True incidence of Meckel’s diverticulum is much higher as compared to cases reported in literature. Only Meckel’s diverticulum of high clinical importance has been reported so far. Carcinoid tumour in perforated Meckel’s diverticulum with ectopic gastric mucosa has been reported in only two cases before and this is a third one, out of 86 and 118 cases of reported perforated Meckel’s diverticulum and carcinoid tumour in Meckel’s diverticulum respectively. Here we are reporting a rare case of perforated Meckel’s diverticulum associated with carcinoid tumour and ectopic gastric mucosa.

An 18 year old presented with sudden onset of stabbing, colicky lower abdominal pain after opening his bowels the day before admission. He had vomited four times (bilious), bowels not opened since the onset of pain. No significant past medical and surgical history. He was pyrexial but haemodynamically stable. The White cell count was elevated 32.5 x 109 per L. Erect chest and supine abdominal X-rays were inconclusive of pneumo peritoneum. As signs of peritonitis were obvious on examination, he underwent laparotomy via mid line incision. Findings were marked pus in pelvis, perforated and acutely inflamed Meckel’s diverticulum stuck in the pelvis. A band of adhesions from loop of Meckel’s to small bowel mesentery. Excision of Meckel’s diverticulum with a loop of small bowel was performed.

Histology revealed ulceration and perforation in the region adjacent to heterotopic gastric mucosa, with a tiny, microscopic focus of carcinoid tumour in the outer, muscularis propria (which stained positive for the immunostain chromografin) of the Meckel’s diverticulum.

At follow up after 3 years, the patient is totally asymptomatic and clinical examination was normal. On USS of liver and 5H1AA examination of the urine, nothing abnormal was detected.

Meckel’s diverticulum is clinically silent and only discovered at the time of complications like inflammation, haemorrhage, obstruction, and tumour. It can mimic common abdominal disorders such as Crohn’s disease, appendicitis and peptic ulcer disease. It causes complications more frequently in males2 and therefore, is more often diagnosed in them. In a collective review of 1806 cases, the complications were as follows; haemorrhage in 31%, inflammation in 25%, band obstruction in 16%, intussusception in 11%, hernia entrapment in 11%, umbilical sinus or fistula formation in 4%, and tumour formation in 2%.3 Yamaguchi et al4 reported the largest modern series of symptomatic Meckels diverticula (600 cases of which nearly 50% were adults) which has reported intestinal obstruction (37%) was a more common complication than haemorrhage (12%). Malignancies in complicated Meckel's diverticulum are found in only 0.5 to 4.9 percent of patients. Carcinoids are the most common neoplasms, followed by sarcomas and adenocarcinomas.5 Stromal tumours including only 7 perforations out of 98 cases6 and adenocarcinoma in Meckel’s diverticulum in 36 cases as well as epithelioma and lymphosarcomatosis one each in perforated Meckel’s diverticulum are reported in current literature. Methods of diagnosis were laparotomy (66%) and autopsy (34%).