The rare observation of Meckel`s diverticulum necrosis which the girl had with the suspicion of fallopian tube torsion

Abstract

Meckel`s diverticulum occurs clinically only while development of complications (peptic ulcer with probable hemorrhage and centesis – 43%; bowel obstruction on the background of the bowel obstruction and introsusception - 25,3%; diverticulitis - 14%, urachal fistula – 3,4%) and is relatively rare. Torsion of the appendages of the uterus takes the 5th place in the structure of urgent gynecological pathology and occurs in almost 3% of girls. We introduce our own observation, which presents difficulties in the preoperative diagnostics of these conditions. Girl of 15 years old was hospitalized complaining on pain in the lower abdomen, diarrhea up to 3 times per day. In the blood tests minor inflammatory changes were detected. While ultrasound the parovarian tubular formation up to 7 cm long with signs of infiltrative changes from the right side was revealed, which did not allow to exclude an isolated torsion of the fallopian tube. Diagnostic laparoscopy was performed, and it was detected that the uterus and appendages were without signs of inflammation and of normal sizes. At a distance of 30 sm from the ileocecal angle the phagedenic changed Meckel`s diverticula up to 7 sm long twisted at the base was detected. Laparoscopic removal of the diverticulum and appendectomy were performed. The postoperative period proceeded smoothly, the girl was discharged home in a satisfactory condition on the 6th day. Conclusion: all girls with a clinical picture of the “acute abdomen” are advisable to perform diagnostic laparoscopy regardless of the results of laboratory diagnostics and ultrasound. In most cases it is possible to perform the curative stage of laparoscopy without conversion.