Ulus Travma Acil Cerrahi Derg. 2024; 30(10): 764-767 | DOI: 10.14744/tjtes.2024.82091

Meckel divertikülitine baðlý akut batýn olgusunda terminal ileumda senkron inflamatuar myofibroblastik tümör: Olgu sunumu

Burak Dinçer, Sinan Ömeroðlu, Onur Güven, Mustafa Fevzi Celayir, Uygar Demir
Þiþli Hamidiye Etfal Eðitim ve Araþtýrma Hastanesi, Genel Cerrahi Kliniði, Ýstanbul, Türkiye

Meckel divertikülü (MD) gastrointestinal sistemin en sýk görülen konjenital anomalisi olup popülasyonda yaklaþýk %2 oranýnda görülmektedir. Eriþkin dönemde MD’nin semptomatik veya komplike olmasý nadirdir. Bu olgu sunumunda batýn ön duvarýna fistülize Meckel divertiküliti ile kliniðe baþvuran ve radyolojik görüntülemelerinde insidental olarak ileal inflamatuar myofibroblastik tümör (IMT) saptanan bir hasta anlatýlacaktýr. Kýrkaltý yaþýnda erkek hasta acile karýn aðrýsý þikayeti ile baþvurdu. Fizik muayenede umblilikus sað tarafýnda lokalize defans saptandý. Kan tetkiklerinde akut faz reaktanlarýnýn arttýðý görüldü (Beyaz küre: 13,800/µL, CRP: 165 mg/L). Batýn bilgisayarlý tomografisinde batýn ön duvarýna fistülize Meckel divertiküliti ve MD’nin distalinde ileum içerisinde polipoid yapý olduðu izlendi. Hasta acil ameliyata alýndý. Segmenter ileum rezeksiyonu ve ileokolik anastomoz yapýldý. Ameliyat sonrasý 4. günde anastomoz kaçaðý geliþen hastaya relaparotomi, sað hemikolektomi, uç ileostomi ve müköz fistül açýlmasý ameliyatý yapýldý. Ýlk ameliyatta rezeke edilen ileum segmentinin patolojik incelemesinde MD’nin distalinde benign ÝMT olduðu görüldü. Yara yeri ve intraabdominal enfeksiyon nedeniyle uzamýþ intravenöz antibiyoterapi uygulanan hasta ameliyat sonrasý 40. günde taburcu edildi. Altý ay sonra hastanýn ileostomisi kapatýldý. Olgumuzda ileum yerleþimli ÝMT’nin aralýklý intestinal obstrüksiyon ataklarýna, fekal staza ve buna baðlý olarak Meckel divertiküliti geliþimine neden olduðu düþünülebilir. Ek olarak hastanýn hikayesinin, laboratuvar ve radyolojik testlerinin dikkatli incelenmesinin tedavi üzerine etkili olabilecek insidental patolojilerin saptanmasýnda katkýsý olacaðý söylenebilir.

Anahtar Kelimeler: Akut batýn, enterokütanöz fistül; inflamatuar myofibroblastik tümör; meckel divertiküliti.

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Acute abdomen due to Meckel's diverticulitis with synchronous inflammatory myofibroblastic tumor in the terminal ileum: A case report

Burak Dinçer, Sinan Ömeroðlu, Onur Güven, Mustafa Fevzi Celayir, Uygar Demir
Department of General Surgery, Þiþli Hamidiye Etfal Training and Research Hospital, Istanbul-Türkiye

Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal system, occurring in approximately 2% of the population. It is rare for MD to be symptomatic or complicated in adulthood. In this case report, we describe a patient who was admitted to the clinic with Meckel's diverticulitis, which had fistulized to the anterior abdominal wall, and was incidentally found to have an ileal inflammatory myofibroblastic tumor (IMT) on radiological imaging. A 46-year-old male patient presented to the emergency department with abdominal pain. Physical examination revealed localized guarding on the right side of the umbilicus. Blood tests showed elevated acute-phase reactants, including a white blood cell count of 13,800/µL, and C-reactive protein (CRP) level of 165 mg/L. Abdominal computed tomography demonstrated Meckel's diverticulitis fistulizing to the anterior abdominal wall and a polypoid structure in the ileum distal to the MD. The patient underwent emergency surgery, during which segmental ileal resection and ileocolic anastomosis were performed. On the fourth postoperative day, the patient developed an anastomotic leak. Relaparotomy, right hemicolectomy with end ileostomy, and mucous fistula creation were subsequently performed. Pathological examination of the resected ileum from the initial surgery revealed a benign IMT distal to the MD. The patient was discharged on the 40th postoperative day after developing a surgical site infection following the second surgery. The end ileostomy was closed six months later. In this case, it appears that the ileal IMT located distal to the MD may have caused intermittent intestinal obstruction, fecal stasis, and the development of Meckel's diverticulitis. Furthermore, a detailed examination of the patient’s history, laboratory results, and radiologic tests may contribute to the detection of incidental pathologies and influence treatment choices.

Keywords: Acute abdomen, enterocutaneous fistula; inflammatory myofibroblastic tumor; Meckel’s diverticulitis.

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