An unexpected giant: incidental discovery of a giant Meckel’s diverticulum during appendectomy

Sep 29, 2026

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Giant Meckel’s diverticula (GMD), defined as lesions exceeding 5 cm in diameter, represent a rare form of a common congenital gastrointestinal anomaly. Larger lesions often associate with inflammation, perforation, or obstruction, creating diagnostic and management challenges. This case report documents an unusual incidentally discovered GMD during surgery for acute appendicitis, described as the first such report in the English-speaking Caribbean. It highlights diagnostic difficulty, the possibility of concurrent pathology, and justification for surgical resection even when detected incidentally.

LanguageEnglish

CategoryHealthcare

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Pages3

Reading Time8 min

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Abstract

Introduction

Case report

Imaging findings

Intraoperative findings and treatment

Postoperative outcome

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Journal of Surgical Case Reports, 2026, 1, rjaf1032 [https://doi.org/10.1093/jscr/rjaf1032](https://doi.org/10.1093/jscr/rjaf1032) Case Report Case Report An unexpected giant: incidental discovery of a giant Meckel’s diverticulum during appendectomy Kadeem A. Knight *, Cherian J. Cherian Division of General Surgery, Kingston Public Hospital, North Street, Kingston, 18768484793, Jamaica *Corresponding author. Division of General Surgery, Kingston Public Hospital, Kingston, [Jamaica. E-mail:](Jamaica. E-mail: kadeemknight@gmail.com)[ kadeemknight@gmail.com](Jamaica. E-mail: kadeemknight@gmail.com) Abstract Giant Meckel’s diverticula (GMD), characterized by a diameter over 5 cm, are a rare manifestation of the most common congenital gastrointestinal anomaly. GMDs challenge the conventional understanding of Meckel’s diverticulum. Their detection may be linked to complications such as inflammation, perforation, or obstruction, which are more frequent in larger lesions. This report presentsan unusual case of GMD found incidentally during surgery for acute appendicitis, representing the first documented instance in the English-speaking Caribbean. It emphasizes the diagnostic difficulties associated with these lesions, the possibility of additional pathology, and the reason for surgical removal, even when they are discovered incidentally. Keywords: Meckel’s diverticulum; acute appendicitis; ileal resection; gastrointestinal anomaly; diverticulitis; surgical management Introduction Meckel’s diverticulum (MD), first identified by Hildanus and subsequently by Johan Friederich Meckel in the early 19th century, is the most common congenital anomaly of the gastrointestinal tract, with an estimated occurrence of 0 . 2% to 4%[1 , 2] . These diverticula are usually found up to 200 cm proximal to the ileocecal valve and measure between 0.4 and 11.0 cm in length and 0. 3 to 7 .0 cm in diameter [3] . Giant Meckel’s Diverticula (GMD), those over 5 cm in diameter, are even more rare, with limited descriptions in existing literature and, to the author’s knowledge, have never been described in the English-speaking Caribbean. Here, the authors present a case of an incidental Giant MD, along with its management. Case report A thirty-year-old man with no chronic illnesses presented to the emergency department with a three-day history of generalized abdominal pain and vomiting. His surgical history was notable fora previous admission one year prior for Computed Tomographic (CT) scan confirmed uncomplicated acute appendicitis that was managed non-operatively. His current complaints included gradually worsening right lower quadrant pain that later became generalized. The history was also positive for multiple episodes of vomiting that contained previously ingested food and later bile-stained fluid. The patient also complained of loose, watery stool and progressive global abdominal distension. On the day before presentation, he experienced subjective fever with chillsand rigors. Physical examination revealed abdominal distension with marked tenderness in the lower abdomen, guarding, andrebound tenderness, most pronounced in the right iliac fossa. No palpable masses or organomegaly were noted; bowel sounds were present but reduced. Cardiovascular, respiratory, and neurological examinations were normal. A CT scan of the abdomen and pelvis showed the following (Figs 1 and 2): • A dilated appendix measuring 1 . 6 cm in diameter with periappendiceal inflammatory changes. A 1 . 1 cm fluid focus with peripheral enhancement was seen, consistent with focal perforation. • A 10 . 9 cm (AP) × 7. 2 cm (W) focus that appeared to arise from a loop of ileum, concerning for a giant small bowel diverticulum After intravascular fluid resuscitation, exploratory laparotomy was performed with findings below (Fig. 3): • 300 cc seropurulent pelvic collection within the right lower quadrant • A grossly dilated, inflamed appendix with 0 . 5 cm

FAQs

What defines a giant Meckel’s diverticulum and why is it clinically challenging?

A giant Meckel’s diverticulum is characterized by a diameter over 5 cm. Larger lesions are linked to complications such as inflammation, perforation, or obstruction, which can make diagnosis and management more difficult than for typical Meckel’s diverticulum.

How was the condition discovered during the appendectomy?

The GMD was found incidentally during surgery performed for acute appendicitis, after clinical presentation and CT imaging suggested the presence of a giant small bowel diverticulum.

What treatment approach was used after the diverticulum was identified?

An appendectomy was performed, followed by segmental ileal resection that incorporated the diverticulum. A primary hand-sewn single-layer ileoileal anastomosis was constructed.

Sep 29, 2026

Uploaded by moss~