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Highlights • Ileal diverticulum rarely causes pelvic abscess. • Pelvic abscess rarely causes thigh phlegmon. • Rupture of presacral abscess to extra-pelvic site carries high mortality. • Intrapelvic pathology has to be considered in patients with thigh phlegmon., Introduction Ileal diverticula usually remain asymptomatic. If complicated, they may present as intra-abdominal or pelvic abscess. Abscess formation in the presacral space is very rare. The rupture of abscess and spread of pus to extra-pelvic sites through anatomical structures of the pelvis is extremely rare. It carries high mortality if not diagnosed on time. Case presentation We report a case of 52-year-old woman presented with thigh phlegmon and septic condition. The CT scan revealed free air in the left leg and pelvic presacral fluid collection descending to extra-pelvic direction through the greater sciatic notch. Moreover, ileal fistula to presacral abscess was suspected. Multiple incisions and fasciotomies were urgently performed to treat thigh phlegmon. Subsequently, laparotomy was carried out and ileal fistula was excised. Histological examination of the surgical specimen demonstrated that the fistula to presacral abscess has formed due to perforated ileal diverticulum. 3 years after the surgery the patient remains healthy without recurrence. Discussion Rupture of presacral abscess to extra-pelvic site due to ileal diverticulum fistula is an extremely rare case, to our best knowledge, never reported in literature. Due to a rare occurrence and early septic complications if diagnosed late, this condition carries a high mortality rate. Conclusion Intrapelvic pathology must be considered in patients with thigh phlegmon in order to prevent complications and associated mortality.

Introduction: Meckel's diverticulum or ileal diverticulum is one of the common congenital anomalies of the digestive system. It may not cause any problems in many, but may form serious life threatening complications in a few. Materials and Methods: We conducted a histo-morphological study of a giant Meckel's diverticulum found during cadaveric dissections of a South Indian adult male cadaver. The diverticulum was 7.5 cm long and had a circumference of 1.5 cm. Results: Gross anatomical and histological observations revealed healthy nature of the diverticulum without any inflammation. However, the mucosa had gastric type of glands with plenty of parietal cells. This incidence of Meckel's diverticulum was noted in only one cadaver among more than 100 cadavers dissected in the past twenty years. Conclusion: Knowledge of its morphological features may be very useful to surgeons, radiologists and gastroenterologists. We discuss the clinical importance of the diverticulum and review the relevant literature in this manuscript.

症例は56歳，男性．平成22年10月，右下腹部痛を主訴に近医受診．急性腹症を疑われ当院救急部受診した．来院時，血液検査にて炎症所見を認めなかったが，右下腹部に最強点を有する腹部全体の圧痛・反跳痛・筋性防御を認めた．CT検査では回盲部の脂肪織濃度上昇，上行結腸憩室・腹腔内遊離ガス像を認め，上行結腸憩室穿孔による腹膜炎と診断し，緊急手術を施行した．術中所見では回腸末端より3cm口側の腸間膜側に穿孔部位を認め，周囲の腸管に炎症所見を認めたため，回盲部切除術を施行した．切除標本および病理組織学的所見より回腸の仮性憩室穿孔と診断した．術後経過は良好であり術後11日目に退院した．消化管憩室の中で小腸憩室の頻度は稀であり，穿通・穿孔をきたすことは少ない．しかし，診断の遅れにより致命的になることがあり，急性腹症の鑑別に回腸憩室穿孔も考慮すべきと考えられた．

小腸憩室はまれな疾患である．Meckel憩室を除くと，その多くは腸間膜側に発生するため，穿通をきたした際には腸間膜膿瘍を形成することが多い．今回われわれは，腸間膜膿瘍を術前にCT検査で診断し手術を施行した回腸憩室穿通の2例を経験したので報告する．症例1:79歳男性．右下腹部痛を主訴に紹介受診した．CT検査で回盲部腸間膜側の膿瘍と上行結腸憩室を認めたため，上行結腸憩室炎の穿通による腸間膜膿瘍と診断し，回盲部切除術を施行した．症例2:63歳男性．近医で大腸内視鏡検査を施行した後，発熱・腹部膨満感が出現したため当院紹介受診となった．CT検査で小腸間膜内に膿瘍形成を認め，小腸穿通による腸間膜膿瘍の診断で小腸切除術を施行した．共に病理組織検査で，回腸憩室穿通による腸間膜膿瘍と診断した．回腸憩室の存在を術前に診断することは困難であるが，CT検査で腸間膜膿瘍を認めた際には本疾患を念頭に置く必要がある．

