Perforated Meckel’s Diverticulum Caused by a Jujube Pit:
A Rare Case Report
Dr. Mohamad Al-Gailani MS, FRCS*, Dr. Mohammad Sultan 1, Dr. Azza Ahmed 1, Dr, Nader Aldabash 1
*Correspondence to: Dr. Mohamad Al-Gailani MS, FRCS. Consultant Breast and General Surgeon Chief of Surgery, Head of Department Medical Education, Academic Education & Training Affairs, Al Hammadi Hospitals, Nuzha, Riyadh, KSA.
Copyright.
© 2026 Dr. Mohamad Al-Gailani, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 16 September 2026
Published: 01 October 2026
DOI: https://doi.org/10.5281/zenodo.23077765
Abstract
Objectives: To report a rare case of Meckel’s diverticulum perforation caused by a jujube pit in an adult patient and to highlight diagnostic challenges and operative management.
Methods: A 35-year-old male on chronic haemodialysis presented with acute abdomen initially suggestive of perforated appendicitis. Clinical evaluation, laboratory investigations, and computed Axial tomography were performed. Emergency laparotomy was undertaken.
Results: Intraoperative findings revealed a perforated Meckel’s diverticulum caused by a sharp jujube pit, associated with a short segment ileal stricture. Segmental resection with stapled side-to-side anastomosis was performed. The patient recovered uneventfully.
Conclusion: Foreign body perforation of Meckel’s diverticulum is extremely rare. Awareness of this entity is essential when evaluating adults with peritonitis and small bowel pathology.
Keywords: Meckel’s diverticulum, perforation, foreign body, jujube pit, acute abdomen, small bowel obstruction.
Introduction
Meckel’s diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract, occurring in approximately 2% of the population (1). Only 4–6% of individuals develop symptoms, most commonly bleeding, obstruction, or inflammation (2,3). Perforation is uncommon, and perforation due to foreign bodies is exceptionally rare (4). Reported objects include fish bones, chicken bones, and fruit pits (5–7).
Jujube pits (Ziziphus jujuba) are sharp, hard structures capable of penetrating the intestinal wall, yet perforation of MD by a jujube pit is exceedingly rare (11). We present a case of MD perforation by a jujube pit in an adult male with significant comorbidities, emphasizing diagnostic challenges and surgical management.
Case Report
A 35-year-old male with end-stage renal disease on thrice-weekly haemodialysis presented with a 4-day history of central abdominal pain and diarrhoea, later localizing to the right iliac fossa. He denied vomiting or haematochezia. His past surgical history included right nephrectomy in childhood.
Clinical Findings
The patient appeared ill and dehydrated. Examination revealed board-like abdominal rigidity, absent bowel sounds, and marked right lower quadrant tenderness. A healed right-sided transverse abdominal scar was noted.
Laboratory Investigations
Radiological Evaluation
Abdominal X-ray: Dilated small bowel loops without free subdiaphragmatic air. (Figure 1)
Ultrasound: Absent right kidney; small free fluid in pelvis and subhepatic region.
CT abdomen (double contrast): Pneumoperitoneum, small bowel obstruction at the ileal level, free intraperitoneal fluid, and suspicion of perforated Meckel’s diverticulum. (Figure 2)
The patient was diagnosed with generalized peritonitis and prepared for emergency laparotomy.
Operative Findings
A lower midline incision revealed dense small bowel adhesions, localized peritonitis in the right abdomen, and a perforated Meckel’s diverticulum with a sharp jujube pit protruding through its wall. A 2-cm distal ileal stricture was identified. (Figure 3) The appendix was normal.
Surgical Procedure
The postoperative course was uneventful, and the patient resumed haemodialysis.
Discussion
Foreign-body perforation of MD is rare, accounting for a small fraction of symptomatic cases (5–7). The diverticulum’s blind-ended anatomy predisposes it to foreign-body retention (1,2). Sharp objects, particularly fish bones, are the most frequently reported culprits (6,7).
Jujube pits are pointed and rigid, making them capable of penetrating the intestinal wall. However, reports of MD perforation by jujube pits are extremely limited (11).
Diagnostic Considerations
The clinical presentation often mimics acute appendicitis, perforated peptic ulcer, or small bowel obstruction. In this case, ESRD and atypical symptoms contributed to diagnostic difficulty. CT imaging is the most sensitive modality for detecting pneumoperitoneum and localizing small bowel pathology, though preoperative diagnosis of MD perforation remains challenging (2,12).
Management
Surgical intervention is mandatory. Segmental resection is preferred when inflammation, perforation, or adjacent stricture is present (3,10). Stapled anastomosis is safe in contaminated fields when performed by experienced surgeons (12).
Conclusion
Perforation of Meckel’s diverticulum by a jujube pit is an exceptionally rare cause of acute abdomen. Clinicians should consider MD complications in adults presenting with peritonitis and small bowel obstruction. Early surgical intervention leads to favourable outcomes.
Reference