A Case of Perforated Meckel's Diverticulum with True Enteroliths

Shingo Oya, Kanji Miyata, Norihiro Yuasa, Eiji Takeuchi, Yasutomo Goto, Hideo Miyake, Keiichi Nagasawa, Kenji Omori, Yoichiro Kobayashi and Masahiko Fujino*

Department of Surgery and Department of Pathology*, Japanese Red Cross Nagoya First Hospital

A 16-year-old man with lower abdominal pain and fever, lower abdominal tenderness, and muscular guarding was found in blood tests to have an elevated inflammatory response and in abdominal computed tomography (CT) to have a mass-like dilated intestine containing air, fluid, calcification, and ascites at rectovesical pouch, necessitating emergency surgery in November 2006. Laparotomy showed turbid ascites and the Meckel's diverticulum located 90 cm oral from the terminal ileum. The diverticulum was 4.5 cm in size and had neck stenosis together with perforation necessitating diverticulectomy. The diverticulum contained two enteroliths composed of bile acid. Pathological examination showed that ectopic gastric mucosa were present in the diverticulum and the perforation was located in ileal mucosa near gastric mucosa. We judged the perforation to be due to acid secretion from ectopic gastric mucosa, stagnation and retention of intestinal content in the diverticulum by the neck stenosis, and direct mechanical stimulation by enteroliths.

Key words
Meckel's diverticulum, perforation, enterolith

Reprint requests
Shingo Oya Department of Surgery, Toyohashi Municipal Hospital
50 Aza Hachiken Nishi, Aotake-cho, Toyohashi, 441-8570 JAPAN

Accepted
November 19, 2008

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