Medical Case Reports

Actinomycosis with Meckel's Diverticulitis in Adult: Case Report of a Rare Histopathology in a Rare Presentation

Introduction: Meckel's diverticulum, a true congenital diverticulum, is found in 2% of the population, is located about 2 feet from the ileocecal valve, and often is no more than 2 inches in length. Fifty percent of these cases contain ectopic tissue most commonly gastric and pancreatic. Two percent of patients are symptomatic, most often presented by the age of 2 years. Actinomycosis is a localized inflammatory mass, usually of the jaw area. The most common site of involvement in the oral cavity and cervicofacial area 50%-60% followed by thoracic 15%-25% and abdominal involvement 20%. Abdominal infection most frequently involves cecal area (usually following appendectomy), Appendix and left colon flexure.

Case Presentation: A 60 years old male patient came to the hospital with lower abdominal pain, fever, constipation, nausea, and vomiting for duration of 3 days. On clinical Examination a generalized tenderness with the maximum area on right iliac fossa with guarding and rebound. Laboratory workup showed WBCS: (18,000) with neutrophilia, CRP: (340), renal and liver function test were normal. CT abdomen showed pneumoperitoneum with suspected omental abscess and pelvic collection, underlying malignant process cannot be excluded. Exploratory laparotomy finding was Meckel diverticulitis with a perforation at the tip and surrounded phlegmons of momentum and segment of the terminal ileum. The result of histopathology revealed, Meckel diverticulitis with intestinal mucosal tissue containing actinomycosis with no evidence of malignancy.

Conclusion: Although Meckel's diverticulitis is a rare entity especially in adult populations, it can appear as an acute abdomen. An early diagnosis and treatment to prevent subsequent complications are essential to ensure an optimal recovery. Clinical picture, complications, and surgical incision are the same in appendicitis and Meckel's diverticulitis patients.

Author(s):

Muhaned Alhassan* , Ahmed Abdulhameed, Ayman Barghash, Ahmed Abass, Hatim Dhiyab, Alaa Osman

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