Perforated Meckel's Diverticulum in a Very Preterm Baby Revealed at Birth

Abstract

Perforated Meckel's diverticulum (MD) in a preterm baby is very rare. We report a case of a very preterm baby, born at 29-week gestation, with a birth weight of 1400 g, admitted in the third hour of life to our intensive care unit (ICU) for respiratory distress syndrome with abdominal distention. An abdominal radiograph showed a pneumoperitoneum. Laparotomy revealed Meckel's perforation. The baby was discharged healthy at the age of 16 days. MD should be kept in mind as one cause of an acute abdomen in preterm neonates mimicking necrotizing enterocolitis. To our knowledge, our patient is the third reported case described in the literature and the first one revealed at birth.

Pneumoperitoneum in a Micro – Preemie due to Perforated Meckel’s Diverticulum

“…[1][2][3][4][5] Our patient is probably the youngest micropreemie baby reported with a perforated MD to date. Despite worsening clinical status, the patient did not have radiographic evidence of pneumoperitoneum until DOL 5.…”

“…Although rare, perforated Meckel's diverticulum (MD) has been reported in neonates causing pneumoperitoneum. [1] We report probably the youngest case of a perforated MD in a micro-preemie, as defined by gestational age less than 26 weeks and weighing less than 800 grams.…”

Perforation of Meckel`s diverticulum in a very low birth weight neonate with severe pneumoperitoneum and review of literature

“…4 Perforation is a rare complication of MD, evident in approximately 3-10% of patients who have symptoms. 5,6 To our knowledge, only four isolated cases of spontaneous MD perforation in VLBW neonates have been described in the literature 7,[9][10][11] , information is summarized in Table I and II. The mechanisms underlying the development of perforation of MD in VLBW neonates have not been fully elucidated. In adults and older children, perforation of MD is often secondary to mucosal ulceration caused by acid-producing ectopic tissue within the wall of MD.…”

“…6 Perforation is a rare complication of MD, but it could be severe, even life-threatening for pediatric patients. 7 There is a paucity of data on the etiology of perforation, as well as clinical manifestations, management and prognosis in very low birth weight (VLBW) patients. Herein, we report and illustrate a case of spontaneously perforated MD in a VLBW neonate with severe pneumoperitoneum managed by emergent surgery.…”

Neonatal Perforation of Meckel Diverticulum: About Two Cases

“…Our patients were very preterm babies born at 28 and 26 week gestation, the pneumoperitoneum was discovered during abdomen distension in the first case, incidentally on the thoraco-abdominal x-ray in the other patient. There are risk factors predisposing to MD perforation such us antenatal and postnatal steroid therapy, hypoxia, and poor intrauterine blood flow, congenital absence of the muscles in the gastrointestinal wall and exchange transfusion for hemolytic disease [5,23] …”