Acquired ileal diverticulum is an uncommon condition and diagnosis is often difficult when bleeding occurs from this source. Here we describe two cases of ileal diverticulum with massive bleeding. Both patients presented with anal bleeding, but upper and lower gastrointestinal endoscopy did not reveal the source. Selective visceral angiography finally detected bleeding lesions in the terminal ileum. Surgical resection was performed in both patients, confirming that the bleeding arose from diverticula less than 1 cm in size. In patients with obscure gastrointestinal bleeding, an ileal diverticulum should be considered, and selective visceral angiography should be performed for precise diagnosis.

We report a very rare case of ileo-abdominal fistula caused by penetration of the ileal diverticulum. Small bowel diverticulosis is generally considered to be an innocuous condition. In this report, we describe a case of ileal diverticulitis associated with an abdominal wall abscess.

Ileal diverticulitis is a rarely reported condition in poultry. Diverticulum of ileum was noticed in a 4 weeks old male Aseel chick, out of 16622 carcasses of chickens of different lines/breeds necropsied and screened for gut lesions for a period of one year. The chick had stunted growth. The diverticulum was present at mid ileum at its mesenteric surface with 0.5 cm long patent stalk and a distal blind sac of 5cm diameter engorged with gas and semisolid brownish contents. Histologically the sac wall was composed of from outer to inner; serosal lining, oedematous muscle layer, cornified epithelium and diphtheritic membrane with scattered areas of inflammatory cells composed heterophils and lymphocytes. The diverticulum may be an acquired type which got inflamed and affected the development of the chick. This is a first report of ileal diverticulum in a native chicken like Aseel.

The authors present a rare case of the middle aged man who presented with a typical history and clinical findings suggestive of an acute appendicitis. After initial assessment, he required a surgical intervention. Operation findings revealed a perforated ileal diverticulum into a giant lipoma of the small bowel. The patient made a good postoperative recovery.

The ileal diverticulum (Meckel's diverticulum) is a congenital outpouching located in the distal ileum which occurs due to the failure of obliteration of the yolk stalk. The peak age in which this anomaly is mostly found is the pediatric age especially below the age of two. Hence it is noted as an uncommon cause of intestinal obstruction and fatality in adult life. We present a case of a 26 year old man with abdominal pain and vomiting for 6 days associated fever for 3 days. Emergency laparotomy revealed ileal diverticulitis with small bowel obstruction. Ileal diverculectomy with ileal resection and ileoileal anastamosis was performed. However, the patient developed renal dysfunction leading to Multiorgan Dysfunction Syndrome and died on the fourth post operative day. This anatomic anomaly is rare in adult patients and is difficult to diagnose early due to its bizarre presentation resulting in high mortality in them. Hence we find this case of interest. El divertículo de ileal o de Meckel es una evaginación congénita en el íleon distal, que se produce debido a la falta de obliteración del conducto vitelino. La edad en que esta anomalía frecuentemente se encuentra es la pediátrica, especialmente en menores de dos años. Por lo tanto, es una causa infrecuente de obstrucción intestinal y de escasa fatalidad en adultos. A continuación presentamos un caso de un hombre de 26 años, que presentaba un cuadro febril de 3 días y dolor abdominal y vómitos durante 6 días. Una laparotomía de emergencia reveló diverticulitis ileal, con obstrucción del intestino delgado. Fue realizada una diverculectomía ileal con resección ileal y anastomosis ileoileal. Sin embargo, el paciente desarrolló insuficiencia renal que condujo a una disfunción multiorgánica y síndrome de muerte al cuarto día postoperatorio. Esta anomalía anatómica es rara observarla en pacientes adultos y difícil de diagnosticar a tiempo, debido a su singular presentación y frecuentemente resulta en una alta mortalidad en estos pacientes.

