Giant Meckel’s Diverticulitis Perforation Due to Necrosis

Abstract

Although Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract, its prevalence is approximately 2% in the general population. Most diverticula remain asymptomatic and can be diagnosed with obstruction, perforation, inflammation, and gastrointestinal hemorrhage. The treatment of complicated MD is surgery, but there is no clear treatment recommendation yet for incidentally detected cases. As in the case we present here, the development of perforation due to Giant Meckel's diverticulitis in an adult female patient is a very rare complication of a disease that can be diagnosed very rarely.

Acute abdomen following axial torsion of a Giant Meckel's diverticulum in a young male: A case report

“…When the MD is long with a narrow base, torsion and diverticulitis are commonly associated complications akin to our patient [19] , [20] , [21] , [22] . Intussusception, necrosis, small bowel obstruction and perforation of the ileum are all reported with Giant MDs [10] , [19] , [23] , [24] , [25] , [26] , [27] . Despite the abundance of reported cases, the prevalence of Giant MD is not yet known albeit the majority if not all, being symptomatic on presentation [27] .…”

Spontaneous Perforation of Meckel’s Diverticulum Presenting as a Rare Cause of Acute Abdomen: A Case Report

“…Commonly, gastrointestinal malformations correspond to approximately 6% of all congenital malformations [6]. MD features are generally quoted by the "rule of 2s" by some authors: is the most common congenital gastrointestinal anomaly, generally found in approximately 2% of the population, twice more likely in males, often found in children at the age of 2 or less, usually located within 2 feet (approximately 60cm) from the ileocecal valve at the antimesenteric border of the ileum (rarely on the mesenteric side), 2 inches (approximately 5 cm) long and may contain 2 types of ectopic mucosas (gastric, mainly, and pancreatic) [8,9]. However, despite the general facts previously presented, based on a recent systematic review, MD is on average 52 cm from the ileocecal valve, 3.05 cm in length and 1.58 cm in diameter [8].…”

“…Although Meckel´s statements claim a 25% complication rate, other authors have concluded that such rate is overestimated [10]. In general, Zani et al stated a 4.2% rate of lifetime risk of complications due to MD, while Cullen et al reported the lifetime risk at 6.4% [8,11,12]. Nevertheless, based on a study including 202 patients, the incidence of complications decreases with age and the pediatric population is at the higher risk: 4% risk in patients younger than 20, 2% risk in patients younger than 40 and 0% risk in the elderly [7,13,14].…”

“…Nevertheless, based on a study including 202 patients, the incidence of complications decreases with age and the pediatric population is at the higher risk: 4% risk in patients younger than 20, 2% risk in patients younger than 40 and 0% risk in the elderly [7,13,14]. There are four criterias that predicts the complication of an asymptomatic incidental MD, accordingly to a retrospective study: diverticulum longer than 2 cm (17%), male gender (25%), younger than 50 years of age (42%) and presence of ectopic tissue (70%) [4,8]. Those complications include obstruction, inflammation (diverticulitis), bleeding and perforation and, overall, while intestinal hemorrhage and obstruction are most common in pediatric patients, obstruction can be the main complication in adults, with incidence rates varying from 22 to 50% [4].…”

“…Apart from nonspecific they also mimic other acute abdominal conditions. On this occasion, the main differential diagnosis is acute appendicitis [8,15]. However, accordingly to a study, if there is a delay in pain reallocation there is a higher suspicion of a complicated MD [13].…”