Unusual Presentation Of Concomitant Appendicitis And Meckel's Diverticulitis From Meckel's Neuroendocrine Tumor.
Appendicitis and Meckel's diverticulitis (MD) are common conditions that rarely present simultaneously. To the best of our knowledge and literature review; this is the second case report of co-presenting appendicitis and MD, and the first of this combination presenting with a neuroendocrine tumor. The standard treatment for uncomplicated acute appendicitis is appendectomy; non-surgical management is an area of ongoing investigation. MD can present similar to acute appendicitis. Small bowel resection is the standard treatment of MD. Non-operative management versus surgical resection is a debatable topic for incidentally found Meckel's diverticulum. Malignancies develop in approximately 5% of Meckel's diverticula with neuroendocrine tumors accounting for 76.5%. We present a patient that was treated surgically for appendicitis and MD, with a neuroendocrine tumor contained within the resected diverticulum.
CASE HISTORY: A 50 year-old man presented with acute lower abdominal pain. CT demonstrated inflammation of the small bowel with a possible blind-ended pouch and minimal free air. Patient underwent an appendectomy and a small bowel resection for appendicitis and MD. Pathology of the resected bowel displayed inflamed and necrotic Meckel diverticulum containing a well-differentiated neuroendocrine tumor.
DISCUSSION: Meckel's diverticula are the most common congenital abnormality of the gastrointestinal tract, presenting in about 2% of the population. They are commonly asymptomatic, but about 4% present with complications. Based on the findings of our case report, we believe that strong consideration should be given to perform small bowel resection of incidentally found Meckel's diverticula as these anomalies may contain malignancies within them.