CASE REPORT   

Chirurgia 2004 December;17(6):243-6

Copyright © 2004 EDIZIONI MINERVA MEDICA

language: English

Complicated Meckel’s diverticulum. A case report

Dicasillati R., Cantaluppi G., Villani F.

The authors describe their experience of the treatment of complicated Meckel's diverticulum. The patient, a 57-year-old male, presented signs and symptoms of intestinal obstruction and was admitted to hospital. The peculiarity of the case is that the obstructive cause was a coprolith, stamp diverticulum shaped, migrated from the pathologic diverticulum and wedged, more typically, in the terminal ileum. The surgical choice was enterotomy to remove the coprolith and the resection of the ileum loop with Meckel's diverticulum. The histology of the diverticulum did not show any ectopic mucosa. Meckel's diverticulum has been described as a persistent residuum of the omphalomesenteric duct and is the most frequent congenital malformation of the small intestine. In about 70% of cases, it remains asymptomatic and is incidentally discovered during laparotomy, laparoscopy or autopsy. In the other 30% of cases it becomes symptomatic because of complications, most frequently in early childhood. Complications are mechanical obstruction (31%), hemorrhage (23%), intussusception (14%), diverticulitis (14%), perforation (10%), miscellaneous (8%). Only a few authors report the finding of coproliths in Meckel's diverticulum, usually multiple, and more often associated with inflammatory and/or hemorrhagic complications. It may contain ectopic tissues: gastric mucosa, pancreatic tissue, duodenal and colonic mucosa are described. Malignancies have been more rarely found: leiomyosarcoma, carcinoid, and, less frequently, adenocarcinoma, which is probably associated with gastric ectopic mucosa.