NSAID-Associated Perforation of a Meckel’s Diverticulum: A Case Report

Abstract

Meckel’s diverticulum is the most frequent congenital malformation of the gastrointestinal tract. The most common ectopic tissue within a Meckel’s is heterotopic gastric mucosa, with bleeding being the most common presentation. However, perforation of a Meckel’s diverticulum is a rare presentation. NSAID-associated Meckel’s perforation has been suggested, however has not been documented in the literature. We present a case of a 17-year-old female with acute abdominal pain and tenderness following a 24-hour history of excessive ingestion of NSAIDS for pain related to tooth extraction. Chest radiograph demonstrated free intra-abdominal air and she was subsequently taken for exploratory laparotomy. A perforated Meckel’s diverticulum was isolated and resected. Though NSAID-associated bleeding of heterotopic gastric mucosa has been described, and perforation of the Meckel’s diverticulum has been suggested, no clear association between heterotopic gastric mucosa and perforation exists. On the other hand, the relationship between NSAIDS and gastric ulcer perforation is well documented. A similar mechanism may also play a role in NSAID-associated Meckel’s perforation. With how common NSAID use is, we believe it is important to document NSAID-associated perforation of a Meckel’s diverticulum.KeywordsMeckel’s diverticulum; NSAIDS; Perforation; Heterotopic gastric mucosa

Steroid Induced Perforation of Meckel's Diverticulum in an Adult

“…Perforation of Meckel's diverticulum is one of the uncommon complications with high morbidity and mortality, almost always preceded by diverticulitis [1][2][3]. The perforations can be NSAID induced [5], fish or chicken bone impaction [6,7]. Steroid induced peptic perforation is a documented complications of long standing systemic steroid therapy [8,9].…”