Case Presentation:
A 37-year-old middle eastern man presented to the emergency department
(ED) with a three-hour history of severe, worsening, generalized
abdominal pain and nausea. Past medical history included inactive
hepatitis B and morbid obesity. Past family history was unremarkable.
Past surgical history included laparoscopic gastric bypass.
On examination, the patient looked unwell, and in pain. His Glasgow coma
scale score was 15, and he had a heart rate of 86 beats per minute,
blood pressure 129/82 mm/Hg, respiratory rate 20 breaths per minute, and
body temperature 36°C. On examination, his abdomen was lax with
generalized tenderness, and his laparoscopic wounds had healed. Body
mass index is 27.9 (52 pre surgery).
Initial laboratory investigations revealed a white blood cell count
(WBC) of 11,800/uL (4000-11000 uL), and hemoglobin 15 g/dL (10-15 g/dL).
Other blood investigations were unremarkable. Abdominal X-Ray showed
dilated small bowels are noted in the left side of abdomen. Computed
tomography (CT) of the abdomen and pelvis with intravenous contrast
revealed two distal ileoileal intussusceptions with high suspicion of a
3 cm mass within the intussusception around the ileocecal region.
(Figure 1 ).
He was admitted under the care of the general surgical team,
resuscitated, and underwent laparoscopic exploration which confirmed the
CT findings and no ischemic bowel identified. Laparoscopic right
hemicolectomy with extracorporeal ileocolic anastomosis was done
(Figure 2 ). Upon examining of the specimens Meckel diverticulum
was found (Figure 3 ). Specimen was sent for pathology which
revealed Meckel’s diverticulum lined by gastric mucosa. A solid diet was
introduced gradually, and the patient was discharged home on day 8 post
operation. He was followed up in the outpatient clinic for almost two
years, with uneventful course.