Perforation of a Meckel's diverticulum by a mussel shell fragment

Abstract

In September 2014, a 48-year-old lady presented to the emergency department with a 2-day history of central and lower abdominal pain. The patient was afebrile, had an elevated white cell count of 15.3 and unremarkable plain films. She was admitted with a provisional diagnosis of diverticulitis, managed with intravenous antibiotics, fluids and fasted. Serial examinations showed no improvement and an abdominal computed tomography revealed the presence of a foreign body (17 × 4 mm), which had penetrated through the small bowel in the right paramedian central abdomen, above the level of the umbilicus with associated inflammatory change and two small extraluminal air pockets (Fig. 1). The patient was consented and an emergency laparotomy was performed.A perforated Meckel's diverticulum was identified intraoperatively (Fig. 2), with a small mussel shell visible (Fig. 3). A small amount of free fluid was identified, minimal soiling transpired. The entirety of the small bowel was examined with no other abnormalities identified. A Meckel's diverticulectomy was performed using a gastrointestinal anastomosis stapler (GIA 60 mm + GIA 90 mm).