Meckel\'s diverticulitis masquerading as acute pancreatitis: A diagnostic dilemma

Abstract

Meckel's diverticulum is a remnant of the proximal part of the vitellointestinal duct and is the most common congenital anomaly of the gastrointestinal tract. It may either remain asymptomatic or present with myriad of clinical presentations. Gastrointestinal bleeding is the most common presentation in children whereas it is intestinal obstruction in the case of adults. We report a 9-year-old boy who presented with acute onset of periumbilical pain and nonbilious vomiting. His clinical and laboratory parameters were unremarkable, except for serum amylase levels. He was conservatively managed initially as acute pancreatitis with paralytic ileus. However, the child deteriorated in a course of 2 days with bilious vomiting, abdominal distension, and dehydration. Imaging was suggestive of an ileoileal intussusception, and exploratory laparotomy identified Meckel's diverticulum as the lead point for the intussusception. The histopathological examination revealed inflamed heterotopic pancreatic tissue at the apex of the diverticulum thus explaining the elevated amylase levels. This case is reported to highlight the atypical presentation of Meckel's diverticulum and the high clinical suspicion warranted in diagnosing such concomitant intussusception.

A Pediatric Case of Inverted Meckel’s Diverticulum Presenting with Cyclic Vomiting-like Symptoms: A Case Report and Literature Review

“…In the literature review including the present case, bloody stool was observed in 55/74 (74.3%) of adults and 3/9 (33.3%) of children, with a significant difference ( p = 0.019) ( Table 1 ). Although it may not be sufficient to conclude that the diagnosis of inverted Meckel’s diverticulum is usually delayed in pediatric cases because of the absence of bloody stool, eight pediatric cases, excluding the present case, resulted in ileus due to intussusception, and imaging findings of intussusception were observed significantly more often in children than in adults ( p = 0.001) [ 2 , 3 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. On the other hand, adult cases may have significantly more anemia due to chronic intestinal hemorrhage ( p < 0.0001) ( Table 1 ), because the adult cases do not present with the acute onset of intussusception, unlike the pediatric cases.…”

“…In total, 94 related articles were retrieved. There were 29 articles for 74 adult [ 3 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ] and 9 pediatric (age < 18 years) [ 2 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ] cases including the present case] that reported the course of each case in detail. These included 55 male and 28 female patients with onset ages of 2 to 78 years.…”

Chronic pancreatitis of jejunal ectopic pancreas: a rare cause of chronic abdominal pain

“…Only a few cases exist in the literature of possible pancreatitis within EP. One case has been reported of a 9-year-old in India with abdominal pain who underwent a bowel resection for a Meckel’s diverticulitis that contained inflamed ectopic pancreatic tissue [ 7 ]. Another case from the Netherlands reports a 58-year-old who presented with abdominal pain and was found to have EP within the jejunal mesentery [ 8 ].…”

Abdome Agudo Obstrutivo Por Divertículo De Meckel Em Adulto

“…Em crianças a manifestação mais comum é a hemorragia digestiva 2 . Recentemente, foi publicado um estudo retrospectivo pela Universidade de Medicina de Wenzhou na China envolvendo pacientes pediátricos de até 14 anos.…”