Diverticular disease in a pediatric patient with Crohn's disease mimicking a perforated post-appendectomy appendiceal stump

We present the finding of a diverticulum in the colonic wall of the cecum, arising in the context of ileocecal stricture in a child with Crohn disease mimicking a post-appendectomy perforated appendiceal stump. To our knowledge, a non-Meckel diverticulum in a pediatric patient with Crohn disease has not yet been reported and we examine the mechanics behind it. According to the Laplace Law, the pressure inside a container with curved walls is inversely proportional to its radius. A diverticulum forms at the point of maximum stricture and at the locus of least resistance (weakness) in the bowel wall due to the inflammatory bowel disease. The long-time interval between diagnosis of ileocecal stricture and surgery (9 months) is important to allow the formation of this diverticulum. Continued follow-up in adulthood is warranted due to an increased risk of intestinal diverticular disease and neoplasms in patients with Crohn disease.

Automated summary

We report a case of a pediatric patient with Crohn disease who presented with a non-Meckel diverticulum in the colonic wall of the cecum. This is the first report of such a diverticulum in a child with Crohn disease and we examine the underlying mechanics. The diverticulum formed at the site of maximum stricture and weakest point in the bowel wall due to the inflammatory bowel disease. The time interval between diagnosis of ileocecal stricture and surgery was important for the development of this diverticulum. Continued follow-up in adulthood is necessary due to the increased risk of intestinal diverticular disease and neoplasms in patients with Crohn disease.