Perforated Meckel's diverticulum: A rare evolution from diverticulitis to sepsis.

Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract and affects ∼2% of the population. Although usually asymptomatic, MD may lead to complications including diverticulitis, bleeding, obstruction, and-rarely-perforation. Because perforated MD often mimics acute appendicitis, diagnosis before surgery is frequently missed. We describe a 58-year-old man who presented with right lower quadrant pain, fever, and nausea. Ultrasound excluded appendicitis and raised suspicion for MD. Contrast-enhanced CT confirmed an inflamed 3.5-cm MD with surrounding fat stranding, consistent with acute diverticulitis. The patient initially improved with conservative therapy but returned five days later with worsening pain and fever. A second CT revealed microperforation with peridiverticular extraluminal gas and fluid. Within 48 hours, clinical sepsis developed. A third CT demonstrated frank pneumoperitoneum and diffuse peritoneal free fluid. Exploratory laparotomy confirmed a perforated MD, which was resected, followed by ileostomy. Postoperative recovery was uneventful. Although rare, MD perforation is potentially life-threatening. This case uniquely illustrates the radiologic evolution from diverticulitis to microperforation and ultimately free perforation, documented across three consecutive CT examinations. Awareness of this progression may improve early recognition and timely surgical management of complicated MD.