A RARE CASE OF NON-MECKEL’S ILEAL DIVERTICULAR PERFORATION DUE TO OCCUPATIONAL MANOEUVRE

Main Article Content

Dr. Arafath Natchiar
Dr. Vignesh Thiagu.B
Dr. Thasneem E. A
Dr.B. Sankararaman

Keywords

Ileal diverticulum, Perforation, Non-Meckel’s, Occupational hazard, ectopic, gastric and pancreatic tissues

Abstract

The incidence of non-Meckel small bowel diverticulosis is rare. It is less than 1% of the population. Duodenum is the commonest site, followed by jejunum and rarely ileum. The causes of Ileal perforation are many. According to literature the commonest cause is spontaneous ileal perforation. Other causes are tuberculosis, typhoid, lymphoma, immunocompromised conditions, trauma, long standing steroid therapy and bowel obstruction. Non-Meckel Small bowel diverticula in the majority are false diverticula as they lack muscular wall which true diverticulum possesses.


The incidence of ileal diverticular perforation is rare. In our case,   it was due to continuous compression by the patient on a pneumatic power drill against the abdominal wall in Valsalva manoevre as part of patient’s occupation. This resulted in perforation of an already existing, asymptomatic ileal diverticulum, and presented as an acute abdomen. The patient underwent resection- anastamosis of the ileal segment, which on biopsy revealed a diverticum with gastric and pancreatic tissue.

Abstract 51 | pdf Downloads 65

References

1. Fisher J.K., Fortin D. Partial small bowel obstruction secondary to ileal diverticulitis. Radiology. 1977;122:321–322.
2. Cattell R.B., Mudge T.J. The surgical significance of duodenal diverticula. N.Engl.J.Med. 1952;246:317–324.
3. Freeman HJ. Spontaneous free perforation of intestine in adults. World J Gastroenterol. 2014;20(29):9990–9997. doi: 10.3748/wjg.v20.i29.9990.
4. Rajagopalan AE, Pickleman J. Free perforation of the small intestine. Ann Surg. 1982;196:576–579. doi: 10.1097/00000658-198211000-00011.
5. Jones D., McMillin R., Greene F. Complications of acquired diverticula of the ileum. Am.Surg. 1983;49:218–220.
6. Gotianand A., Katz S. Jejunal diverticulitis with localized perforation and intramesenteric abscess. Am.J.Gastroenterol. 1998;93(7):1173–1175.
7. De Raet J, Brugman T, Geukens A. Non-Meckel's ileal diverticulitis with perforation: a rare cause of acute lower quadrant pain. Acta Chir Belg. 2010;110(1):90-92.
8. Kirbas I, Yildirim E, Harman A, Basara O. Perforated ileal diverticulitis: CT findings. Diagn Interv Radiol. 2007;13(4):188-189.
9. Park H, Lee B. The Management of Terminal Ileum Diverticulitis. Am Surg. 2009;75(12):1199-1202.
10. Wilcox RD, Shatney CH. Surgical significance of acquired ileal diverticulosis. Am Surg. 1990;56(4):222-225.
11. Semeao E. Pediatric Gastroenterology. In: Kleinman RE, Sanderson IR, Goulet OJ, et al., editors. Walker's Pediatric Gastrointestinal Disease. 5th ed. Hamilton, ON: BC Decker Inc; 2008.