Perforated Meckel's Diverticulum in a Neonate With Bucket-Handle Anorectal Malformation: A Rare Surgical Emergency.

Background: Neonatal pneumoperitoneum is a life-threatening condition requiring urgent surgical intervention. Although Meckel's diverticulum (MD) and anorectal malformations (ARMs) are individually recognised congenital anomalies, their coexistence is uncommon, and perforated MD in a neonate with a bucket-handle ARM has been rarely described in the literature. Case Presentation: A term male neonate (birthweight 2600 g) presented on Day 4 of life with progressive abdominal distension and nonbilious vomiting. Examination revealed tachycardia, tachypnoea, delayed capillary refill and a bucket-handle ARM with meconium staining. Abdominal radiograph showed free subdiaphragmatic air. Emergency laparotomy identified a 4-5 mm perforation at the tip of a MD located 40 cm proximal to the ileocaecal valve, with severe feculent contamination. A wedge diverticulectomy including the perforated segment was performed, the ileum was closed transversely in two layers and a divided sigmoid colostomy was fashioned. Recovery was uneventful. Discussion: Perforation occurs in only 3%-10% of symptomatic MD cases and is extremely rare in neonates, particularly with coexisting ARM. No prior literature describes perforated MD in a bucket-handle ARM. This case highlights the importance of thorough evaluation for associated gastrointestinal anomalies in ARM patients and raises the question of whether selective or routine screening is warranted.