Abstract:
Background: Meckel’s diverticulum is an uncommon cause of intestinal perforation in extremely preterm and very low birth weight (VLBW) infants and may clinically mimic spontaneous intestinal perforation or necrotizing enterocolitis.
Case Presentation: A male infant was delivered by emergency lower-segment caesarean section at 28 weeks of gestation for severe fetal growth restriction with worsening placental resistance and progressive reduction followed by reversal of end-diastolic flow on antenatal Doppler studies. The infant was extremely preterm, VLBW and IUGR, with a birth weight of 780 g. He was managed on CPAP and passed urine and meconium within the first 24 hours. Minimal enteral feeding was initiated on day 2 of life with 1 mL feeds, which were gradually increased to 2 mL. Subsequently, the infant developed progressive abdominal distension. Abdominal radiography demonstrated multiple air-fluid levels with pneumoperitoneum, raising suspicion of intestinal perforation. In view of the clinical and radiological findings, emergency exploratory laparotomy was performed.
Operative Findings: Laparotomy revealed a perforated Meckel’s diverticulum with features of diverticulitis. The remaining bowel appeared grossly normal, with no evidence of extensive bowel necrosis or other perforations. Segmental resection of the diverticulum was performed followed by primary ileo-ileal anastomosis.
Conclusion: Perforated Meckel’s diverticulitis is a rare but important differential diagnosis of intestinal perforation in extremely preterm and VLBW infants. Although the clinical and radiological presentation may mimic spontaneous intestinal perforation or necrotizing enterocolitis, careful intraoperative evaluation can establish the diagnosis. Early recognition and prompt surgical intervention may allow bowel preservation and successful management even in an extremely low birth weight infant.
