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Requests for reprints should be addressed to Kathryn Pearson, Department of Internal Medicine, Rochester Regional Health, Unity Hospital, 1555 Long Pond Road, Rochester, NY 14626.
A 73-year-old man with past medical history of coronary artery disease presented with
recurrent episodes of abdominal pain and constipation, relieved by enemas. He had
a normal screening colonoscopy 6 years prior, and previous normal abdominal radiographs
during such episodes. He again presented, complaining of 2 days of severe, localized
left lower quadrant pain and initially, 2 loose non-bloody bowel movements that progressed
to constipation. This was accompanied by diaphoresis, light-headedness, bloating,
and nausea without vomiting. On presentation to the emergency department, he was hemodynamically
stable, although febrile to 38.7°C. Pertinent physical examination demonstrated a
non-distended abdomen with hypoactive bowel sounds and tenderness in the left lower
quadrant with voluntary guarding, but no rebound tenderness. Blood work revealed mild
leukocytosis at 11.8 × 103/uL, creatinine elevated from baseline at 1.19 mg/dL, elevated total bilirubin at
2.1 mg/dL, with otherwise unremarkable electrolytes and liver function tests. A computed
tomography scan of the abdomen revealed a Meckel's diverticulum with focal mesenteric
edema without any evidence of abscess formation (Figure).
FigureMeckel's diverticulum with focal mesenteric edema.
