Presumed appendiceal abscess discovered to be ruptured Meckel diverticulum following percutaneous drainage.
A Meckel diverticulum is an embryonic remnant of the omphalomesenteric duct that occurs in approximately 2% of the population. Most are asymptomatic; however, they are vulnerable to inflammation with subsequent consequences including diverticulitis and perforation. We report an 11-year-old boy who underwent laparoscopic appendectomy for perforated appendicitis at an outside institution. During his convalescence he underwent percutaneous drainage of a presumed postoperative abscess. A follow-up drain study demonstrated an enteric fistula. The drain was slowly removed from the abdomen over a period of 1 week. Three weeks following drain removal the patient reported recurrent nausea and abdominal pain. A CT scan demonstrated a 3.7-cm rim-enhancing air-fluid level with dependent contrast consistent with persistent enteric fistula and abscess. Exploratory laparoscopy was performed, at which time a Meckel diverticulum was identified and resected. This case highlights the diagnostic challenge and limitations of conventional radiology in complicated Meckel diverticulum.
Yang
Jeannie C
JC
Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA.
Rivard
Douglas C
DC
Morello
Frank P
FP
Ostlie
Daniel J
DJ
D000038:Abscess / Q000000981:diagnostic imaging*; D001065:Appendix / Q000000981:diagnostic imaging*; D002648:Child; D003937:Diagnosis, Differential; D004322:Drainage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008467:Meckel Diverticulum / Q000175:diagnosis*; D011859:Radiography; D012421:Rupture / Q000000981:diagnostic imaging / Q000209:etiology