Intussuscepted Meckel diverticulum

Clinical History

A 16 year old boy presented to the emergency room with diffuse abdominal pain and vomiting, that had begun a week earlier. The abdomen was slightly distended.

Imaging Findings

Abdominal ultrasound showed signs of a long segment ileocolic intussusception, extending to the colonic hepatic flexure, and peritoneal fluid (Figure 1a, 1b). Abdominopelvic CT was performed thereafter, confirming ileocolic intussusception associated with diffuse dilated small bowel loops filled with fluid, and collapsed colon; the intussuscepted small bowel shows a terminal glove finger morphology (Figure 2a, 2b, 2c). A mass at the tip with a central core of fat density was visible, which was surgically and pathologically proven to be an intussuscepted Meckel diverticulum.

Discussion

Meckel diverticulum, a true diverticulum, is a congenital anomaly, which results from incomplete obliteration of the omphalomesenteric duct and occurs in 2% of the population. It affects both sexes with equal frequency, however symptoms and complications are more common in male patients [1, 2].
It is often located about 45-90 cm proximal to the ileocecal valve. Heterotopic mucosa is frequently found; in half the cases gastric mucosa is present, as was the case in our patient [2].
Intestinal obstruction is one of the most common complications, second only to haemorrhage, and it is generally seen in older children and adults [1]. It usually manifests clinically with abdominal pain and distention, vomiting and constipation. Small bowel obstruction can result from volvulus, intussusception, herniated diverticulum, trapping of bowel by a fibrous band that connects the diverticulum with the umbilicus, diverticulitis or neoplastic obstruction [1].
A Meckel diverticulum can invaginate and/or invert into the lumen of the small intestine and thereby cause ileoileal or ileocolic intussusception. An inverted Meckel diverticulum appears at CT as a central core of fat attenuation surrounded by a collar of soft-tissue attenuation [3], which was also the case with our patient.
Although CT is a sensitive technique for diagnosing small-bowel obstruction and intussusception, the diagnosis of a Meckel diverticulum as a cause, is rarely made preoperatively.
In our patient, the clinical context and the imaging findings allowed the preoperative diagnosis.

Differential Diagnosis List

Final Diagnosis

Ileocolic intussusception caused by Meckel diverticulum.

URL:	https://www.eurorad.org/case/13120
DOI:	10.1594/EURORAD/CASE.13120
ISSN:	1563-4086