Adenocarcinoma arising from Meckel's diverticulum in the ileum with malrotation of the midgut
A 19-year-old woman received an examination from the department of gynecology with complaints of pain in the left lower abdomen. Laboratory test results included the following: carbohydrate antigen (CA) 125, 38.75 U/mL (normal, 0 to 35.0 U/mL); CA 19-9, 2,038.0 U/mL (normal, 0 to 36.10 U/mL). Serum electrolytes, tests of liver and renal function were within normal ranges. A sonography by the gynecologist revealed a right ovarian cyst (8.2 cm × 7.4 cm) but computed tomography (CT) revealed a chronic inflammatory mass (abscess from unknown etiology, 6.7 cm × 6.4 cm × 6.3 cm) with severe inflammatory infiltrations into adjacent mesentery, sigmoid colon and small bowel loops and magnetic resonance imaging indicated the same findings (). Positron emission tomography (PET)-CT revealed a malignant tumor in the pelvic cavity abutting the small bowel and rectum (). Colonoscopy revealed erythematous masses like external indentations on the distal descending colon (50 cm from anal verge) and sigmoid colon (15 cm from anal verge) ().\nShe underwent laparoscopic exploration. During operation, a 6 cm-sized mass in the antimesenteric border of the ileum was noted, approximately 40 cm proximal from the ICV. Adult malrotation of the midgut was found incidentally at exploration. She underwent laparoscopic Ladd procedure and segmental resection of the ileum (). Intraoperative frozen biopsy was performed and the temporary pathologic report showed metastatic adenocarcinoma, probably originating from the colon or endometrium. Intraoperative endometrial biopsy was performed by the gynecologist and a frozen biopsy showed no tumor on endometrium. The final pathological diagnosis was adenocarcinoma, moderately differentiated (6.0 cm × 4.0 cm) from MD with serosa invasion and one regional lymph node metastasis (T4N1M0, stage IIIA according to the 7th American Joint Committee on Cancer classification). She was discharged uneventfully on post-operative day 6.