A gastrointestinal stromal tumour presenting incidentally with haemorrhage and perforation associated with a Meckel's diverticulum: a case report

A 59-year-old Caucasian man presented with acute right iliac fossa pain with localized peritonism. At surgery, he was found to have a perforated and haemorrhagic Meckel's diverticulum, associated with a gastrointestinal stromal tumour within the apex of the diverticulum. The absence of necrosis and a low mitotic rate indicated primary resection with subsequent computed tomography surveillance to be the most appropriate management strategy.We report a unique triad of complications associated with the presentation of a Meckel's diverticulum. This article reviews this common congenital abnormality and discusses the management of a gastrointestinal tumour. Meckel's diverticulum will mimic other intra-abdominal pathologies in presentation and should therefore often be considered as a differential diagnosis.This is the first reported case of perforation and haemorrhage of a Meckel's diverticulum leading to the incidental finding of a gastrointestinal stromal tumour within the diverticulum. Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract, however, when symptomatic, it is often misdiagnosed at presentation. Common complications presenting in adults include bleeding, obstruction, diverticulitis and perforation. Tumours within a Meckel's diverticulum are a rare but recognised complication.A 59-year-old Caucasian man presented with peri-umbilical pain that had localized to the right iliac fossa. On examination, he was tender in the right iliac fossa, with localized peritonism. His white cell count was 10.2 × 109 (neutrophils 8.1 × 109) and with C-reactive protein (CRP) <5. Acute appendicitis was diagnosed clinically and a diagnostic laparoscopy performed.A perforated Meckel's diverticulum was found, associated with free intra-abdominal fluid and haemorrhage. At subsequent laparotomy, 75 mm of small bowel was resected and primary anastamosis was performed. Histology confirmed a Meckel's diverticulum and with a 25 mm area of perforat