An extremely rare complication of Meckel's diverticulum: enterocutaneous fistulization of umbilical hernia

INTRODUCTION

Meckel's diverticulum is the most common malformation of the gastrointestinal tract with an incidence of 2% of the population. This congenital anomaly results from incomplete yolk duct development¹. Meckel's diverticulum has a complication rate of 4-6%. Most common complications are haemorrhage, perforation, obstruction and inflammation⁴. It is mostly asymptomatic and most often diagnosed when complications occur. Also it may be diagnosed incidentally during laparoscopy or laparatomy for unrelated conditions¹.

Fistula formation (between abdominal organs), herniation (of abdominal wall), and Littre hernia (protrusion of a Meckel's diverticulum through an abdominal wall defect) are well-described complication. However, umbilical herniation of Meckel's diverticulum is rare³. Herein is presented a case with enterocutaneous fistula between Meckel's diverticulum and umbilicus associated with umbilical hernia.

CASE REPORT

A 40-year-old man was admitted to the department of General Surgery with a 24 h history of abdominal pain focused on the umbilical region, as well as fever, anorexia and vomiting. He had a history of previous umbilical abscess drainage five years ago. He reported no other medical history. Examination of the abdomen showed tenderness over the umbilical region without abdominal guarding and rigidity. A leakage of intestinal fluid through an opening (an external fistula orifice) was determined inside the umbilicus. There was no increase in local heat, swelling or edema. The laboratory findings, including complete blood count and electrolytes, and abdominal X-ray showed no abnormality. Abdominal ultrasound showed a well-limited liquid collection of 1.5x1.5 cm subcutaneously under the umbilicus. The contrast-enhanced abdominal computerized tomography scan revealed a small intestine segment lying subcutaneously throughout the fascia defect on the umbilicus The intestine was fistulized throughout the umbilical hernia into the external layer of the skin (Figure 1). With the clinical and radiological findings, the patient was initially diagnosed as enterocutaneous fistula with a Meckel's diverticulum. In the surgery, abdomen was opened and the exploration revealed Meckel's diverticulum (lying subcutaneously throughout the fascia defect on the umbilicus) and a fistula between this and the umbilicus. There was no fluid contamination in the abdomen. A diverticulectomy and an excision including the fistula tract and umbilicus were performed (Figure 2). The patient was discharged at fifth postoperative day safely. Histopathologic examination approved Meckel's diverticulum.