P2672 - Intestinal Perforation in Elderly Gentleman Found to Be Meckel’s Diverticulum

Gnanashree Dharmarpandi, MD¹, Waqas Rasheed, MD¹, Muhammad Anil, MD², Shahana ishfaque, MBBS³, Muhammad Anees, MD¹, Sarah Naveed. Qureshi, MBBS^4
1Texas Tech University Health Sciences Center, Amarillo, TX; ²Beaumont Hospital, Dearborn, MI; ³Punjab Medical College, Faisalabad, Pakistan, Dearborn, MI; ⁴CMH Multan Institute of Medical Sciences, Multan, Pakistan, Beaumont, TX

Introduction: Intestinal perforation is the loss of continuity of the bowel wall and it is usually caused by trauma, instrumentation, inflammation, infection, malignancy, ischemia, and obstruction. Meckel's diverticulum (MD) is a congenital anomaly caused by failure of vitelline duct obliteration, usually asymptomatic, but can lead to complications.

Case Description/Methods: A 78-year-old Caucasian male with benign prostatic hyperplasia, chronic kidney disease stage IV complicated by hyperparathyroidism, hypertension, hypothyroidism, and past gastric bypass surgery and ventral hernia repair presented with nausea, anorexia, urinary retention, and confusion for 3 days. Physical exam showed right upper quadrant tenderness and abdomen was non-distended with normoactive bowel sounds. He was found to be hypotensive and in atrial fibrillation with rapid ventricular rate. Initial work up was notable for elevated creatinine, BUN, and potassium consistent with acute kidney injury likely secondary to dehydration. CT abdomen showed small bowel obstruction with evidence of perforation with extraluminal free air (Figure 1). The patient was managed with supportive care including bowel rest, intravenous fluids, and analgesics followed by surgery. He was found to have mesenteric abscess, significantly inflamed and perforated Meckel’s diverticulum, and thickening of the ileum. Surgeon performed bowel resection with extensive lysis of adhesions to separate bowel from anterior abdominal wall. Patient recovered slowly on antibiotics and was discharged home.

Discussion: MD is often discovered incidentally when it causes complications such as intestinal obstruction, inflammation, bleeding, and torsion. Intestinal obstruction in adults is typically caused by the diverticulum being attached to the umbilicus, abdominal wall, or other organs by a fibrous band. Although CT scan is the preferred test for identifying MD, it may not always detect a diverticulum without concurrent complications. The rarity of its presentation often leads to poor preoperative diagnosis in complicated MD patients and a significant number of cases are identified during exploratory laparotomy, as seen here. While the benefits of removing incidentally discovered MD are not well understood, early diagnosis and resection in complicated cases offer a better prognosis. Hence, small bowel obstruction secondary to Meckel's diverticulum should be considered in adults with an acute abdomen.



Disclosures:


Gnanashree Dharmarpandi, MD¹, Waqas Rasheed, MD¹, Muhammad Anil, MD², Shahana ishfaque, MBBS³, Muhammad Anees, MD¹, Sarah Naveed. Qureshi, MBBS⁴. P2672 - Intestinal Perforation in Elderly Gentleman Found to Be Meckel’s Diverticulum, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.