Ruptured Meckel's diverticulum coexisting with a duplex appendix

Abstract Background Duplicate appendix is a rare anatomic variation of the vermiform appendix with an incidence rate of 0.004–0.009 %. A Meckel's diverticulum (MD) is a common congenital anomaly resulting from the persistence of the omphalomesenteric duct. It may present as lower gastrointestinal hemorrhage, intestinal obstruction, or inflammation. The co-existence of a MD and duplex appendix is rare and our literture search revealed only 2 previous reports. The objective of this article is to report a co-existing duplex appendix and symptomatic MD in a child, review the literature, and illustrate the challenges with the diagnostic process in a resource-limited setting. Case summary We present a 3-year-old male who was referred to our facility following a successful reduction of an incarcerated umbilical hernia at a peripheral facility. He presented 5 days later with signs of peritonitis and was optimized for surgery. Laparotomy was performed which revealed perforated MD with minimal peritoneal soiling. He also had an incidental duplex appendix consistent with Cave-Wallbridge type B1 and a 2 × 2cm umbilical defect. Segmental resection of the MD, double appendectomies, and peritoneal lavage was performed. Conclusion A co-existing duplex appendix with MD is extremely rare. Complications of MD are challenging to diagnose. A duplex appendix has clinical and medicolegal implications. Surgeons should explore the cecum during appendectomy to avoid missed diagnosis.