Perforation of Meckel's Diverticulum Manifesting as Aseptic Peritonitis in a Neonate: Report of a Case

Abstract

We report a case of perforated Meckel's diverticulum with aseptic peritonitis in a 17-day-old neonate. The baby had been brought to the hospital with fever and abdominal distention. Abdominal computed tomography showed a 5-cm abscess in the lower abdomen, and emergency laparotomy was performed for suspected perforated appendicitis. However, we found a perforated Meckel's diverticulum. No bacteria were detected in the purulent ascites from the peritoneal cavity. We speculate that the narrow lumen between the small intestine and the diverticulum, accompanied by poor self-emptying had caused acute inflammation resulting in perforation of Meckel's diverticulum. The anatomic limitations in "walling off" the perforated Meckel's diverticulum by the surrounding loops of small intestine prevented the bowel contents from spreading within the peritoneal cavity.

Meckel’s diverticulum

“…Other investigations included ultrasonography (US) and computed tomography (CT), which were found to be unnecessary when plain radiographs revealed pneumoperitoneum. In the study by Oyachi et al [19], abdominal CT showed an intraabdominal mass/abscess in a neonate who was found to have a perforated MD at laparotomy. In another study, abdominal US showed ascites, which was secondary to a perforated MD [15].…”

Neonatal Perforation of Meckel Diverticulum: About Two Cases

“…Most of these are asymptomatic and occur during childhood in the first two years of life, with a male-to-female ratio of 2:1 [2]. The most common symptoms are gastrointestinal bleeding, bowel obstruction and diverticulitis [20].…”

Perforated Meckel's Diverticulum causing Intussusception in a Neonate

“…In our case radiological exploration was not helpful. Perforated Meckel's diverticulum is rarely found in neonates [5]. To summarize, neonatal intussusception is an extremely rare clinical entity.…”