A gastrointestinal stromal tumour presenting incidentally with haemorrhage and perforation associated with a Meckel's diverticulum: a case report

Abstract

IntroductionThis is the first reported case of perforation and haemorrhage of a Meckel's diverticulum leading to the incidental finding of a gastrointestinal stromal tumour within the diverticulum. Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract, however, when symptomatic, it is often misdiagnosed at presentation. Common complications presenting in adults include bleeding, obstruction, diverticulitis and perforation. Tumours within a Meckel's diverticulum are a rare but recognised complication. We discuss the management of a gastrointestinal tumour within the diverticulum.Case presentationA 59-year-old Caucasian man presented with acute right iliac fossa pain with localized peritonism. At surgery, he was found to have a perforated and haemorrhagic Meckel's diverticulum, associated with a gastrointestinal stromal tumour within the apex of the diverticulum. The absence of necrosis and a low mitotic rate indicated primary resection with subsequent computed tomography surveillance to be the most appropriate management strategy.ConclusionWe report a unique triad of complications associated with the presentation of a Meckel's diverticulum. This article reviews this common congenital abnormality and discusses the management of a gastrointestinal tumour. Meckel's diverticulum will mimic other intra-abdominal pathologies in presentation and should therefore often be considered as a differential diagnosis.

Gastrointestinal stromal tumor in perforated Meckel’s diverticulum: a case report and literature review

“…All patient data were combined to create this report. There have been 18 cases of GIST in perforated Meckel's diverticulum, as shown in Table 1 [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. No recurrences were reported.…”

A gastrointestinal stromal tumor found in perforated Meckel’s diverticulum

“…Tumors found in Meckel’s diverticulum are also rare (0.5–3.2 %) [6], with carcinoid being the most common. To date, only 15 cases of GIST arising in a Meckel’s diverticulum have been reported [6–13, 16, 17]. The exact mechanism of perforation in patients with GIST within Meckel’s diverticula has not been fully described in the literature.…”

“…However, cases exist where tumors such as carcinoid or gastrointestinal stromal tumors (GIST) are found in the resected specimen of perforated or symptomatic Meckel’s diverticulum [6–13]. Perforation in combination with another complication is even more rare [14–16]. We report a case of perforated Meckel’s diverticulum in an adult patient with a recent history of hematochezia with unknown source.…”