Hydatid Cyst in a Meckel’s Diverticulum

Abstract

A 39-year-old male was presented with sudden onset abdominal pain, nausea, and vomiting, which were present for 12 h. The physical examination revealed hypertension (142/94 mmHg), tachycardia (102 beats per minute), normal body temperature (36.9 °C), and guarding in the right lower quadrant. There were itchy rashes on the abdominal skin, and the patient had no history of chronic disease or surgery. Laboratory test results revealed elevated lactate dehydrogenase (248 U/L; normal range, 135– 225 U/L), c-reactive protein (103 mg/L; normal value, < 5 mg/L) level, white blood cell count (14.5 K/uL; normal value, 4–10.5 K/uL), and eosinophilia (eosinophil count of 1.32 K/uL; normal range, 0.02–0.50 K/uL). Other laboratory results, including creatinine, urea, liver function tests, and urine analysis results, were within normal limits. Contrastenhanced abdominal computed tomography (CT) was performed with a suspicion of acute abdomen. Abdominal CT showed the normal appendix in the right lower quadrant. However, CT revealed an inflamed bowel segment in the distal ileum, peri-intestinal fat stranding, and a cystic lesion in the right lower quadrant with a 7 cm diameter including air-fluid level and septa (Fig. 1). Abdominal CT findings suggested the diagnosis of complicated Meckel’s diverticulitis, and laparotomy was performed. The appendix was found to be normal during the operation, and an inflamed Meckel’s diverticulum was detected about 100 cm proximal to the ileocecal valve. Moreover, an intestinal and peritoneal ruptured white-colored lesion was detected at the tip of Meckel’s diverticulum which suggested the diagnosis of a hydatid cyst (Fig. 2). Peri-intestinal and pelvic free fluid were also observed. Diverticulectomy was performed, and histopathological evaluation of the surgical specimen was consistent with Meckel’s diverticulitis and ruptured hydatid cyst (Fig. 3). The patient was discharged on the fourth postoperative day, and oral albendazole therapy was initiated. The 6-month follow-up of the patient was uneventful. Cystic echinococcus is also known as hydatid disease, is caused by Echinococcus granulosus, and can result in cyst formation anywhere in the body but usually affects the liver. 1, 2 The