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Year : 2017  |  Volume : 5  |  Issue : 2  |  Page : 82-83

Meckel's diverticulum in ectopic location: A rare presentation

Department of General Surgery, Government Medical College, Amritsar, Punjab, India

Date of Web Publication26-Jul-2017

Correspondence Address:
Sumitoj Singh
C-12, Medical College Campus, Amritsar - 143 001, Punjab
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ssj.ssj_79_16

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Meckel's diverticulum is a common congenital anomaly that present with different clinical manifestations. A case of 35 year old male is being reported who presented with acute pain in right iliac fossa. On exploration meckel's diverticulum was found over the lateral surface of the ileum instead of the anti-mesenteric location. Review of the rare ectopic presentations of meckel's diverticulum, their diagnostic characteristics with their possible explanations has been done in this case report.

Keywords: Anomlies, ectopic location, meckel's diverticulum

How to cite this article:
Mahindru S, Singh S, Sandhu MS, Kumar A. Meckel's diverticulum in ectopic location: A rare presentation. Saudi Surg J 2017;5:82-3

How to cite this URL:
Mahindru S, Singh S, Sandhu MS, Kumar A. Meckel's diverticulum in ectopic location: A rare presentation. Saudi Surg J [serial online] 2017 [cited 2021 Jun 15];5:82-3. Available from: https://www.saudisurgj.org/text.asp?2017/5/2/82/211613

  Introduction Top

Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, but it can be a challenge to diagnose the same clinically.[1] Affecting about 2% of general population, the common presentations include painless bleeding per rectum, intestinal obstruction, diverticulitis, or rarely intussusception. Being found about two feet proximal to ileocecal junction and antimesenteric location of diverticulum are often considered cardinal features of Meckel's diverticulum.[2] However, in literature, there are cases which mention about the ectopic location of Meckel's diverticulum, but all of them describe the mesenteric location.[3],[4],[5],[6],[7] No case has been mentioned in literature reporting Meckel's diverticulum over the lateral surface of the ileum. We probably describe the first case of ectopic Meckel's diverticulum arising from the lateral surface of the ileum. The clinical presentation and management has also been described.

  Case Report Top

A 35-year-old male presented in emergency with a complaint of acute pain in the right iliac region for 1 day associated with nausea and vomiting. There was no history of fever and neither was any complaint of altered bowel habits nor bleeding per rectum. On examination, the abdomen was soft but tenderness was present in right illiac fossa. There was no organomegaly. Ultrasonography suggested acute appendicitis with mildly dilated gut loops. Blood investigations were within normal limits (hemoglobin = 13.2 g/dl; total leukocyte count = 10,500; differential leukocyte count = 544,420; platelets = 2.5 lakhs; blood sugar = 90; blood urea = 36; and serum creatinine = 0.8). With the provisional diagnosis of acute appendicitis, the patient was explored through gridiron incision. Intraoperative, appendix was found to be normal. About two feet proximal to ileocecal junction, Meckel's diverticulum of 7 cm × 3 cm was found arising from the lateral wall of the gut [Figure 1]. The diverticulum was inflamed, thick walled, broad based and apex was perforated. The diverticulum was not sharing the wall with the gut. Specimen was sent for histopathology after diverticulectomy which revealed features consistent with true diverticulum with well-preserved muscularis mucosa, submucosa, and serosa. The patient was discharged after 1 week under satisfactory condition.
Figure 1: (a and b) Operative photographs showing meckel's diverticulum on lateral wall of small intestine

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  Discussion Top

Meckel's diverticulum usually presents in childhood and it occurs because the omphalomesenteric duct fails to close properly.[1] Features suggestive of Meckel's diverticulum include location of diverticulum two feet proximal to ileocecal valve, independent vascular supply, five layers of small intestine, presence of ectopic gastric or pancreatic tissue, and antimesenteric location.

