Case reports in pediatrics · 2026
Perforated Meckel's Diverticulum in a Neonate With Bucket-Handle Anorectal Malformation: A Rare Surgical Emergency.
СтатьяНазвание и аннотация: Перевод в очереди
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Mahmood Umar, Khalid Rija, Azmat Chaudhary Ehtsham, Rehman Wajeeh Ur, Siddique Sunaina, Bakhat Raisa
Аннотация
BACKGROUND: Neonatal pneumoperitoneum is a life-threatening condition requiring urgent surgical intervention. Although Meckel's diverticulum (MD) and anorectal malformations (ARMs) are individually recognised congenital anomalies, their coexistence is uncommon, and perforated MD in a neonate with a bucket-handle ARM has been rarely described in the literature.
CASE PRESENTATION: A term male neonate (birthweight 2600 g) presented on Day 4 of life with progressive abdominal distension and nonbilious vomiting. Examination revealed tachycardia, tachypnoea, delayed capillary refill and a bucket-handle ARM with meconium staining. Abdominal radiograph showed free subdiaphragmatic air. Emergency laparotomy identified a 4-5 mm perforation at the tip of a MD located 40 cm proximal to the ileocaecal valve, with severe feculent contamination. A wedge diverticulectomy including the perforated segment was performed, the ileum was closed transversely in two layers and a divided sigmoid colostomy was fashioned. Recovery was uneventful.
DISCUSSION: Perforation occurs in only 3%-10% of symptomatic MD cases and is extremely rare in neonates, particularly with coexisting ARM. No prior literature describes perforated MD in a bucket-handle ARM. This case highlights the importance of thorough evaluation for associated gastrointestinal anomalies in ARM patients and raises the question of whether selective or routine screening is warranted.
CASE PRESENTATION: A term male neonate (birthweight 2600 g) presented on Day 4 of life with progressive abdominal distension and nonbilious vomiting. Examination revealed tachycardia, tachypnoea, delayed capillary refill and a bucket-handle ARM with meconium staining. Abdominal radiograph showed free subdiaphragmatic air. Emergency laparotomy identified a 4-5 mm perforation at the tip of a MD located 40 cm proximal to the ileocaecal valve, with severe feculent contamination. A wedge diverticulectomy including the perforated segment was performed, the ileum was closed transversely in two layers and a divided sigmoid colostomy was fashioned. Recovery was uneventful.
DISCUSSION: Perforation occurs in only 3%-10% of symptomatic MD cases and is extremely rare in neonates, particularly with coexisting ARM. No prior literature describes perforated MD in a bucket-handle ARM. This case highlights the importance of thorough evaluation for associated gastrointestinal anomalies in ARM patients and raises the question of whether selective or routine screening is warranted.