メッケル憩室炎穿通による後腹膜炎の１例

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  • Retroperitonitis due to Penetrated Meckel's Diverticulitis

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Perforations of Meckel's diverticulum commonly present as diffuse peritonitis. We report a patient with a penetration of Meckel's diverticulum who developed severe retroperitonitis. A 69-year-old man was referred to our clinic with a diagnosis of an acute abdomen. The patient had a history of hypertension and diabetes mellitus. On admission, the patient looked pale and unwell. His body temperature was 39.0°C, and his pulse rate was 108 bpm. His systolic arterial blood pressure was 74mmHg. A physical examination upon admission showed a diffuse tenderness throughtout the whole abdomen with rebound tenderness. An abdominal radiograph was normal and showed no free air. A computed tomographic scan of the abdomen, performed after the intravenous administration of a contrast material, showed emphysema in the mesenterium and retroperitoneum. Under a provisional diagnosis of diffuse peritonitis resulting from the perforation of a duodenal ulcer, an emergency operation was performed. A laparotomy revealed a penetration of Meckel's diverticulum to the mesenterium, with severe acute inflammation and retroperitonitis. As the penetration was covered by the mesoileum, the emphysema extended from the mesoileum to the mesocolon and retroperitoneum. Meckel's diverticulum was resected using a linear stapler and sufficient drainage was performed. The pathologic diagnosis of the resected specimen showed mucosal necrosis with severe inflammation around the penetration of Meckel's diverticulum. No aberration of the gastric mucosa or pancreatic mucosa was found. Although the postoperative recovery was complicated by septic shock, respiratory insufficiency, and a transient paralytic bowel obstruction, the patient gradually recovered and was discharged approximately 3 months after surgery. He has been well for 30 months after his discharge.

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