S6116 A Case of Newly Diagnosed Meckel’s Diverticulum With Spontaneous Perforation

Introduction: Meckel’s diverticulum is the most common congenital anomaly of the gastrointestinal tract, affecting approximately 2% of the population. It arises from incomplete obliteration of the omphalomesenteric duct during fetal development. Though often asymptomatic, complications such as bleeding, obstruction, inflammation, and perforation can occur, more frequently in males and children under 2 years of age. In adults, diagnosis is challenging due to nonspecific symptoms and overlap with other abdominal pathologies. While technetium-99m pertechnetate scintigraphy is effective in children, adult cases often require surgical exploration for definitive diagnosis. Case Description/Methods: A 35-year-old woman with a history of a ruptured hemorrhagic ovarian cyst and cervical intraepithelial neoplasia (status post-LEEP) presented with right lower quadrant abdominal pain radiating to the left, accompanied by non-bilious, non-bloody emesis. Computed tomography imaging revealed diffuse mesenteric edema, a narrowed hyperenhancing small bowel segment, free intra-abdominal air, and signs of early loculated fluid collections, concerning for bowel obstruction and perforation. She underwent diagnostic laparoscopy with laparoscopic appendectomy. Intraoperatively, diffuse purulent fluid and extensive adhesions were noted. An inflamed and perforated Meckel’s diverticulum was identified as the source of obstruction. A small bowel resection with primary anastomosis was performed. Discussion: This case illustrates a rare and severe presentation of Meckel’s diverticulum in an adult woman, a demographic in which the condition is seldom diagnosed. The presence of spontaneous perforation and abscess formation underscores the potential severity of complications when diagnosis is delayed or unexpected. This case reinforces the need to include Meckel’s diverticulum in the differential diagnosis of acute abdomen, even in patients outside the traditional risk profile.