Desmoplastic fibroma with perineural spread: conventional and diffusion-weighted magnetic resonance imaging findings

http://dx.doi.org/10.1590/0100-3984.2014.0134 is the most common symptom, usually occurring as a result from inflammation or ileal volvulus. Meckel’s diverticulum rupture is rarely found in neonates, occurring in less than 10% and manifesting at radiography as pneumoperitoneum. In such situations, the differential diagnosis should be made with necrotizing enterocolitis, since this disease is responsible for 41% of cases of neonatal pneumoperitoneum. In the present case, there was a clinical suspicion of necrotizing enterocolitis, but this hypothesis was ruled out as the presence of a perforated MD was intraoperatively confirmed. The causes of MD include inflammatory reaction, mucosal ulceration and defective muscular layer of the diverticulum. Rarely, MD perforation may occur as a result from umbilical catheterization by means of an umbilical vein connection with the MD via umbilical cord. In the present case, catheterization of umbilical vein and artery was performed with two hours of life; but the late symptoms onset and the exploratory laparotomy demonstrated that the catheterization was not related to the MD perforation. Hirschsprung’s disease may also predispose to MD perforation due to delayed passage of meconium, determining increased pressure upstream of the diverticulum. Such a condition occurs with typical symptoms of bowel obstruction, abdominal pain and bilious vomiting. In the present case, despite the symptoms of bowel obstruction and abdominal discomfort at palpation, bilious vomiting was not observed. Furthermore, the histopathological analysis of the surgical specimen ruled out the hypothesis of Hirschsprung’s disease. Finally, MD should be included as a diagnostic hypothesis in the absence of other factors that might justify the presence of pneumoperitoneum in a neonate. Such a complication is confirmed by means of a surgical procedure.