Perforated Meckel's diverticulum mimicking appendicitis in a 64-year-old male: a case report and comparative analysis from a resource-limited setting.

Introduction and Importance: Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract, typically asymptomatic but occasionally presenting with complications such as bleeding, obstruction, or rarely, perforation. Symptomatic MD is unusual in the elderly, often mimicking other acute abdominal conditions and posing diagnostic challenges, especially in low-resource settings. Case Presentation: We report a case of a 64-year-old male presenting with a 2-day history of right iliac fossa pain, fever, nausea, and vomiting. Clinical examination and laboratory findings were suggestive of perforated appendicitis. Due to the unavailability of CT imaging, an urgent exploratory laparotomy was performed, revealing a perforated MD located 40 cm from the ileocecal valve. A wedge resection was conducted. Histopathological examination confirmed ischemic necrosis and ectopic gastric mucosa. The patient recovered smoothly and was discharged on postoperative Day 5. Clinical Discussion: Perforation of MD is rare, particularly in elderly patients, and often leads to diagnostic confusion with more common causes of acute abdomen. In the absence of reliable imaging modalities, clinical acumen and timely surgical exploration are crucial. The presence of ectopic gastric mucosa within MD increases the risk of perforation. Surgical resection, tailored to intraoperative findings, remains the definitive treatment. Conclusion: This case underscores the need to consider MD in the differential diagnosis of acute abdomen, even in older adults. In resource-limited settings, prompt surgical intervention guided by clinical evaluation can be lifesaving and highlights the importance of maintaining a broad differential to avoid missed or delayed diagnoses.