gms | German Medical Science

Background: Meckel diverticulum is the most frequent gastrointestinal malformation affecting 2% of the population. Complications are reported to occur in 2-40% of patients. Despite several modern diagnostic modalities, diagnosis of Meckel diverticulum is still a challenge. The authors report two surprising cases that presented with untypical clinical features and diagnostic results in which the final diagnosis of Meckel diverticulum could only be made intraoperatively. Both patients recovered uneventfully.

Results: The first case refers to a boy that had an intraabdominal cystic formation in the pre-natal ultrasound screening. At 3 years of age he presented in our emergency department after the mother noticed two episodes of dark bloody stool. A technecium-99m scan showed focal activity in the right lower abdominal quadrant, but the area was extremely large so our radiologists considered it to be an untypical Meckel diverticulum image (more likely a vascular malformation or tumor). An MRI showed only a thickened intestinal loop. Intraoperatively the diagnosis of an extremely large Meckel diverticulum with a 6 cm base was made, the intestinal segment was surgically removed and the patient recovered uneventfully. The pathology report described heterotopic gastric mucosal tissue with no malignity.

The second case refers to a 4 year old boy that presented to our emergency department with typical gastroenteritis clinical features. One day later he developed an ileus. An abdominal x-ray showed a foreign body in the pelvis. Intraoperatively a perforated Meckel diverticulum with a button battery at the perforation site was seen. The intestinal segment was surgically removed and the patient recovered without further complications.

Conclusion: Meckel diverticulum still poses a diagnostic challenge for pediatricians and pediatric surgeons. A careful attention to patient history and examination are of the utmost importance, as is a correct diagnostic process. In spite of modern diagnostic tools in some cases the final diagnosis can only be made intraoperatively (sometimes with most surprising findings!).

Figure 1 [Fig. 1]