Fatima Urooj, Ismail Muhammad Shair, Ismail Ahmad, Nadeem Ghazia
Faisalabad Medical University Faisalabad, Pakistan.
Faisalabad Medical University Faisalabad, Pakistan.
Int J Surg Case Rep. 2025 Apr;129:111208. doi: 10.1016/j.ijscr.2025.111208. Epub 2025 Mar 25.
Meckel's diverticulum (MD) is a congenital anomaly of the gastrointestinal tract that occurs in approximately 2% of the population. While often asymptomatic, it can present with complications such as gastrointestinal bleeding, inflammation, or intestinal obstruction. The coexistence of MD with acute appendicitis is exceedingly rare and poses significant diagnostic and therapeutic challenges.
We report the case of a 15-year-old male who presented with severe abdominal pain, nausea, vomiting, constipation, and fever. Clinical examination revealed a distended and tender abdomen with marked paraumbilical and right iliac fossa tenderness. Imaging studies indicated features of intestinal obstruction. During exploratory laparotomy, a Meckel's diverticulum tethered to the umbilicus by a fibrous band was identified, with the ileum twisted around the band causing an obstruction. Additionally, acute appendicitis with pelvic pus was discovered. Surgical management involved division of the fibrous band, wedge resection of the Meckel's diverticulum, and appendectomy. The patient had an uneventful recovery and was discharged on the fifth postoperative day.
This case highlights the rare presentation of concurrent Meckel's diverticulum-associated small bowel obstruction and acute appendicitis. It underscores the importance of maintaining a high index of suspicion for multiple abdominal pathologies in patients presenting with acute abdomen. Prompt diagnosis and surgical intervention are critical to achieving favorable outcomes in such complex cases.
This case emphasizes the diagnostic and management challenges of concurrent abdominal pathologies and provides valuable insights into the surgical approach for such rare clinical scenarios.
梅克尔憩室（MD）是一种胃肠道先天性异常，在大约2%的人群中出现。虽然通常无症状，但它可能出现诸如胃肠道出血、炎症或肠梗阻等并发症。MD与急性阑尾炎并存极为罕见，且带来重大的诊断和治疗挑战。
我们报告一例15岁男性病例，该患者出现严重腹痛、恶心、呕吐、便秘和发热。临床检查发现腹部膨隆且压痛，脐周和右下腹明显压痛。影像学检查显示肠梗阻特征。在剖腹探查术中，发现一个通过纤维带与脐相连的梅克尔憩室，回肠围绕该带扭转导致梗阻。此外，还发现了伴有盆腔积脓的急性阑尾炎。手术处理包括切断纤维带、楔形切除梅克尔憩室和阑尾切除术。患者恢复顺利，术后第五天出院。
本病例突出了梅克尔憩室相关的小肠梗阻与急性阑尾炎并发的罕见表现。它强调了对急性腹痛患者的多种腹部病变保持高度怀疑指数的重要性。在这种复杂病例中，及时诊断和手术干预对于取得良好预后至关重要。
本病例强调了并发腹部病变的诊断和管理挑战，并为这种罕见临床情况的手术方法提供了有价值的见解。
