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This case series examines each distinct patient's presentation, discusses the diagnosis, management and outcome and compares findings while discussing literature on this topic. A high index of suspicion and familiarity with unusual forms and treatment options is required to allow timely diagnosis and appropriate treatment.

MD occurs in 2% of the population and is the most common congenital malformation of the gastrointestinal tract. Most patients are asymptomatic and complications are found in about 5%. This study reports an exceptional case where a longstanding Meckel's diverticulum (MD) was initially misdiagnosed as inflammatory bowel disease and further complicated with ureterohydronephrosis. A 14-year-old male presented with abdominal pain and fever, minor elevation of inflammatory markers, the ultrasound showed a liquid collection and suggested complicated acute appendicitis. Laparoscopy showed a thickened small bowel segment, low grade inflammation of the appendix and no collection; appendectomy was performed. Follow-up ultrasound showed bowel wall thickening and collections, which further suggested inflammatory bowel disease. One month after discharge, the patient returned with abdominal pain and subfebrile temperature. Imaging studies showed pelvic plastron, purulent fluid, collections and right ureterohydronephrosis. Treatment for complicated inflammatory bowel disease was ineffective, there was worsening of the ureterohydronephrosis, however, the collections were small and persisted roughly unchanged, which suggested a different etiology. Scintigraphy with technetium-99m pertechnetate was positive and surgery was proposed. A MD was found intimately adherent to the posterior abdominal wall, involving the ureter. En bloc enterectomy and primary anastomosis were completed successfully. Follow-up ultrasound 11-days after surgery was normal. After 6-months, the patient was asymptomatic. This case represents a diagnostic challenge since ureterohydronephrosis was never described as a complication of MD and it was an important element in the diagnosis.

No abstract

This study reports an exceptional case of a 14-year-old girl with sickle cell disease that was diagnosed with agenesis of the vermiform appendix and ileal duplication. Both consist of extremely rare gastrointestinal malformations whose association has never been described. The preadolescent girl presented with abdominal pain and vomiting, and the ultrasound was suggestive of acute appendicitis. Surgical findings were agenesis of the vermiform appendix and a T-shaped ileal malformation with inflammatory changes. The patient underwent resection and ileal end-to-end anastomosis. Histopathological evaluation identified an ileal duplication, with small bowel and colonic mucosa, no communication to the adjacent ileum and ischaemic changes. At 8-month follow-up, the patient was asymptomatic.