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Meckel’s diverticulum results from failure of the omphalomesenteric duct (vitelline duct) to regress during embryologic development. The incidence of Meckel’s diverticulum  varies between 1-2% and carries a lifetime risk of 4-6% of becoming symptomatic. The incidence of complications relating to  Meckel’s diverticulum decreases with increasing age.Stone formation in Meckel’s diverticulum is rare.¹ Here, we report a case of Meckel’s diverticulum with lithiasis in a patient who presented with right lower quadrant abdominal pain.

A 62-year old male presented with recurrent right lower abdominal pain for 2 months. 

He had previously undergone laparoscopic cholecystectomy for calculous cholecystitis. On examination, his vitals were stable and abdomen was soft and non tender. X- ray abdomen (supine) (Figure 1) showed calcification in the right lower quadrant. CT abdomen and pelvis (Figure 2) revealed  an ileal diverticulum  with calculi within it. He underwent a laparotomy which revealed Meckel’s diverticulum with a narrow base with smaller diverticulae containing multiple stones (Figure 3,4). Subsequently, a Meckel’s diverticulectomy was performed. The post- operative recovery was uneventful and the patient was discharged after 4 days. The biopsy report was consistent with Meckel’s diverticulum.

Meckel’s diverticulum is the commonest congenital malformation of the gastrointestinal tract.² Although it mostly remains silent, it can present with pain abdomen, bleeding, perforation, intestinal obstruction, intussusception, and malignant transformation.³ Stone formation in Meckel’s diverticulum is rare1 and to identify this pre-operatively is extremely difficult. Meckel’s stones may be misinterpreted as gallstones, teeth within a dermoid  or an appendicealfaecolith when symptomatic. The pathogenesis of lithiasis in Meckel’s diverticulum remains unclear. It may be related to stasis resulting from poor coordination of peristaltic waves at the site of Meckel’s diverticulum.^1,2 The absence of ectopic gastric mucosa may also lead to a more alkaline environment in the diverticulum, favouring precipitation of calcium and other minerals necessary for lithiasis.^4,5 The “stone” itself may usually be either a fecolith, bezoar, or gallstone. Meckel’s diverticulumlithiasis can cause acute or intermittent abdominal pain, chronic gastrointestinal blood loss, diverticulitis, perforation1 or sub-acute intestinal obstruction. This case report illustrates one of the few circumstances when a plain abdominal X-ray may provide a helpful clue to the diagnosis of Meckel’s diverticulum.