TY - JOUR T1 - Incidental Meckel’s diverticulum at time of laparotomy for perforated diverticulitis JF - Trauma Surgery & Acute Care Open JO - Trauma Surg Acute Care Open DO - 10.1136/tsaco-2021-000840 VL - 6 IS - 1 SP - e000840 AU - Erin M Sadler AU - Nada Gawad AU - Nori L Bradley Y1 - 2021/11/01 UR - http://tsaco.bmj.com/content/6/1/e000840.abstract N2 - A middle-aged man, with a medical history of rheumatoid arthritis (treated with methotrexate) and gastroesophageal reflux disease presented to a community hospital with a 1-day history of abdominal pain. A CT scan abdomen/pelvis revealed acute diverticulitis with extensive sigmoid colon inflammation but no abscess. The patient was clinically well and non-peritonitic so intravenous antibiotics were initiated. He was later discharged home with oral antibiotics and a referral for outpatient colonoscopy. Approximately 6 weeks later, colonoscopy identified severe diverticulosis and internal hemorrhoids, but no evidence of malignancy. After colonoscopy, the patient returned to the community hospital with severe left lower quadrant (LLQ) abdominal pain. Laboratory investigations revealed a C-reactive Protein of 132 and neutrophilia leukocytosis White Blood Cell Count 11.1). A CT scan abdomen/pelvis demonstrated an abscess collection (7×3.5×6 cm) in the LLQ, persistent sigmoid colon thickening, and multiple scattered pockets of free intraperitoneal air (figure 1). The CT report diagnosed perforation of the colon either from diverticulitis or recent colonoscopy. Fluid resuscitation and broad-spectrum intravenous antibiotics were initiated. The patient was transferred to a tertiary care hospital for surgical management. On arrival, the patient was reassessed by the surgical team and found to be peritonitic but hemodynamically stable. Consent for a laparotomy, possible bowel resection, and … ER -