Ain shams University, Egypt
Mahmoud El-Shafei has completed his MD degree in General Surgery, Faculty of Medicine, Ain Shams University (1994) and completed the ISO Training course-Quality system documentation-Atlantic Engineering-Management Academy (AEMA). He is currently working as a Professor of General and Laparoscopic Surgery, Ain Shams University, Egypt. He is also a Consultant of General, Laparoscopic & Oncosurgery in Ain Shams Specialized Hospital & Eldemerdash University Hospital. He is a Visitor Consultant of General, Laparoscopic & Oncosurgery, Shobra Health Insurance Hospitals and General Transportation Hospitals from 2006 to till date.
A Meckel’s diverticulum is a vestigial remnant of the omphalomesenteric (vitello-intestinal) duct. As a congenital anomaly, it is a true diverticulum that includes all three coats of the small intestine. Generally, a Meckel diverticulum ranges from 1 to 12 cm in length and is found 45-90 cm proximal to the ileocecal valve. It frequently contains heterotropic tissue; when it does, gastric mucosa accounts for 50%. It is no exaggeration to say that tumors within Meckel’s diverticulum are very uncommon with particular concern to GIST which is very rare finding. Fortunately we reported a case of 74 years old man with acute right iliac fossa pain and shock. On examination the patient had tachycardia and hypotension with tenderness and rebound tenderness in the hypogastrium suggestive of pelvic peritonitis. Chest X ray revealed air under diaphragm, ultrasound abdomen showed right iliac fossa mass. Diagnosis of perforated hollow organ was established. After rapid resuscitation, he was operated on via a lower midline incision and surprisingly we found perforated tumor mass in Meckel’s diverticulum. We resected the Meckle’s divertivculum containing the mass with 4 cm of small bowel on either side and primary restoration of bowel continuity was done. Histopathological assessment of the mass confirms GIST. According to our analysis we recommend all surgeons to consider tumors of Meckel’s diverticulum as one of differential diagnosis of intra-abdominal neoplasms.