Perforation of Meckel's diverticulum manifesting as aseptic peritonitis in a neonate: report of a case

Perforated Meckel’s diverticulum in neonates: a report of six cases and systematic review of the literature

Background

Perforation of Meckel Diverticulum (MD) is a rare cause of pneumoperitoneum in neonates. We hereby report six cases of perforation of MD in neonates, with addition of 53 cases from systematic review of the literature. A systematic review was performed using Mesh terms “Neonate, Meckel Diverticulum, Perforation, Pneumoperitoneum.” All reports of perforated MD in the English literature were identified. Details of our 6 cases were analyzed in similar fashion.

Results

A total of 3027 manuscripts were screened and 59 cases including 6 of our own were identified. The vast majority (78%) were female. Fifty patients (84.7%) presented in the newborn period. Half of the cases (52.5%) had associated anomalies and 13 neonates (22%) required oxygen supplementation including CPAP or ventilatory support before surgery. In 73% of the cases, a resection of gut was undertaken. Histopathological assessment in 44 cases (74.6%) revealed no ectopic gastric mucosa. Three cases demised prior to treatment. The outcome in the vast majority was excellent with 84.7% surviving and discharged well.

Conclusion

Perforated MD is an unusual cause of a pneumoperitoneum in the newborns. Diagnosis is established at laparotomy and it rare to find ectopic mucosa histopathologically. The overall outcome is excellent.

Acute abdomen in children due to different presentations of complicated Meckel’s diverticulum: a case series

Background

Meckel’s diverticulum (MD) is the commonest congenital abnormality of the gastrointestinal tract that occurs in 2% of general population. It remains asymptomatic, but it may lead to life-threatening complications. These complications may be misdiagnosed with other gastrointestinal disorders like acute appendicitis, making its diagnosis challenging among pediatricians and pediatric surgeons. In this study, we reported five cases with different presentations of complicated MD in children.

Results

Five patients with different presentations of MD were reported during the period from January 2016 to January 2020. Patients’ demographics, clinical presentations, investigations, operative data, and postoperative outcome were recorded and analyzed.

Conclusions

The present study highlights different presentations of MD. Surgical interference is the main key of treatment of symptomatic MD either by wedge resection of a small base diverticulum or by resection anastomosis of the small intestine in wide base and inflamed diverticulum.

Beware the Innocent Presentation of a Spontaneous Perforated Meckel Diverticulum: A Rare Case and Review of the Literature

Perforation of a Meckel diverticulum in a preterm neonate is very rare. To our knowledge, only 7 cases of spontaneous Meckel perforation in a preterm neonate have previously been described in the literature. The etiology is uncertain. We present the case of a 30-week preterm female twin with a spontaneous Meckel diverticulum perforation discovered on day 3 of life and review the published cases. A possible etiological explanation for this rare entity at this age group is also suggested.

Perforated Meckel's Diverticulum in a 3-day-old Neonate; A Case Report

Perforation of Meckel’s diverticulum is a rare complication in neonatal period. A 3-dayold term male neonate was transferred to our emergency room due to bowel perforation. Surgical exploration was done and perforated Meckel’s diverticulum was detected. Pathological report of the tissue showed inflamed diverticulum with heterotopic gastric mucosa. This is the first report of Meckel’s diverticulum perforation in a neonate in our country

Symptomatic Meckel's diverticulum in newborn: two interesting additional cases and review of literature

OBJECTIVES

This study aimed to review the literature about symptomatic Meckel's diverticulum (MD) in the neonatal period with 2 additional uncommon cases.

METHODS

The authors describe 2 interesting neonatal cases of symptomatic MD and analyze the literature on this topic, with particular reference to the prevalence of sex, age at presentation, most common signs and symptoms, treatment, histology, associated anomalies, and outcome.

RESULTS

The first patient was a term newborn with bowel obstruction by a pseudocystic MD. The second patient was a preterm infant with double perforation of the MD and ileum. Literature search for published case reports and case series on this topic reveals only 18 cases of neonatal symptomatic MD. Males are more frequently involved than females, and even preterm infants may be affected. Bowel obstruction (58.3%) and pneumoperitoneum (33.3%) are the most frequent clinical manifestation. Acute inflammation of the MD is the prominent histopathological finding (75%), although it does not seem to be related with the presence of heterotopic tissue within the MD. Surgical treatment is essential. The association of neonatal symptomatic MD with other anomalies is exceptional but is otherwise life threatening despite surgery.

CONCLUSIONS

Bowel obstruction and pneumoperitoneum are the most frequent clinical manifestations of symptomatic MD in the newborn. Surgery is required for a definitive diagnosis and successful outcome.

Perforated Meckel's diverticulum in a micropremature infant and review of the literature

A 28-week estimated gestational age infant presented to our neonatal intensive care unit at 6 days of life with intestinal perforation. Urgent surgical exploration revealed a perforated Meckel's diverticulum (MD) with no other intestinal abnormalities. Pathologic examination of the specimen demonstrated a perforated MD with no heterotopic mucosa present. According to our literature review, this is the first reported case of a perforated MD in a micropremature infant. In the English literature, there have been a total of seven reported cases of perforated MD in the last 25 years. This report summarizes those cases and characterizes the presentation, prognosis and management of this very rare complication in neonates.

An unusual complication of umbilical catheterisation

We report the first case of perforated Meckel's diverticulum in a 1-day-old pre-term infant as a consequence of umbilical vein catheterisation. The clinical course consisted of abdominal distension and pneumoperitoneum that occurred after 12 h of life. Perforated Meckel's diverticulum was found at laparotomy. Neither inflammatory phenomena nor ectopic mucosa were found at microscopical examination. Perforation of the diverticulum was a complication of umbilical catheter insertion through a narrow lumen in the umbilical cord mistaken for an umbilical vein and connected to Meckel's diverticulum through a very short fibrous band. A search of the literature did not reveal any similar cases.