Wong Banny S, Larson David W, Smyrk Thomas C, Oxentenko Amy S
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA.
J Med Case Rep. 2010 Aug 11;4:264. doi: 10.1186/1752-1947-4-264.
Meckel's diverticulum is a common congenital anomaly of the gastrointestinal tract, but is an uncommon cause of serious complications in adults. Although cases of patients with hemorrhage, bowel obstruction or perforation associated with Meckel's diverticulum have been reported, there have been no prior reports of patients with combined urinary and bowel obstruction due to abscess formation.
We describe the case of a 21-year-old man with a history of recurrent papillary thyroid cancer, but no prior abdominal surgeries, who presented with a one-month history of rectal pain and new-onset obstipation with urinary retention. He reported night sweats and weight loss, and had a second-degree relative with known Crohn's disease. A digital rectal examination was notable and revealed marked tenderness with proximal induration. A computed tomography scan of the patient's abdomen revealed a large, complex, circumferential perirectal abscess compressing the rectal lumen and base of the urinary bladder, associated with terminal ileal thickening and an ileocecal fistula. A flexible sigmoidoscopy with an endorectal ultrasound scan displayed a complex abscess with extensive mucosal and surrounding inflammation. An exploratory laparotomy revealed a Meckel's diverticulum with a large perforation at its base, positioned near the ileocecal fistula and immediately superior to the perirectal abscess. The section of small bowel containing the Meckel's diverticulum, the terminal ileum, and the cecum, were all resected, and the abscess was debrided.
Pre-operative diagnosis of Meckel's diverticulum can be difficult. If the nature of the complication makes ultimate surgical management likely, an early laparoscopic or open exploration should be performed to prevent the morbidity and mortality associated with late complications.
梅克尔憩室是胃肠道常见的先天性异常，但在成人中是严重并发症的罕见原因。虽然已有与梅克尔憩室相关的出血、肠梗阻或穿孔患者的病例报道，但此前尚无因脓肿形成导致尿路和肠道联合梗阻患者的报道。
我们描述了一名21岁男性的病例，该患者有复发性乳头状甲状腺癌病史，但既往无腹部手术史，出现了1个月的直肠疼痛病史以及新发的便秘伴尿潴留。他报告有盗汗和体重减轻，并且有一位已知患有克罗恩病的二级亲属。直肠指检结果显著，显示近端硬结处有明显压痛。患者腹部的计算机断层扫描显示一个巨大、复杂、环绕直肠周围的脓肿，压迫直肠腔和膀胱底部，伴有回肠末端增厚和回盲部瘘管。乙状结肠镜检查结合直肠内超声扫描显示一个复杂的脓肿，伴有广泛的黏膜和周围炎症。剖腹探查发现一个梅克尔憩室，其底部有一个大穿孔，位于回盲部瘘管附近且紧邻直肠周围脓肿上方。切除包含梅克尔憩室的小肠段、回肠末端和盲肠，并对脓肿进行清创。
梅克尔憩室的术前诊断可能困难。如果并发症的性质使得最终手术治疗成为可能，应尽早进行腹腔镜或开放探查，以预防与晚期并发症相关的发病率和死亡率。
