Darlington C Danny, Anitha G Fatima Shirly
Department of Urology, Stanley Medical College, Chennai, Tamil Nadu, India.
Department of Pediatrics, CSI Kalyani Hospital, Chennai, Tamil Nadu, India.
Indian J Crit Care Med. 2017 Nov;21(11):789-792. doi: 10.4103/ijccm.IJCCM_317_17.
Meckel's diverticulum is a remnant of the proximal part of the vitellointestinal duct and is the most common congenital anomaly of the gastrointestinal tract. It may either remain asymptomatic or present with myriad of clinical presentations. Gastrointestinal bleeding is the most common presentation in children whereas it is intestinal obstruction in the case of adults. We report a 9-year-old boy who presented with acute onset of periumbilical pain and nonbilious vomiting. His clinical and laboratory parameters were unremarkable, except for serum amylase levels. He was conservatively managed initially as acute pancreatitis with paralytic ileus. However, the child deteriorated in a course of 2 days with bilious vomiting, abdominal distension, and dehydration. Imaging was suggestive of an ileoileal intussusception, and exploratory laparotomy identified Meckel's diverticulum as the lead point for the intussusception. The histopathological examination revealed inflamed heterotopic pancreatic tissue at the apex of the diverticulum thus explaining the elevated amylase levels. This case is reported to highlight the atypical presentation of Meckel's diverticulum and the high clinical suspicion warranted in diagnosing such concomitant intussusception.
梅克尔憩室是卵黄管近端的残余部分，是胃肠道最常见的先天性异常。它可能无症状，也可能有多种临床表现。胃肠道出血是儿童最常见的表现，而在成人中则以肠梗阻为主。我们报告一名9岁男孩，他出现急性脐周疼痛和非胆汁性呕吐。除血清淀粉酶水平外，他的临床和实验室参数均无异常。最初他被作为急性胰腺炎合并麻痹性肠梗阻进行保守治疗。然而，该患儿在2天内病情恶化，出现胆汁性呕吐、腹胀和脱水。影像学检查提示回肠套叠，剖腹探查发现梅克尔憩室是套叠的起始点。组织病理学检查显示憩室顶端有炎症性异位胰腺组织，这就解释了淀粉酶水平升高的原因。报道此病例是为了强调梅克尔憩室的非典型表现以及诊断这种合并套叠时需要高度的临床怀疑。
