A case of perforation of a meckel's diverticulum with ulcerative perforation in a juvenile patient

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 70; no. 8; pp. 2377 - 2381
• Main Authors: NAKAMURA, Kenichi, YAMAMOTO, Makoto, YAMAMOTO, Norihiko, MONDEN, Kazuyuki, HOSODA, Yohei, OKA, Hiroshi
• Format: Journal Article
• Language: Japanese
• Published: Japan Surgical Association 2009
• Subjects: ectopic gastric mucosa; Mecker's diverticulum; perforation of peptic ulcer
• ISSN: 1345-2843; 1882-5133
• DOI: 10.3919/jjsa.70.2377

Meckel's diverticulum is a rare entity and it can occasionally cause perforation and hemorrhage. In this paper we present a case of Meckel's diverticulum causing ulcerative perforation in a juvenile patient, together with a review of the literature. A 13-year-old boy, who had visited a hospital because of lower abdominal pain in the evening, was brought into our hospital by ambulance for aggravated abdominal pain on the next day. When he was first seen, the abdominal wall was hard and there was strong peritoneal sign. Inflammatory reaction showed a high value on blood examination. Abdominal CT scan demonstrated findings of peritonitis due to intestinal perforation. Emergency laparotomy was thus performed when a Meckel's diverticulum with a large perforation in its center was identified in the ileum at about 50cm proximal to the ileocecal region. A wedge resection of the ileum including the diverticulum was performed. The histopathological studies showed the greater cul-de-sac line near the bottom of the ulcer, and it was etiologically considered that the ulcer had been formed in the ectopic gastric mucosa, causing perforation. Meckel's diverticulum is rare but it can sometimes cause gastrointestinal perforation or hemorrhage of unknown cause. Accordingly the diseases must be kept in mind as a possible cause of acute abdomen in juvenile patients.