A Rare Case of Perforated Meckel's Diverticulum Presenting as a Gatrointestinal Stromal Tumor

Headnote

Abstract

Meckel's diverticulum is located on the antimesentric border of the ileum, approximately 45 to 60 cm proximal to the ileocecal valve, and results from incomplete closure of the omphalomesentric or viteline duct. Common complications presenting in adults include bleeding, obstruction, diverticulitis, and perforation. Tumors within Meckel's diverticulum are a rare, but recognized complication.

A 62year-old woman presented with peri-umbilical pain that had localized to the right iliac fossa. On examination, she was tender in the right iliac fossa, with localized peritonism. At surgery,a perforated Meckel's diverticulum was found that was associated with free intra-abdominal fluid and hemorrhage. A 25 mm nodule was found at the apex of Meckel's diverticulum.We resected 100 mm of the small bowel and a primary anastamosis was performed.Histopathological examination of the resected lesion revealed a mesenchymal tumor categorized as a gastrointestinal stromal tumor (GISTs).

GISTs arising from Meckel's diverticulum are an extremely rare, but recognized complication. Surgery is considered the standard treatment for non-metastatic GISTs with enbloc resection and clear margins.

Keywords: Complications, gastrointestinal stromal tumor, Meckel's diverticulum

Cite this article as: Sozen S, Tuna O. A Rare Case of Perforated Meckel's Diverticulum Presenting as a Gatrointestinal Stromal Tumor. Arch Iran Med. 2012; 15(5): 325 - 327.

Introduction

Meckel's diverticulumis located on the antimesentric border of theileum, approximately 45 to 60 cm proximal to the ileocecalvalve, and results from incomplete closure of the omphalomesentricor viteline duct.1Common complications presentingin adults include bleeding, obstruction, diverticulitis, andperforation. Tumors within a Meckel's diverticulum are a rare but recognized complication. Meckel's diverticulumis surgically removed only when a complication arises ora neoplasia develops. The tumors are infrequent andobserved only in 0.5% - 3.2% of the Meckel's diverticula.Of thesetumors, 12% are gastrointestinal stromal tumors(GISTs).2

GISTs occurs predominantly in adults at a median age of58 years. The majority of GISTs (60% to 70%) have been reported to arise in the stomach, whereas 20% to 30% originate in the small intestine, and less than 10% in the esophagus, colon, and rectum. GISTs also occur in the extra-intestinal abdominopelvic sites such as the omentum, mesentery, andretroperitoneum.3,4 GISTs arising from Meckel's diverticulum are extremely rare.5

Case Report

A 62-yearold woman presented with peri-umbilical pain that had localized to the right iliac fossa. On examination, she was tender in the...