ACUTE ABDOMEN • SENIOR RESIDENT / SURGEON

Meckel's Diverticulitis

Meckel's disease can mimic appendicitis, bleed, obstruct or perforate; diagnosis often becomes clear only during exploration.

PROTOTYPE REVIEW REQUIRED

The Call

Young adult with right lower-quadrant pain

Clinical picture resembles appendicitis, but the appendix is normal at exploration and inflamed distal ileum is encountered.

Stable

A normal appendix should trigger a deliberate search for another source, including Meckel's diverticulum.

Read the Image • Clinical Data

Operative Image An inflamed antimesenteric diverticulum of the distal ileum is the key operative finding. Clinical image slot reserved for this case.

Make the Decision • Commit to a Plan

A young adult has focal ileal inflammation and a blind-ending antimesenteric structure consistent with inflamed Meckel diverticulum and localized peritonitis. Best strategy?

Meckel's Diverticulitis

Young adult with right lower-quadrant pain

A young adult has focal ileal inflammation and a blind-ending antimesenteric structure consistent with inflamed Meckel diverticulum and localized peritonitis. Best strategy?

The diverticular base is broad and inflamed with ulceration extending into adjacent ileum. Best approach?

POD 4 the patient develops GI bleeding and falling hemoglobin after limited diverticulectomy. Best concern?

Inspect the ileum when the appendix does not explain the case.

The presentation predicts follow-up needs.

Surgical Pearls

Pitfalls

At appendectomy the appendix is normal. What is the best next principle?