Brar Avneet S, Gill Richdeep S, Gill Sumeet S, Wang Haili
Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada.
J Clin Med Res. 2011 Apr 4;3(2):96-8. doi: 10.4021/jocmr504w.
Meckels diverticulum is the most frequent congenital malformation of the gastrointestinal tract. The most common ectopic tissue within a Meckels is heterotopic gastric mucosa, with bleeding being the most common presentation. However, perforation of a Meckels diverticulum is a rare presentation. NSAID-associated Meckels perforation has been suggested, however has not been documented in the literature. We present a case of a 17-year-old female with acute abdominal pain and tenderness following a 24-hour history of excessive ingestion of NSAIDS for pain related to tooth extraction. Chest radiograph demonstrated free intra-abdominal air and she was subsequently taken for exploratory laparotomy. A perforated Meckels diverticulum was isolated and resected. Though NSAID-associated bleeding of heterotopic gastric mucosa has been described, and perforation of the Meckels diverticulum has been suggested, no clear association between heterotopic gastric mucosa and perforation exists. On the other hand, the relationship between NSAIDS and gastric ulcer perforation is well documented. A similar mechanism may also play a role in NSAID-associated Meckels perforation. With how common NSAID use is, we believe it is important to document NSAID-associated perforation of a Meckels diverticulum.
Meckels diverticulum; NSAIDS; Perforation; Heterotopic gastric mucosa.
梅克尔憩室是最常见的胃肠道先天性畸形。梅克尔憩室内最常见的异位组织是异位胃黏膜，出血是最常见的表现。然而，梅克尔憩室穿孔是一种罕见的表现。有研究提示非甾体抗炎药（NSAID）相关的梅克尔憩室穿孔，但文献中尚无记载。我们报告一例17岁女性，因拔牙后疼痛过量服用NSAID 24小时后出现急性腹痛和压痛。胸部X线片显示腹腔内有游离气体，随后她接受了剖腹探查术。发现并切除了一个穿孔的梅克尔憩室。虽然已有关于异位胃黏膜NSAID相关出血的描述，也有关于梅克尔憩室穿孔的提示，但异位胃黏膜与穿孔之间尚无明确关联。另一方面，NSAID与胃溃疡穿孔之间的关系已有充分记载。类似的机制可能也在NSAID相关的梅克尔憩室穿孔中起作用。鉴于NSAID使用如此普遍，我们认为记录NSAID相关的梅克尔憩室穿孔很重要。
梅克尔憩室；非甾体抗炎药；穿孔；异位胃黏膜
