Large gallstone impaction at a Meckel's diverticulum causing perforation and localized peritonitis: report of a case
An 82-year-old man was admitted to the hospital with a 12-h history of right iliac fossa pain. He woke up with the pain, which gradually progressed throughout the course of the day. He felt feverish with anorexia and nausea; there were no other bowel symptoms. On admission, physical examination revealed a soft abdomen with maximal tenderness over Mcburney's point, localized percussion tenderness and Rovsing's test was positive.\nHe had low-grade pyrexia and his inflammatory markers were raised with a white cell count of 15.2 × 109/l and a C-reactive protein of 62. Plain chest and abdominal radiographs were unremarkable. Past medical history included gastroplasty and multiple dilatations for a benign oesophageal stricture, he was otherwise well.\nA computed tomography (CT) scan was performed in light of the patient's age (Fig. ), which reported ‘a dilated fluid filled appendix, containing an appendicolith.’ Laparoscopic appendicectomy was therefore planned (Fig. ).\nDuring laparoscopy, there was evidence of localized peritonitis, and an inflamed MD was found containing a large gallstone that had eroded through the wall. The appendix appeared to be normal (Fig. ).\nThe operation remained laparoscopic and the MD was resected using an Endo GIA™ 45 stapler, allowing continuity of the small bowel. The specimen and gallstone were extracted through the superior umbilical port site in an endobag.\nThe specimen was extracted and confirmed a 3×2.5 cm gallstone based on its yellow-green colour and laminated crystalline appearance [] (Fig. ).\nOur patient recovered well postoperatively and was discharged 2 days later. At a 3-week outpatient follow-up, the patient was back to his usual diet and feeling well. The histology report confirmed that the specimen was an MD with gangrenous inflammation, focal perforation and no evidence of malignancy.