pus was found.
Case of primary Meckel's diverticulitis with perforation is rather rare.
