Perforation of Meckel`s diverticulum in a very low birth weight neonate with severe pneumoperitoneum and review of literature

Abstract

Perforation is a rare complication of Meckel's diverticulum (MD), but it could be severe, even life-threatening for pediatric patients. There is a paucity of data on etiology of perforation, as well as clinical manifestations, management and prognosis in very low birth weight (VLBW) neonates with perforated MD. We report a rare case of spontaneously perforated MD in a VLBW neonate presenting with severe pneumoperitoneum. To our knowledge, this is one of the earliest reported VLBW cases with this rare complication. Furthermore, we review relevant publications and summarize major characteristics of all VLBW cases previously reported in order to provide some practical experience and interesting issues for pediatricians. Perforated MD should be kept in mind when VLBW neonates present with pneumoperitoneum.

Perforated Meckel’s diverticulum in neonates: a report of six cases and systematic review of the literature

“…Complications may occur in up to 4% of cases, and in the symptomatic, intestinal perforation is seen fewer than 10% of cases [ 1 ]. Diverticular length and base diameter are well-known predisposing factors to complications with long, narrow-based diverticula thought to predispose to obstruction on the basis of intussusception and inflammation [ 3 , 5 , 7 ]. Common manifestations of neonatal MD include perforation, intussusception, segmental ileal dilatation, and ileal volvulus [ 8 , 28 , 61 ].…”

“…2 Reconstructive Surgery, Nationwide Children's, Columbus, OH, USA. 3 King Faisal Specialist Hospital & Research Center, Jeddah 21499, Saudi Arabia. 4 Children's Hospital, Lahore, Pakistan.…”

“…The most common causes in this age group are necrotizing enterocolitis and intestinal atresia including a host of idiopathic pathologies. A rare cause is a perforated Meckel diverticulum (MD), of which, only a limited number of cases have been reported to date [1][2][3].…”

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

“…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].…”

“…Conventional radiographs are, in general, nonspecific and have limited value [6]. In case MD is perforated, pneumoperitoneum is often unremarkable, however, it may be elusive in case there is an obstruction, demonstrating characteristic findings or enteroliths, for instance [4,6,12]. Sonography can be a good method to evaluate intussusception, obstruction (evidence of a tubular distended structure) and, mostly, inflammatory process, in which case findings can be quite similar to acute appendicitis [6].…”