Abstract

An appendectomy is one of the most commonly performed abdominal surgical procedures. During this operation, a Meckel's diverticulum (MD) can occasionally be found as an incidental finding, but the coexistence of both appendicitis and a perforated MD is fairly rare. Complications associated with an MD commonly occur in males, but the frequency of complications decreases with aging. Here, we present a rare case with a simultaneous coexistence of appendicitis and a perforated MD in an older patient. A 54-year-old man presented to the emergency department with a 24-hour history of gradually progressive abdominal pain. An abdominal ultrasound revealed free abdominal fluid in the lower abdomen, a non-compressible appendix that was 8.5 mm in diameter, and an increased wall thickness of the terminal ileum and caecum, suggesting perforated appendicitis. An exploratory laparotomy through a lower midline incision was performed. A typical appendectomy was performed and further abdominal exploration revealed an MD that was 3 cm in length with an inflamed and fibrinoid appearance located 60 cm proximal to the ileocecal valve and adhering to the pelvic peritoneum. A subsequent diverticulectomy was performed using a stapler. The patient had an uneventful recovery and was discharged on the sixth postoperative day. We recommend that searching for an MD should be done even when an acute appendicitis has been diagnosed. The reason for this is because these two conditions may exist simultaneously in patients of an advanced age and present with similar clinical features.

Authors and Affiliations