Meckel’s Diverticulum Fistulization: Another Complication to Consider

Abstract

A 27-year-old man presented to the emergency department with a 1-day history of abdominal pain, distention, and obstipation. He had no previous surgeries and denied any medical history, including inflammatory disease or prior trauma. On CT of the abdomen and pelvis, he was found to have a high-grade SBO with a transition point in the right lower quadrant (Fig. 1). In the absence of an explanatory etiology for a high-grade SBO in a virgin abdomen, the patient was consented for a diagnostic laparoscopy. Upon laparoscopic entry, the patient was found to have extensive filmly intra-abdominal adhesions throughout his gastrointestinal tract. After a 4-hour lysis of adhesions and conversion to laparotomy, a diverticulum was found 2 ft from the ileocecal valve on the antimesenteric border of the terminal ileum, and in continuity with a proximal small bowel loop. The diverticulum was resected from the antimesenteric borders of the two loops of the small bowel, and confirmed to have formed a fistulous connection (Fig. 2). Pathology conf i rm e d t h e r e s e c t e d d i v e r t i c u l um t o b e a n omphalomesenteric remnant—a Meckel’s diverticulum— without gastric or pancreatic heterotropia. The patient was discharged after a prolonged 2-week hospitalization due to post-operative ileus.