A Meckel’s diverticulum, the most common congenital abnormality of the gastrointestinal tract, occurs with incomplete closure of the omphalomesenteric duct [1]. Most patients with a Meckel’s diverticulum do not exhibit any specific symptoms. The most common symptom is bleeding, followed by intestinal obstruction and inflammation [2]. Perforation of a Meckel’s diverticulum by a foreign body is a rare complication. Whether in children or adults, swallowing a fish bone has been reported to cause perforation in a Meckel’s diverticulum, but few cases of perforation from swallowing relatively large bones such as chicken bones have been reported [3]. Here, we report a case of perforation in a Meckel’s diverticulum caused by a chicken bone that was successfully treated surgically.

A 50-year-old man complaining of a 7-day history of diffuse abdominal pain, bilious vomiting, and diarrhea presented to the Emergency Department. Physical examination findings indicated increased abdominal and rebound tenderness throughout the abdomen. Hematological test results indicated a white blood cell count of 14,050/mm³ (neutrophils, 84.8%) and a C-reactive protein level of 59.63 mg/L (reference range, 0–5 mg/L). Other hematological test results were normal. Abdominal contrast-enhanced computed tomography (CT) scans showed a high-density object in the small intestine with increased mesenteric fat attenuation (Fig. 1). The patient underwent diagnostic laparoscopy and a Meckel’s diverticular perforation resulting from chicken bone ingestion was identified (Fig. 2). Meckel’s diverticulum was located approximately 100 cm proximal to the ileocecal valve.

After mini-laparotomy, we performed 20 cm segmental resection of the ileum, including the Meckel’s diverticulum, followed by hand-sewing end-to-end anastomosis. The patient was discharged without complications on postoperative day 7. Histological examination of the surgical specimen was consistent with a Meckel’s diverticular perforation (Fig. 3). The patient provided written informed consent for the publication of clinical details and images.

A Meckel’s diverticulum is a congenital abnormality of the small intestine that is estimated to affect approximately 2% of the population and is more common in males. The condition was named after German anatomist Johann Freidrih Meckel, who first described it in 1809 [4].

A Meckel’s diverticulum occurs when the omphalocele, which connects the developing intestine to the umbilical cord, is not completely closed during fetal development, causing a small pouch-like protrusion to form in the wall of the small intestine [5]. Most patients with a Meckel’s diverticulum remain asymptomatic; however, in some cases, complications can occur. A Meckel’s diverticulum is usually discovered in children who present with lower abdominal pain, vomiting, or rectal bleeding, whereas it is often an incidental finding in adults when investigating other gastrointestinal issues.

A Meckel’s diverticulum is usually non-problematic; however, in some cases, complications such as inflammation of the diverticulum, resulting in abdominal pain, fever, and sometimes abscess formation can result. The causes of perforation of a Meckel’s diverticulum include diverticulitis, ulceration owing to ectopic gastric mucosa and, on rare occasions, perforation owing to a foreign body.

It has been reported that 1% of ingested foreign bodies cause gastrointestinal perforation, with perforation of the Meckel’s diverticulum accounting for 1.6% of all gastrointestinal perforations [5]. The mechanism through which ingested foreign substances perforate a Meckel’s diverticulum involves such substances becoming trapped in the blind pouch of the diverticulum [6].

A diagnosis typically involves a positive history of foreign body ingestion; however, it is not always easy for patients to recall having ingested foreign bodies [4]. Patients typically present with signs and symptoms of appendicitis, and bowel perforation is usually the initial diagnosis. Once transferred for surgery, a definitive diagnosis can be made intraoperatively [7,8]. However, with the advancement of imaging technology, diagnoses are occasionally made through evaluation of CT scans performed prior to surgery.

Treatment for a Meckel’s diverticulum perforation is surgical, with surgical methods including diverticulectomy and segmental resection of the small bowel, based on the degree of inflammation in the diverticulum. In this case, the author performed laparoscopic-assisted extracorporeal small bowel resection. However, laparoscopic intracorporeal resection and diverticulectomy, which are not laparoscopy-assisted extracorporeal resections, have also been recently reported [9].

A perforated Meckel’s diverticulum is challenging to diagnose; therefore, determining a recent history of foreign body ingestion is important. Early diagnosis and surgical treatment can help to improve patient prognosis.