PreprintCase ReportVersion 1Preserved in Portico This version is not peer-reviewed
Meckel’s Diverticulum Causing Ileal Volvulus and Peritonitis after a Recent Appendectomy: Case Report and Review of Literature – Should We Resect an Incidental One?
Zanchetta, M.; Inversini, D.; Pappalardo, V.; Grappolini, N.; Morabito, M.; Gianazza, S.; Carcano, G.; Ietto, G. Meckel’s Diverticulum Causing Ileal Volvulus and Peritonitis after a Recent Appendectomy: A Case Report and Literature Review—We Should Likely Resect an Incidental MD. Life2023, 13, 1996.
Zanchetta, M.; Inversini, D.; Pappalardo, V.; Grappolini, N.; Morabito, M.; Gianazza, S.; Carcano, G.; Ietto, G. Meckel’s Diverticulum Causing Ileal Volvulus and Peritonitis after a Recent Appendectomy: A Case Report and Literature Review—We Should Likely Resect an Incidental MD. Life 2023, 13, 1996.
Zanchetta, M.; Inversini, D.; Pappalardo, V.; Grappolini, N.; Morabito, M.; Gianazza, S.; Carcano, G.; Ietto, G. Meckel’s Diverticulum Causing Ileal Volvulus and Peritonitis after a Recent Appendectomy: A Case Report and Literature Review—We Should Likely Resect an Incidental MD. Life2023, 13, 1996.
Zanchetta, M.; Inversini, D.; Pappalardo, V.; Grappolini, N.; Morabito, M.; Gianazza, S.; Carcano, G.; Ietto, G. Meckel’s Diverticulum Causing Ileal Volvulus and Peritonitis after a Recent Appendectomy: A Case Report and Literature Review—We Should Likely Resect an Incidental MD. Life 2023, 13, 1996.
Abstract
Meckel’s diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract with a 1-3% prevalence in general population. The surgical management of symptomatic MD is well described in the literature, but there is still no consensus on the indication for prophylactic resection of incidental asymptomatic MD. To address this issue, we extensively reviewed the current literature and report our experience with laparoscopic management of an unusual case of MD causing ileal volvulus and acute peritonitis two weeks after a laparoscopic appendectomy for acute gangrenous appendicitis performed in another hospital. A 50-year-old man presented to the emergency department with acute and severe abdominal pain, vomiting and constipation. He had undergone a laparoscopic appendectomy for acute appendicitis two weeks before in another hospital. The patient was apyretic, distressed, and sought an antalgic position. The abdomen was mildly distended, tender, and the Blumberg sign was mildly positive in the central quadrants. The clinical picture deteriorated with fever, peritonismus, and leukocytosis. A CT scan showed an ileo-ileal adhesion near the ileocolic junction and dilatation of the upstream loops with air-fluid levels. Through an urgent laparoscopy, a necrotic mass, the MD, was wedge-resected and the surrounding ileal volvulus derotated. The postoperative course was uneventful. There is no definitive consensus on the appropriate management of incidental asymptomatic MD, although several studies have attempted to identify guiding criteria. Features of the MD, patient’s risk factors, clinical presentation, and surgical approach need to be considered to establish definitive guidelines for the management of incidental asymptomatic MD. In the absence of definitive guidelines, personal expertise and judgement are the main resources for the surgeon approaching an incidental asymptomatic MD.
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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