1Department of Clinical Laboratory, Nishi-Kobe Medical Center, 2Department of Pediatrics, Nishi-Kobe Medical Center, 3Department of Surgery, Nishi-Kobe Medical Center, 4Department of Internal Medicine, Nishi-Kobe Medical Center, 5Department of Pathology, Nishi-Kobe Medical Center, 6Laboratory of Anatomic Pathology, Kyoto University Hospital
A 5-year-old girl was brought to the hospital because of abdominal pain and vomiting. She complained of epigastralgia, but no abdominal mass was palpable on physical examination. White blood cell count was 20700 /μl but other results of laboratorytest were within normal limits. Plain abdominal X-ray film showed an abnormal intestinal shadow in the lower abdomen; contrast enhanced CT scan and ultrasonography, dilation of the small intestine and a cystlike mass near the umbilicus. The cystlike mass seemed likely to be part of the small intestine and appeared as a thick, not clearly defined structure consisting of a single layer with an irregular wall. Doppler color flow imaging showed poor vascularization of the wall. We carried out an exploratory laparotomy after arriving at a diagnosis of either necrosis of Meckel’s diverticulum or strangulation of the small intestine. We detected necrotic Meckel’s diverticulum at 60 cm oral side from the ileocecal valve. It was a 7-cm long fibrous band connecting the tip of the diverticulum to the mesentery. No bowel obstruction was observed. Histopathologic examination showed that the diverticulum had retained all the layers of the ileum, and examination of the histologic section identified severe hemorrhage and necrosis in the full thickness of the resected diverticulum. Because the band showed the presence of an artery, vein, and fat tissue, it was characterized as a mesodiverticular band. Because no involvement of the small intestine was indicated, our diagnosis was hemorrhagic infarction of Meckel’s diverticulum with a mesodiverticular band.