Rare anomaly of the terminal ileum in a patient with peritonitis clinic

Doubling of the intestine is a rare abnormal formation that duplicates the original organ in its morphological structure. There are various forms of intestinal doubling, the size of these formations and the clinic accompanying them. Meckel's diverticulum is a local sac-like protrusion of the ileum wall, it is the most common congenital anomaly of the gastrointestinal tract, approximately 2% in the population. Material and methods: A rare clinical observation of a double ileum anomaly is presented – doubling of the terminal section and the presence of Meckel's diverticulum in a 17-year-old boy, manifesting in the clinic of acute pancreatitis. The patient was being treated at the surgery department of the State Medical Institution Clinical Hospital of Emergency Medical Care No. 15 in Volgograd, where he was taken by the EMC carriage with complaints of epigastric pain, nausea, vomiting. He was hospitalized in the surgical department with a preliminary diagnosis of acute pancreatitis. Results and discussion: As a result of dynamic observation, X-ray and ultrasound examination, the presence of acute intestinal obstruction was suspected. A video laparoscopy was performed: there is a conglomerate of ileum, a serous hemorrhagic effusion more on the right flank in volume to 400 millilitres. It was followed a laparotomy with resection of the ileum conglomerate, sanation, drainage of the abdominal cavity. The postoperative period was complicated by early adhesive intestinal obstruction. Timely relaparotomy made it possible to restore passage through the intestine. After re-operation, the calculation of Revised Mannheim Peritonitis Index was made, the results of which the third operation is not required. After 11 days, the patient was discharged for outpatient follow-up treatment. diagnosed with tubular doubling of the ileum. Meckel's diverticulum. Nodulation with necrosis of the small intestine. Diffuse serous peritonitis. Acute small bowel obstruction. Conclusion: If signs of acute surgical pathology from the abdominal organs are detected in young patients, which are atypical for this age group, occur suddenly and do not have a clear causal relationship, it is necessary to exclude the presence of anomalies of the terminal ileum.