Presentation
Negative appendectomy 45 days earlier. Now presenting with severe right lower quadrant pain and abdominal distention.
Patient Data
Upright and supine frontal x-rays showing multiple air-fluid levels and dilated small bowel loops, suggestive of small intestinal obstruction.
Evidence of surgery with subcutaneous fat stranding noted in the right lower abdominal wall. The small bowel loops are dilated and fluid filled with a transition zone noted in the terminal ileum.
There is blind-ending tubular structure arising from the distal ileum. This structure shows wall enhancement with significant surrounding fatty stranding seen, concerning for an inflamed Meckel's diverticulum.
A small amount of free fluid is present, with fatty stranding, regional lymph nodes and peripherally enhancing small collection and foci of gas noted at the appendicular stump. The large bowel is collapsed.
Case Discussion
This patient presented 45 days ago to the emergency department with severe right lower quadrant pain, the suspicion of acute appendicitis was high so he underwent an appendectomy and the appendix was surprisingly not inflamed.
He then presented with acute right lower quadrant abdominal pain and abdominal distention. Initial abdominal x-ray showed signs of intestinal obstruction. Complicated inflammation of the appendiceal stump was suspected. The patient underwent this CT scan and an inflamed blind-ending tubular structure arising from the terminal ileum (rather than the cecum) was found suggestive of Meckel's diverticulitis.
The patient underwent surgery to relieve the obstruction and inflamed Meckel's diverticulum was found.
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