EC Paediatrics

Meckel’s diverticulum (MD) is most commonly encountered as an incidental finding during exploration for acute abdomen due to appendicitis. Incidental Meckel’s diverticulectomy in such a condition is controversial and there are specific criteria to do diverticulectomy in the same sitting and should be avoided if there is significant peritonitis. MD is also known to be increasing seen in association other gastro-intestinal conditions and rarely with other system anomalies. A 4-year-old child underwent laparoscopy for acute appendicitis had incidentally detected Meckel’s diverticulum. There was a mesodiverticular band (from MD), which was attached to adjacent ileum, with a potential risk for internal herniation. The band was divided using hook diathermy and since there was significant peritonitis, the MD was not resected. This child also was noted to have a large bladder diverticulum filling the pelvis (which was not known preoperatively). On further evaluation with ultrasound and micturiting cystourethrogram, posterior urethral valves with a large bladder diverticulum arising form posterior bladder wall was confirmed. The child was electively planned for a MD scan during follow up to look for ectopic gastric mucosa and was also planned for cystoscopy with division of PUV. The child was lost to follow up and represented acutely with lower GI bleed. As the child was previously known to have a MD, the potential source of bleed was presumed to be MD and the need for Meckel’s scan was not required. During this index admission, the child underwent cystoscopy with PUV fulguration and laparoscopic Meckel’s diverticulectomy under same anaesthesia. The child was placed on anticholinergic medication and the bladder diverticulum persisted during subsequent ultrasound scans. As the bladder diverticulum would be potentially acting as a pressure pop off, an urodynamic study done after child had attained toilet training confirmed a quiescent bladder. Considering that the diverticulum was no longer acting as a pressure pop off, but was a source of urinary infection, an elective cysto-laparoscopic excision was performed. The child has been doing well, is toilet trained with no urinary infections.

When encountered with multiple co-incident anomalies, prioritizing the surgical approach and staging management is highlighted in this report.

Keywords: Appendicular Perforation; Meckel’s Diverticulum; Urological Anomalies; Multiple Anomalies

1. Keese D., et al. “Symptomatic Meckel’s Diverticulum in Pediatric Patients-Case Reports and Systematic Review of the Literature”. Frontiers in Pediatrics 7 (2019): 267.
2. Nissen M., et al. “Meckel’s Diverticulum in Children: A Monocentric Experience and Mini-Review of Literature”. Children 9 (2022): 35.
3. Barakat AJ. “Association of congenital anomalies of the kidney and urinary tract with those of other organ systems: Clinical implications”. Nephrology and Renal Diseases 5 (2020): 1-4.
4. Ludwig WW., et al. “Bladder exstrophy and postoperative intussusception due to Meckel's diverticulum: A confluence of congenital anomalies”. Journal of Pediatric Surgery Case Reports 16 (2017): 22-24.
5. Celebi S., et al. “Current diagnosis and management of primary isolated bladder diverticula in children”. The Journal of Pediatric Urology2 (2015): 61-65.