Successful interval LATUM for sealed perforated Meckel's diverticulum in a child: a ticking bomb defused in time - a case report.

INTRODUCTION AND

IMPORTANCE

Meckel's diverticulum (MD), an embryological remnant of the omphalomesenteric duct, may be complicated by gastrointestinal bleeding, bowel obstruction, and diverticulitis with or without perforation. We report the first pediatric case initially managed conservatively and later treated with interval LATUM (laparoscopic-assisted transumbilical Meckel's diverticulectomy) as definitive surgical therapy.

CASE PRESENTATION: A 9-year-old girl presented with 4 days of lower abdominal pain and non-bilious vomiting. Abdominal ultrasonography revealed free fluid in the right iliac fossa, and a contrast-enhanced computed tomography scan showed a perforated MD with pelvic collection and free air. Conservative management with antibiotics and analgesics was instituted, leading to improvement. After 6 weeks, she underwent LATUM. Intraoperatively, a perforated MD with adhesions was identified and resected with ileal reconstruction. Histopathology confirmed ectopic gastric tissue in the diverticulum without malignancy. The patient recovered without complications and remained symptom-free at follow-up visits after 1 week, 6 months, and 2 years.

CLINICAL DISCUSSION: While symptomatic MD often requires immediate surgery, selected cases with localized inflammation may benefit from initial conservative management. This approach can prevent emergency procedures and allow for safer, delayed, minimally invasive resection. LATUM, chosen in our case, offered a tactile advantage and a cost-effective, hand-sewn anastomosis. To date, only three adult cases of interval MD resection have been reported, with none in children.

CONCLUSION

A complicated MD in a child with acute abdomen presents diagnostic and treatment challenges. Accurate imaging aids diagnosis, and careful case selection can prevent emergency surgery, enabling delayed, minimally invasive interventions like LATUM.