TWO CASES OF MECKEL'S DIVERTICULUM DIAGNOSED WITH THE PREOPERATIVE USE OF CONTRAST-ENHANCED COMPUTED TOMOGRAPHY (CT) OF THE ABDOMEN

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  • 術前腹部造影ＣＴで診断したＭｅｃｋｅｌ憩室の２例

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Abstract

Patient 1 : A 46-year-old man was transferred to the emergency unit of our hospital with a complaint of lower abdominal pain. On examination at arrival, he had tenderness in the right lower abdomen and muscular defense over the whole abdomen. Pan-peritonitis due to perforation of Meckel's diverticulum was diagnosed based on the result of contrast-enhanced computed tomography (CT) images of the abdomen resulting in an emergency operation. Partial resection of the ileum including the diverticulum and end-to-end anastomosis of the small intestine were performed.<BR>Patient 2 : A 50-year-old man visited the department of gastrointestinal medicine of our hospital with complaints of abdominal pain and queasy. Bacterial enteritis was diagnosed and he went home with a prescription of oral medicines. However, he visited our hospital again because of worsening of abdominal pain. On examination at the second visit, he had tenderness and rebound pain in the right lower abdomen. Meckel's diverticulitis was diagnosed based on the result of contrast-enhanced CT images of the abdomen. An emergency operation was performed. The swelling Meckel's diverticulum was laparoscopically extracted from the body. The full thickness wedge resection of the diverticulum at the base and layer-to-layer anastomosis were performed. A foreign body suspected to be a fruit seed was found impacted in the base of the diverticulum, and the mucosa on the peripheral side from the diverticulum was necrotic. With the recent progression in the diagnostic imaging, lesions that had been difficult for detection by imaging in the past has become enable to be detected. In the differential diagnosis as a probable cause of acute abdomen, it is important that CT images of the abdomen should be seen carefully with consideration of Meckel's diverticulum.

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