Case history
Case history #1
A 20-month-old boy is admitted to hospital with a history of having passed a bloody stool 8 hours before presentation. He has previously been well. On examination, he is pale and distressed but has no abdominal mass or tenderness. A contrast enema proves negative for intussusception.
Case history #2
A 68-year-old man presents to the accident and emergency department with a 24-hour history of colicky central abdominal pain associated with anorexia and intractable constipation (obstipation). The pain is associated with nausea and vomiting. He has had no previous abdominal surgery. On examination, he is dehydrated with no clinical signs of sepsis. His abdomen is distended and diffusely tender with no rebound tenderness or guarding. He has no hernias. Laboratory studies reveal an elevated white blood cell count. The abdominal plain x-rays show grossly dilated small bowel loops with paucity of gas in the colon. However, after 24 hours of treatment for small bowel obstruction, his abdominal pain worsens.
Other presentations
Diverticulitis occurs in around 20% to 30% of patients with Meckel's diverticulum who become symptomatic and is clinically indistinguishable from appendicitis, with periumbilical pain that radiates to the right lower quadrant.[3][4] Atypical abdominal locations of Meckel's diverticulum have been reported, due to a mobile or 'floating' diverticulum.[5] Diverticular obstruction can lead to distal inflammation, necrosis, and perforation, resulting in an abscess, peritonitis, or, rarely, haemoperitoneum.[6]
Use of this content is subject to our disclaimer