Acute abdomen due to Meckel's diverticulitis with synchronous inflammatory myofibroblastic tumor in the terminal ileum: A case report.

Abstract

Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal system, occurring in approximately 2% of the population. It is rare for MD to be symptomatic or complicated in adulthood. In this case report, we describe a patient who was admitted to the clinic with Meckel's diverticulitis, which had fistulized to the anterior abdominal wall, and was incidentally found to have an ileal inflammatory myofibroblastic tumor (IMT) on radiological imaging. A 46-year-old male patient presented to the emergency department with abdominal pain. Physical examination revealed localized guarding on the right side of the umbilicus. Blood tests showed elevated acute-phase reactants, including a white blood cell count of 13,800/µL, and C-reactive protein (CRP) level of 165 mg/L. Abdominal computed tomography demonstrated Meckel's diverticulitis fistulizing to the anterior abdominal wall and a polypoid structure in the ileum distal to the MD. The patient underwent emergency surgery, during which segmental ileal resection and ileocolic anastomosis were performed. On the fourth postoperative day, the patient developed an anastomotic leak. Relaparotomy, right hemicolectomy with end ileostomy, and mucous fistula creation were subsequently performed. Pathological examination of the resected ileum from the initial surgery revealed a benign IMT distal to the MD. The patient was discharged on the 40th postoperative day after developing a surgical site infection following the second surgery. The end ileostomy was closed six months later. In this case, it appears that the ileal IMT located distal to the MD may have caused intermittent intestinal obstruction, fecal stasis, and the development of Meckel's diverticulitis. Furthermore, a detailed examination of the patient's history, laboratory results, and radiologic tests may contribute to the detection of incidental pathologies and influence treatment choices.