Perforated Meckel’s Diverticulum in a Neonate With Bucket‐Handle Anorectal Malformation: A Rare Surgical Emergency

TL;DR

A rare case of a neonate with a perforated Meckel’s diverticulum and a bucket-handle anorectal malformation is reported, emphasizing the need for thorough evaluation in such patients.

Contribution

This is the first reported case of perforated Meckel’s diverticulum in a neonate with a bucket-handle anorectal malformation.

Findings

Perforated Meckel’s diverticulum is extremely rare in neonates with anorectal malformations.

The case underscores the importance of evaluating for gastrointestinal anomalies in patients with anorectal malformations.

Emergency surgical intervention successfully managed the perforation and contamination.

Abstract

Neonatal pneumoperitoneum is a life‐threatening condition requiring urgent surgical intervention. Although Meckel’s diverticulum (MD) and anorectal malformations (ARMs) are individually recognised congenital anomalies, their coexistence is uncommon, and perforated MD in a neonate with a bucket‐handle ARM has been rarely described in the literature.

A term male neonate (birthweight 2600 g) presented on Day 4 of life with progressive abdominal distension and nonbilious vomiting. Examination revealed tachycardia, tachypnoea, delayed capillary refill and a bucket‐handle ARM with meconium staining. Abdominal radiograph showed free subdiaphragmatic air. Emergency laparotomy identified a 4‐5 mm perforation at the tip of a MD located 40 cm proximal to the ileocaecal valve, with severe feculent contamination. A wedge diverticulectomy including the perforated segment was performed, the ileum was closed transversely in two layers and a divided sigmoid colostomy was fashioned. Recovery was uneventful.

Perforation occurs in only 3%–10% of symptomatic MD cases and is extremely rare in neonates, particularly with coexisting ARM. No prior literature describes perforated MD in a bucket‐handle ARM. This case highlights the importance of thorough evaluation for associated gastrointestinal anomalies in ARM patients and raises the question of whether selective or routine screening is warranted.

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