El diverticulo de ileal o de Meckel es una evaginacion congenita en el ileon distal, que se produce debido a la falta de obliteracion del conducto vitelino. La edad en que esta anomalia frecuentemente se encuentra es la pediatrica, especialmente en menores de dos anos. Por lo tanto, es una causa infrecuente de obstruccion intestinal y de escasa fatalidad en adultos. A continuacion presentamos un caso de un hombre de 26 anos, que presentaba un cuadro febril de 3 dias y dolor abdominal y vomitos durante 6 dias. Una laparotomia de emergencia revelo diverticulitis ileal, con obstruccion del intestino delgado. Fue realizada una diverculectomia ileal con reseccion ileal y anastomosis ileoileal. Sin embargo, el paciente desarrollo insuficiencia renal que condujo a una disfuncion multiorganica y sindrome de muerte al cuarto dia postoperatorio. Esta anomalia anatomica es rara observarla en pacientes adultos y dificil de diagnosticar a tiempo, debido a su singular presentacion y frecuentemente resulta en una alta mortalidad en estos pacientes.

Hemorrhage from a non-Meckelian jejunoileal diverticulum is rare, and it is generally difficult to diagnose the source of the bleeding. Here, we report the case of a 59-year-old male with hemorrhage from an ileal diverticulum. Contrast computed tomography scans demonstrated the ileal diverticulum and extravasation of the contrast medium around it. The diagnosis was then made by computed tomography scans, and endoscopic mechanical hemostasis was performed under colonoscopy with three metal clips. The management of hemorrhage from jejunoileal diverticula is discussed.

A 54-year-old male with infective bacterial endocarditis experienced right lower quadrant pain and gastrointestinal hemorrhage. The clinical impression of hemorrhagic diverticulitis was supported by the preoperative angiographic findings of a collection of extravasated contrast material in the right lower quadrant of the abdomen originating from a branch of the ileocolic artery. Exploratory laparotomy and pathologic examination of the resected specimen confirmed an ileal diverticulum which had perforated and was the source of hemorrhage.

INTRODUCTIONWhen adhesions, internal hernias, malignant intra- and retro-peritoneal neoplasms are excluded in patients presenting with new onset constipation and abdominal mass appearance after previous abdominal surgery, other causes must be considered.PRESENTATION OF CASEGiant enteroliths formed within ileal diverticula in the site of small bowel anastomosis may extrude and produce a palpable abdominal lump. Recent experience with such a patient is the basis of this report.DISCUSSIONIleal diverticula with interior enteroliths may be suspected in patients presenting with an abdominal lump following previous small bowel resection.CONCLUSIONOpen or laparoscopic assisted surgical resection of the involved segment is the treatment of choice.

This is a report on a torquated solitary ileal diverticulum in a boy of 2 1/2 years of age who was operated on on suspicion of an appendiceal abscess. Bericht uber einen 2 1/2jahrigen Jungen, der wegen Verdachtes auf einen Blinddarmabszes operiert wurde. Es fand sich ein torquiertes lleumdivertikel.

Johann Friedrick Meckel, 1,2 a German anatomist and surgeon, in 1808 first described and explained the embryological origin of the diverticulum that now bears his name. Meckel described the diverticulum as being solitary, antimesenteric, and congenital. He found it to be located in the ileum at the site where the original yolk stalk coursed between the gut and the yolk sac. The diverticulum is a result of the incomplete disappearance of the omphalomesenteric or vitelline duct. He also observed that occasionally the obliterated umbilical vessels or the duct itself may persist as fibrous strands between the umbilicus and the ileal diverticulum. This observation was confirmed and its importance stressed by Cullen 4 in 1916. Cullen observed that the vitelline duct normally is obliterated in the sixth to seventh week of embryonic life. Obliteration of none or only part of this duct leads to a number of congenital anomalies, the commonest

Adenocarcinoma arising in an ileal diverticulum are very rare. A 66-year-old man was recognized to have high serum CEA level and periappendiceal polycystic tumor in CT findings. Colonoscopy showed no abnormality in the ileocecal mucosa. However, the patient was suspected of appendiceal adenocarcinoma by PET/CT, which revealed FDG uptake with SUVmax of 3.9 in the tumor, and underwent radial surgery by single-incision laparoscopic surgery. Intraoperative findings showed the mass in the mesenterium of the terminal ileum but not the abnormality of the appendix. The resected specimen revealed a cystic tumor of 45 mm on the back side of the intestinal tract. Pathological findings showed that the tumor lesion mainly consisted of mucinous adenocarcinoma was developing from the base of the ileal diverticula. The postoperative process was going well, and the patient left the hospital 14 days after the operation. The recurrence has not been evident 10 months after the operation.