Acute appendicitis and carcinoid tumor in Meckel’s diverticulum. Three pathologies in one: a case report

Abstract

Incidental carcinoid tumor of the Meckel's diverticulum is an uncommon event. Herein, a case of a carcinoid tumor in Meckel's diverticulum that was incidentally found in a patient with acute appendicitis is presented. A 42-year-old Caucasian man presented with acute abdomen and clinical signs of acute appendicitis. A typical appendectomy was performed during which further abdominal exploration revealed a Meckel's diverticulum 60 cm proximal to the ileocecal valve, with an irregular and somewhat indurated serosal region on one side. A stapled diverticulectomy was performed. Pathology revealed an incidental carcinoid tumor measuring 1 cm within the Meckel's diverticulum. CT scan of the abdomen and 24-h urine 5-hydroxyindoleacetic acid results were normal. The patient had an uneventful recovery and was discharged at the 5th postoperative day. He is alive and without evidence of disease 23 months after the operation. Coexistence of acute appendicitis along with an incidental Meckel's diverticulum raises controversies in their surgical management. We discuss the issues in managing patients with two or more of these coexistent pathologies.

Neuroendocrine Tumors Arising in Meckel's Diverticula: Frequency of Advanced Disease Warrants Aggressive Management

“…A number of reports in the literature describe NETs in a Meckel’s diverticulum that were discovered incidentally during an abdominal exploration for another indication or at autopsy[11,15,16,17]. A review of the literature by Nies et al[6] found that 64% of patients with NETs in a Meckel’s diverticulum were asymptomatic at the time of diagnosis, and 26% were found incidentally at autopsy.…”

Neuroendocrine tumours within a Meckel’s diverticulum

“…The mean age of patients with a MD associated NET is 55 years and the incidence is 2.5 times higher in men. 2,5 The five-year tumour specific survival rates range from 100% for stage I to 84.8% for stage IV. 5 In terms of NET grades, the survival rates are around 93.8% for low grade, 83.0% for intermediate grade and 50.0% for high grade tumours.…”

“…1 MD is a remnant from the incomplete obliteration of the vitelline duct during gestation; it is commonly asymptomatic and the average rate of complications being approximately 4%. 1,2 According to previous reports, diverticulectomy is the best option for complicated diverticula as well as the accepted treatment for incidental MD in the paediatric population. Prophylactic resection of asymptomatic diverticula discovered incidentally in adults remains controversial.…”

“…1 Around 0.5-0.75% of all NETs occur inside a MD and they are often found incidentally. 1,2 We present a case series of three patients with a NET arising from a MD.…”

Meckel’s diverticulum: misdiagnosis and late presentation

“…53 Carcinoid tumor associated with MD is usually diagnosed after bowel resection. 14,36,70,71 Moyana 54 found that jejunoileal carcinoid tumors most similarly resemble the type associated with MD, on immunohistochemical analysis. The survival rate for patients with locally-staged, small bowel carcinoid tumors in the absence of MD is approximately 75%.…”