An Unexpected DiscoverySamantha Mc Kenzie Stancu, Bogdan Aurelian Popescu, Mircea Beuran
Clinical case, no. 3, 2016
Meckel's Diverticulum is the most common congenital malformation of the gastrointestinal tract with a prevalence of 2 % in the general population, being twice as common and symptomatic in males. Not seldom is the diagnosis made incidentally, upon laparotomy for other intra-abdominal conditions, namely acute appendicitis. Simple Diverticulectomy is the surgical treatment of choice. We present the case of S.M., a 38 year-old male who was admitted to the Surgery Department of the Bucharest Clinical Emergency Hospital for sudden onset of initially periumbilical pain, which later migrated and localized in the right iliac fossa (RIF) accompanied by vomiting after the onset of pain, approximately 24 hours prior to admission. Examination of the abdomen revealed localized peritoneal signs. An Alvarado score of 8 was calculated. A laparotomy for appendectomy was performed, upon which the sigmoid colon was found in the RIF, and an appendix of 10 cm in length was visualized in a subhepatic, ascendant position. At a distance of 90 cm from the ileocecal valve, a Meckel's Diverticulum with dimensions of 7/4 cm was discovered. A retrograde appendectomy was performed first, along with a simple diverticulectomy, with the use of a TA 30 mm stapler. The operative time was 90 minutes without intraoperative complications, and an uneventful postoperative recovery, culminating with discharge of the patient on the fifth postoperative day. Despite its high prevalence, Meckel's Diverticulum still represents a diagnostic challenge, especially in the adult population, notably in asymptomatic patients. Moreover, ectopic gastric or pancreatic tissue, present in 50% of the cases, leads to a vast array of differential diagnoses. Due to its numerous life-threatening complications such as bleeding, intestinal obstruction, volvulus, intussusception, diverticulitis, fistulization and perforation, accurate diagnosis and timely treatment is crucial.