Perforated Meckel’s Diverticulum in a Neonate with a Low Anorectal Malformation: A Case Report

The coexistence of perforated Meckel’s diverticulum with a low-type anorectal malformation is extremely unusual and has rarely been reported in the literature. We report a one-day old neonate diagnosed with a low anorectal malformation in the form of an anocutaneous fistula and a subepithelial tunnel up to the scrotum. He underwent an uneventful cut-back anoplasty on the first day of life and was discharged home in stable condition on the next day. Four days later, he was brought to the hospital due to severe abdominal distention, lack of bowel movements, and bilious vomiting. Abdominal radiography demonstrated pneumoperitoneum, suggesting an intestinal perforation. Emergency laparotomy revealed a Meckel’s diverticulum with a perforation at the tip. We did a resection of the affected ileal segment that contained the diverticulum, and primary end-to-end anastomosis. He was maintained without enteral feedings for five days. Enteral feedings were initiated on postoperative day 6, and he was discharged home on postoperative day 7. He remains asymptomatic at one year of follow-up. Perforated Meckel's diverticulum, although rare, should be included in the differential diagnosis of neonates who develop an acute abdomen and pneumoperitoneum. • Perforated Meckel’s diverticulum is a rare cause of pneumoperitoneum in neonates. • The coexistence of perforated Meckel’s diverticulum with low-type anorectal malformation is extremely uncommon. • Persistent or recurrent abdominal distention after ARM repair should raise suspicion for intra-abdominal pathology. • Early recognition of bowel perforation and prompt surgical intervention are essential to prevent morbidity. • Segmental ileal resection with primary end-to-end anastomosis provides effective management in perforated Meckel’s diverticulum.