A Rare Case Od Meckel’s Diverticulum Perforation Caused By a Toothpick Mimicking Acute Appendicitis

Abstract

Meckel’s diverticulum (MD) is the most common congenital abnormality of the gastrointestinal tract and is caused by the failure of omphalomesenteric duct to obliterate during embryonal maturation. Most patients are asymptomatic with only 4-16% presenting complications which include hemorrhage, intestinal obstruction, inflamation and occasionally perforation. A preoperative diagnosis of a complicated Meckel’s diverticulum may be challenging because of the overlapping clinical and imaging features of other acute surgical and inflammatory conditions of the abdomen. A 32-year old male was admitted to the emergency department with a 48-hour history of colicky like pain in the lower part of the abdomen, which was gradually increased and was localised in the lower right quadrant, with no history of fever, nausea or vommiting, no urinary symptoms nor altered bowel habits. Laboratory revealed leukocytosis and elevated CRP, while on physical examination guarding and rebound tenderness were found in the right lower quadrant. Abdominal ultrasound  established a distended small bowel with very slow peristalsis in ileocecal region. Complete workup raised suspicion for an acute appendicitis, therefore the patient was operated. Intraoperatively, the perforated Meckel’s diveriticulum was found, caused by a toothpick. Diverticulectomy and appendectomy were done. Postoperative course was uneventful. Regardless of the fact that a variety of diagnostic procedures are at the disposal of surgeons, we feel that the diagnose of a complicated MD remains a challenging task, largely in thanks to the fact that it mimics some other acute abdominal pathology and, often, is misdiagnosed.