Perforation of Meckel's Diverticulum, Peritonitis, and Intestinal Obstruction in the Newborn with Survival

Abstract

Meckel's diverticulum is the most frequent gastrointestinal anomaly and occurs in approximately 2% of the population. The incidence is higher in males. Other congenital anomalies occur in about one-third of the cases and it is estimated that Meckel's diverticulum is a cause of clinical disease in 15% to 25% of people in whom it occurs. The complications in childhood are greatest in the first two years of life. Of these, intestinal obstruction and perforation are the most serious, and in the newborn these conditions are particularly lethal. Inflammation and perforation of a Meckel's diverticulum with peritonitis, and partial obstruction in the neonatal period with survival following surgery, is the basis of this report. A search of the literature did not reveal a similar case. The removal of a Meckel's diverticulum in another older male sibling makes this report of additional interest.

Meckel�s diverticulum causing intestinal obstruction in the newborn

“…Hemorrhage, secondary to peptic ulceration, is the most frequent manifestation. Next in frequency is intestinal obstruction, intussusception being the leading cause [4]. Intestinal obstruction accounts for 30 to 56% of symptomatic Meckel's diverticulum.…”

Meckel’s diverticulum

“…Neonatal presentation of MD is uncommon and clinical presentations include intestinal obstruction, gastrointestinal hemorrhage, diverticulitis, and perforation [2][3][4]. Perforation of the gastrointestinal tract in neonates is commonly due to necrotizing enterocolitis or some mechanical obstruction such as atresia, stenosis, meconium ileus, or Hirschsprung's disease; it can also occur spontaneously in the premature [15].…”

Spontaneous Perforation of Meckel's Diverticulum Without Peritonitis in a Newborn: Report of a Case

“…On reviewing the literature from 1953 to 2005, only 10 such cases have been reported (Table 1). [5][6][7][8][9][10][11][12][13][14] Most of them were preterm, with a male to female ratio of 4 : 1. Although an accurate diagnosis before operation was difficult, nearly all these cases eventually required a laparotomy and the postoperative recovery was excellent.…”

“…Only one female baby, who was suspected to have an intrauterine perforation, died 9 h after delivery without operation. 14 Because the clinical presentation varied among these infants, the reported PM usually resembles serious complications such as peritonitis, [5][6][7][8][9] intestinal obstruction, 10 necrotizing enterocolitis, 11,12 strangulated inguinal hernia, 13 or meconium peritonitis. 14 However, pneumoperitoneum without the presence of peritonitis has never been reported.…”

“…[6][7][8][9][10]12,14 However, it is unimaginable that an ectopic mucosa undergoes changes of inflammation, ulceration, or even perforation soon after birth. In our case, the neighboring bowel loop was grossly healthy.…”