However, in literature, few cases of ectopic location of Meckel's diverticulum have been reported, most commonly being the mesenteric location.[4],[5],[6],[7]

Different explanations as proposed for mesenteric location of diverticulum are as follows:

  1. Persistence of short vitelline artery which creates a mesodiverticular band from mesentery to the tip of the diverticulum, thus diverting the diverticulum away from the antimesenteric border during the process of the elongation [5]
  2. Adherence of vitelline duct to the ileal mesentery due to congenital or inflammatory adhesions.[2]

The usual differential of mesenteric-sided Meckel's diverticulum is the intestinal duplication cyst. However, in general, ileal duplication cysts share the wall and the blood supply of the ileum, and Meckel's diverticulum has its own artery.[8] However, distinct vitelline artery could be delineated in only 10% of patients with Meckel's diverticulum.[9] In our case, distinct blood supply was not found but histopathology revealed the presence of all layers with no ectopic mucosa.

In cases of symptomatic mesenteric diverticulum, resection is generally advised.[4],[5] It is because the mesenteric diverticulitis may erode the mesentery and its vasculature, thus leading to catastrophic complications.[10] In our patient, diverticulum was near the mesentery over lateral surface of gut and was not affecting the mesentery. Hence, diverticulectomy was preferred.

  Conclusion Top

Ectopic location of Meckel's diverticulum is a rare entity. Ectopic location of Meckel's diverticulum other than mesenteric location favors the theory of persistence of short vitelline artery. The differential of ileal duplication cyst may be difficult to make but has to be considered a due possibility. Ectopic location of Meckel's diverticulum is more alarming and should be dealt with resection when possible.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Uppal K, Tubbs RS, Matusz P, Shaffer K, Loukas M. Meckel's diverticulum: A review. Clin Anat 2011;24:416-22.  Back to cited text no. 1
Donellan WL. Meckel's diverticulum and related anomalies. In: Donellan WL, Burrington JD, Kimura K, Schafer JC, White JJ, editors. Abdominal Surgery of Infancy and Childhood. Luxembourg: Harwood Academic Publishers; 2001. p. 41/1-41/12.  Back to cited text no. 2
Walczak DA, Falek W, Zakrzewski J. An uncommon location of Meckel's diverticulum or small intestine duplication? Case report and literature review. Pol Przegl Chir 2011;83:457-60.  Back to cited text no. 3
Segal SD, Albrecht DS, Belland KM, Elster EA. Rare mesenteric location of Meckel's diverticulum, a forgotten entity: A case study aboard USS Kitty Hawk. Am Surg 2004;70:985-8.  Back to cited text no. 4
Sarioglu-Buke A, Corduk N, Koltuksuz U, Karabul M, Savran B, Bagci S. An uncommon variant of Meckel's diverticulum. Can J Surg 2008;51:E46-7.  Back to cited text no. 5
Seitun S, Vito LD, Rossi UG, Panetta M, Cabiddu F, Tedeschi U, et al. Perforated Meckel's diverticulitis on the mesenteric side: MDCT findings. Abdom Imaging 2012;37:288-91.  Back to cited text no. 6
Carpenter SG, McCullough AE, Pasha S, Kristi L, Harold KL. Mesenteric Meckel's diverticulum: A real variant. Int J Anat Var 2013;6:145-8.  Back to cited text no. 7
Li L, Zhang JZ, Wang YX. Vascular classification for small intestinal duplications: Experience with 80 cases. J Pediatr Surg 1998;33:1243-5.  Back to cited text no. 8
Kusumoto H, Yoshida M, Takahashi I, Anai H, Maehara Y, Sugimachi K. Complications and diagnosis of Meckel's diverticulum in 776 patients. Am J Surg 1992;164:382-3.  Back to cited text no. 9
Mohanty PK, Panda1 SS, Das RR, Mallick S. Mesenteric location of Meckel's diverticulum: Is it really uncommon? Saudi J Health Sci 2014;3:166-7.  Back to cited text no. 10
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