2015 Volume 19 Issue 1 Pages 63-68
The patient was a 33-year-old man with post-meal intermittent abdominal distension and upper abdominal discomfort since six months; he had been treated with oral medication. He suffered epigastric pain and vomiting after lunch and enhanced right lower abdominal pain and pyrexia in the evening, after which he visited the emergency outpatient department of our hospital. He presented with marked tenderness and rebound tenderness in the right lower abdomen, and an enlarged appendix and increased density of fat tissue surrounding the appendix on computed tomography. He was diagnosed with localized peritonitis due to acute appendicitis. Simultaneously, the ileum in the left lower abdomen showed findings of intussusception (target sign). Despite the absence of passage disorder findings such as gut distention, the patient was suspected of having concurrent ileum intussusception with a long tumor at its presenting part. He underwent emergency laparotomy with midline incision in the lower abdomen under general anestheia. As he showed findings indicative of acute cellulitis appendicitis, appendectomy was performed. He subsequently showed antegrade ileal intussusception at approximately 60 cm from the orifice of the ileocecal region in the left lower abdomen and a giant inverted sausage-like neoplastic lesion of the serous membrane opposite the mesentery, which was pulling the serous membrane. As reduction of inverted diverticulum was impossible, the patient underwent partial ilectomy. The resected specimen showed a dark-red lesion of 60×22×20 mm protruded into the inner cavity of the ileum opposite the mesentery, with its tip showing granuloma-like findings. In the pathological findings, the patient was diagnosed with true diverticulum with an inverted elevated tumor. And part of the mucosal epithelium showed ectopic atypical membrane with parietal cells. Based on these findings, the patient was diagnosed with inverted Meckel’s diverticulum. He had a favorable postoperative course and abdominal feeli g of distension and the symptoms such as lower abdominal pains that he recognized always led to disappearance after a discharge. We report the rare case of a patient with intussusception due to inverted Meckel’s diverticul m that was identified at the onset of ppendicitis, along with a review of the literature.
