Gangrenous Meckel's diverticulum secondary to ascariasis in a child
A two-year-old boy presented to us with a history of excessive cry, bilious vomiting and abdominal distension since three days with worms in the vomitus. On examination the child was pale, toxic, dehydrated and febrile (101°F). Abdomen was distended, tender with generalized rebound tenderness. On investigation he was anemic (hemoglobin of 5.9 gm/dl), with leucocytosis (18.5 × 109/L). Plain X-ray abdomen revealed multiple air fluid levels with no free gas under the diaphragm. Ultrasonography of the abdomen showed dilated small bowel loops with multiple worms and free fluid having internal echoes. Child was resuscitated with intravenous fluids and blood transfusion done. Exploratory laparotomy revealed about 500 ml of purulent fluid with round worms in the peritoneal cavity in the right iliac fossa []. There was a volvulus with gangrene and perforation of Meckel's diverticulum and adjacent 10 cm of the ileum [] with worm bolus incarcerated in the Meckel's. The base of the Meckel's was narrow []. In addition, worms were present in whole of the small bowel. Gangrenous Meckel's diverticulum and ileum was resected, worms removed and primary anastomosis done. Peritoneal lavage was given and drain kept. Abdomen was closed in layers. Child had an uneventful post operative period and was discharged on seventh day.