Abstract
Meckel's diverticulum is a common congenital malformation of the small intestines. This true diverticulum can lead to complications such as intestinal obstruction, bleeding, and rarely perforation, particularly in adults where the diagnosis is uncommon and often complicated by overlapping symptoms with conditions such as acute appendicitis. Giant Meckel's diverticulum (>5 cm) cases are extremely rare and pose significant clinical challenges due to severe complications. A 44-year-old male patient presented with a two-day history of diffuse, colicky abdominal pain, nausea, and diarrhea. Initial evaluations, including lab tests and imaging, were inconclusive. However, on the following day, the patient exhibited worsening pain, mild tachycardia, and elevated white blood cell count. A computed tomography scan revealed a tubular structure with significant enhancement and surrounding fat stranding, suggestive of an inflamed Meckel's diverticulum with micro-perforation. Exploratory laparotomy confirmed a giant (>5 cm) perforated Meckel's diverticulum with a large fecalith and extensive adhesions. Surgical intervention included adhesiolysis, bowel resection, and anastomosis. Postoperatively, the patient's condition improved, and he was discharged on the third day. Histopathology confirmed acute suppurative inflammation and perforation without evidence of malignancy or ectopic tissue. This case highlights the diagnostic challenges and severe complications of giant Meckel's diverticulum in adults. Timely surgery is critical, especially for rare presentations like giant perforated diverticulum with fecalith obstruction. Awareness of Meckel's diverticulum in adult acute abdomen cases is essential to avoid delays and reduce morbidity and mortality.