Saudi Journal of Gastroenterology
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CASE REPORT Table of Contents   
Year : 1997  |  Volume : 3  |  Issue : 3  |  Page : 147-148
Meckel diverticulum presenting as an abdominal mass


Department of Surgery, College of Medicine and King Khalid University Hospital, Riyadh, Saudi Arabia

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Date of Submission05-Aug-1997
Date of Acceptance09-Sep-1997
 

How to cite this article:
Al-Samarrai AI. Meckel diverticulum presenting as an abdominal mass. Saudi J Gastroenterol 1997;3:147-8

How to cite this URL:
Al-Samarrai AI. Meckel diverticulum presenting as an abdominal mass. Saudi J Gastroenterol [serial online] 1997 [cited 2020 Oct 28];3:147-8. Available from: https://www.saudijgastro.com/text.asp?1997/3/3/147/33925


Meckel diverticulum, a remnant of the vitelline duct, is present in around 1.5 - 2 percent of the population and presents most commonly as an incidental fmding at laparotomy. We are reporting an interesting presentation where an abdominal mass was the main presenting clinical finding.


   Case Report Top


A 15-month-old boy presented with a history of abdominal pain and vomiting. Hematological examination showed a leukocytosis with a WBC 12.2 and with differential neutrophil count of 62.4%. On abdominal examination, a huge tender mass could be palpated, occupying the left side of his abdomen. Plain X-ray demonstrated a mass filled with gas [Figure - 1]. Urgent abdominal ultrasound was done. This showed a well defmed lemon size cystic mass is noted in the hypogastrium/left iliac fossa. It had a well defmed wall measuring 4 mm with an inner echogenic lining low level debris was seen in its dependent half. Air densities were noted in its non-dependent portion. It measured 4.2 x 3.4 cm. The features of the left lower quadrant cystic mass suggest duplication cyst with communication to the bowel. There was no need for contrast study. The provisional clinical preoperative diagnosis was duplication cyst or torsion of mesenteric cyst. However laparotomy revealed torsion of a Meckel diverticulum with a distended, infracted, distal end [Figure - 2]. Resection was carried out; the histology was consistent with Meckel diverticulum with acute hemorrahgic inflammation at the distal end. Following discharge the patient was reviewed in the clinic and he remained symptom free.


   Discussion Top


Meckel diverticulum arises from the anti mesenteric border of the terminal ileum due to incomplete obliteration of the yolk sac, usually within 100 cm of the ileo-cecal junction [1] . It may be connected to the umbilicus by a fibrous band or cord, which may lead to intestinal obstruction, or it may remain patent, leading to umbilical-intestinal fistula. Textbooks describe several varieties of presentations, but it is usually non symptomatic and only found incidentally at laparotomy, where its management is controversial, as these Meckel diverticulum rarely cause disease. Diverticulectomy may be carried out if there is a persistent vitelline duct remnant, if it contains palpable heterotropic tissue or tumor or if the patient has abdominal pain of unknown etiology.

The most serious complication is bleeding due to ulceration of ileal mucosa adjacent to ectopic gastric mucosa, while other complications vary from inflammation to intestinal obstruction, intussusception, perforation and umbilical discharge.

Presentation as intestinal obstruction with a mass is rare. Leconte et al 1988 [2] describe a case of obstruction in a newborn, due to a Meckel diverticulum, which was manifest by repeated vomiting and where a rounded mass was palpable on abdominal examination. Another case of Meckel identified at prenatal ultrasound examination as a complex mass superior and posterior to the urinary bladder, a 4 - 0 cm Meckel diverticulum mass was found as layer containing heterotropic gastric mucosa [3] .

A case similar to ours has been reported by Bouin et al in 1988, where a giant Meckel diverticulum presented as a sub-umbilical abdominal mass associated with an infectious picture and anaemia in a 16-month-old boy. The oldest reported patient with a Meckel diverticulum was a man of 90 years who presented clinically as acute appendicitis and was found to have an abdominal mass, which histology proved to be leiomyosarcoma of Meckel diverticulum [5].

 
   References Top

1.Clifford D Benson. Surgical implications of Meckel diverticulum in M M Ravitch, K J Welch, and C D Benson, et al. Pediatric Surgery 3rd ed. Chicago Yearbook Medical Publisher. 1979;PP955-60.  Back to cited text no. 1    
2.Leconte D, Van-Kate G, Questiquz E, et al. A rare case of neonatal occlusion by a palpable abdominal mass: Meckel diverticulum. Chir-Pediatr 1988;29:216-8.  Back to cited text no. 2    
3.Aultman CJ, Samples TL. In utero appearance of a giant Meckel diverticulum. Pediatr-Radiol 1966;26:398-401.  Back to cited text no. 3    
4.Bouin H, Diard F, Vergnes P, et al. Giant Meckel diverticulum presenting on tumor. Arch Fr Pediatr 1986;43:637-9.  Back to cited text no. 4  [PUBMED]  
5.Amar A, Edouard A, Marry JP, et al. Leiomyosarcoma of the Meckel diverticulum and multiple diverticulosis of the ileum: A Apropos of a case. J Chir Paris 1990;127:590-600.  Back to cited text no. 5    

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Correspondence Address:
Asal Izzidien Al-Samarrai
Department of Surgery (37), King Khalid University Hospital, P.O. Box 2925, Riyadh-11461
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


PMID: 19864794

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