S H Waqar, Farah Husain, Rafique Memon, Abdul Jabbar, Abdul Majeed Baloach.
A Huge Meckel`s Diverticulum.
J Coll Physicians Surg Pak Jan ;12(2):122-4.

Meckel`s diverticulum is intestinal remnant of the vitello-intestinal duct. The clinical problems associated with a diverticulum are gastrointestinal hemorrhage, obstruction, acute abdominal pain and intussusception. It is commonly diagnosed in adults at the time of routine exploration during appendicectomy. We present a case of huge sized Meckel`s diverticulum which was presented in accident and emergency department of JPMC, Karachi as acute intestinal obstruction.

Case Report: A 20 years male was presented in Accident and Emergency Department of Jinnah Postgraduate Medical Centre, Karachi on 21st March, 2000, with complaints of pain in umbilical region for 30 hours and vomiting for 16 hours. Pain was sudden in onset, localized and was colicky in nature. Later on, he had four to six episodes of vomiting. Vomitus initially consisted of partly digested food particles and later on was billious greenish in colour. There was no history of fever, cough, weight loss but he had history of constipation off and on. He used to smoke about 20 cigarettes per day and was also addicted to Charas (opium). On examination he appeared ill and moderately dehydrated. Abdomen was flat and moving with respiration. There was tenderness over the umbilical region with audible bowel sounds. Digital rectal examination was normal. Rest of the systemic examination was normal. Patient was rehydrated with intravenous fluids. Analgesia and antibiotics were given. Routine hematological investigations were normal. X-ray abdomen erect posture showed multiple air-fluid levels at the umbilical region. Exploratory laparotomy was performed through right paramedian incision, which revealed a huge Meckel`s diverticulum of about 40 x 18 cms in size, arising from the antimesenteric border of ileum, about 50 cms from the ileo-caecal junction. Diverticulum was grossly distended with intestinal contents and gut was dilated proximally. Rest of the abdominal visceras were normal. Resection of segment of the ileum with the Meckel`s diverticulum was done followed by end-to-end anastomosis. Recovery was uneventful. Follow-up was done upto one year without any complication.

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