Synchronous Complicated Meckel’s Diverticulum and Acute Appendicitis Across the Paediatric Spectrum: A Case Series and Evidence-Based Operative Appraisal

Abstract

Background

Meckel’s diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract, with a prevalence of approximately 2–4% in the general population. Although most individuals remain asymptomatic, a minority develop clinically significant complications. Acute appendicitis remains the most frequent indication for emergency abdominal surgery worldwide. The synchronous occurrence of complicated MD and acute appendicitis is rare and presents diagnostic and therapeutic challenges.

Case presentation

We report three cases across the paediatric–adolescent spectrum: a 17-year-old male with perforated MD and concurrent appendicitis presenting as generalised peritonitis; a 9-year-old boy with inflammatory MD identified during laparoscopic appendicectomy; and a 5-year-old child with torsion and gangrenous perforation of MD with concomitant acute suppurative appendicitis. We correlate clinical presentation, imaging findings, intraoperative decision-making, and operative strategy with contemporary surgical evidence. In all cases, segmental ileal resection with primary anastomosis and appendicectomy achieved definitive source control and favourable outcomes.

Conclusion

These cases underscore the importance of maintaining diagnostic vigilance for dual pathology, routine distal ileal inspection when indicated, and adherence to morphology-based resection principles in complicated MD.