Appendage Small Intestine (Differential Diagnosis as before)

Operative findings in a schoolchild with 'surgical abdomen' and signs similar to an appendicitis. In the history there are recurrent melena and low hemoglobin values. The involved intestinal loop is lying on a green cloth and dilated. In addition, a large antimesenteric appendage with findings of acute inflammation is visible on the left side of the patient. The diagnosis is Meckel's diverticulum with acute diverticulitis. Compare it with the normal appearance of the ascending colon and of the appendix on the right side of the patient. Beyond the age of 5 years diverticulitis is the most common complication of Meckel's diverticulum; prior to 5 years of age there are melena and obstructive ileus. Acute diverticultis can certainly be mixed up with acute appendicitis. Howver, inflammatory complications are often recognized and operated at first when a perforation similar to a perforated appendicitis or due to an ulcer has occurred. The local findings 'pain on palpation and on release of finger pressure, local tenderness' are often found at an atypical site because the localization of the Meckel's diverticulum may be different. Indeed, in the present case abdominal pain was present, but surgery was performed due to the anamnestic and scintigraphic indication of recurrent melena in Meckel's diverticulum.