Perforation of Meckel's Diverticulum by a Peanut Presenting as a Mesentery Abscess
A 4-year-old 19-kg male child suffered from sudden onset of abdominal pain and fever for about 5 days. Parents reported no significant past medical or surgical history. On arrival at our hospital, the patient had stable hemodynamics with a body temperature of 37.4 °C, a pulse rate of 94 beats per minute, a blood pressure of 124/79mm Hg, and a decreased urine output. On physical examination, the abdomen was distended mildly, and bowel sound was absent. Abdominal tenderness to deep palpation in the right upper quadrant without rebounding pain was found. Rectal examination showed yellowish stool that was Hemoccult-negative. Laboratory data were as follows: total white blood cell count, 17.2×109/L with a significant left shift; hematocrit, 34.9%; serum amylase, 61U/L; serum lipase, 19U/L and serum C-reactive protein, 78.21 mg/mL. The abdominal radiograph showed normal bowel gas pattern and no abnormal free air was identified. Abdominal sonography showed a hypoechoic mass with debris. A computed tomographic scan of the abdomen with intravenous contrast showed an abscess measuring 22×25×24 mm in the small bowel mesentery (). The appendix was not swelling.\nIn light of the abnormal image findings, it was decided that a surgical intervention should be performed; and a laparoscopic approach was elected. Laparoscopy was performed in supine position with a 5-mm Hasson port at the umbilicus and two 5-mm ports at the right upper and left lower quadrants. Video laparoscopy was performed with a 5-mm 30° laparoscope (Karl Storz GmbH, Tuttlingen, Germany). The cecum was initially identified and the entire small bowel was examined. Some serous fluid was observed in the peritoneal cavity. There was an abscess located in the small bowel mesentery right side of the abdomen. Then, the cavity of the abscess was opened attentively and the content was sucked out completely. A piece of peanut was found lying free in the cavity of the abscess (), and the ileal loop and omentum had walled off an inflamed and perforated Meckel's diverticulum (). Diverticulectomy and wedge resection of the ileum were performed. The anastomosis of the ileum was performed intracorporeally.\nHistology confirmed the diagnosis of a perforated Meckel's diverticulitis with abscess formation. Macroscopically, the specimen consisted of one enteric segment measuring 50 mm in length and maximal 20 mm in diameter (). A perforation was found at the tip. On microscopic examination, it showed ulcerative intestinal mucosa with diffusely necrotizing inflammation, with acute and chronic inflammatory cells infiltrating transmurally and fibrinoid substance coating on the serosa. No recognizable ectopic mucosa was identified. The patient was discharged 4 days after operation and remains healthy without any sequelae on one-year follow-up at our outpatient clinic.