Peritonitis of small bowel with perforated Meckel diverticulum by inadvertently fish bone: A Case report and Literature Review

Abstract

Introduction: Meckel diverticulum is the most common congenital abnormality of the gastrointestinal tract. Foreign body-induced perforation of Meckel diverticulum is extremely rare, with challenging consequences in adults. Case presentation: A 20 years old young boy presented to our department with a three days history of severe abdominal colicky pain of sudden onset. There were also associated symptoms of nausea, and vomiting. On physical examination his abdomen was distended with rebound tenderness. His blood investigation showed raised C reactive protein level with inflammatory markers. CT scan revealed signs of exudation of surrounding fat space. The initial diagnosis was diffuse peritonitis with gastrointestinal perforation by a foreign body, so the patient underwent diagnostic laparoscopy. Findings included a needle-shaped white foreign body about 2.5 cm in length with an edematous hyperemic small intestine that was covered with pus, and adherent to the pelvic cavity. Laparoscopic surgery was converted to open laparotomy surgery. A foreign body was removed and confirmed as a fishbone. Partial resection of ileum, and perforated diverticulum with side-to-side anastomosis done. The patient was discharged 7 days postoperatively. Discussion: perforation of the gastrointestinal tract by a fish bone foreign body is not a common event in the clinical setting. Unfortunately, with the incomplete patient history, it is usually misdiagnosed as with acute appendicitis or other pathologies. CT scan can be a useful modality to diagnose foreign bodies, however, the sensitivity is low to detect complications that occur by fish bone ingestion. Conclusion: Preoperative diagnosis of perforated Meckel diverticulum by fish bone is really rare and difficult. The management of perforated diverticulum by fish bone on time can really reduce the rate of morbidity and immortality. It should be also included in the differential diagnosis of acute abdomen in young people.