Pseudolipoma of inverted Meckel's diverticulum: clinical, radiological and pathological correlation

Abstract

Three cases of isolated inverted Meckel's diverticulum are described. In two cases an initial pathological diagnosis of small bowel lipoma was suggested. In a third case central fat was demonstrated on CT and peristalsis of the intraluminal polypoid mass was observed during US examination. In all three cases small bowel enema examination demonstrated the lesion. Correlation of the clinical, radiological and pathological features is emphasised, as this will allow the correct diagnosis.

An unusual cause of acute abdominal pain in a child: An inverted meckel diverticulum: Report of a case

“…5 The radiologic diagnosis of inverted Meckel diverticulum has been established mainly by intestinal contrast series with typical findings of a polypoid or tubular filling defect. 2,4,6,8 However, a shorter diverticulum more closely resembles a polyp, and such a finding may cause delay in the correct diagnosis. 4 Patients who have an isolated inverted Meckel diverticulum tend to be older and have a more chronic clinical course than those in whom the diverticulum acts as a pathologic leading point of intussusception.…”

“…Intussusception may occur when the Meckel diverticulum inverts and acts as the leading point. 1,2,4 Although inverted Meckel diverticulum is a well-described pathology in a child as a pathologic leading point of intussusception, isolated inversion of diverticulum is exceedingly rare and reported only in adult patients. From a review of the literature, we found only a few cases of isolated inversion of Meckel diverticulum, which presented with chronic gastrointestinal bleeding and iron-deficiency anemia without abdominal symptoms.…”

“…Bleeding usually arises from ulceration of the ileal mucosa due to heterotopic gastric mucosa. 1,4 Other complications of diverticulum are inflammation, perforation, and obstruction due to small bowel volvulus or intussusception. Intussusception may occur when the Meckel diverticulum inverts and acts as the leading point.…”

“…From a review of the literature, we found only a few cases of isolated inversion of Meckel diverticulum, which presented with chronic gastrointestinal bleeding and iron-deficiency anemia without abdominal symptoms. 4,[5][6][7] The largest series of Meckel diverticulum to date was a report by PantongragBrown and colleagues in 1996 of 18 cases in which the patients had a median age of 32 years. 8 In this series, 13 of the 18 cases with inverted Meckel diverticulum were associated with small bowel intussusception.…”

“…3 However, patients with an isolated inversion of Meckel diverticulum are usually older and present with a longer history of symptoms. 4 Preoperative diagnosis of isolated inversion of Meckel diverticulum is usually difficult and necessitates knowledge of the radiologic features of the disease. We report the case of a boy who was admitted with acute onset of severe intermittent abdominal pain and was found to have isolated inversion of Meckel diverticulum without intussusception.…”