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A 79-year-old woman presented with a 4 day history of central abdominal pain and vomiting. Clinical examination revealed a distended abdomen with predominantly right sided tenderness. Following an initial period of supportive treatment pending further imaging, evolving abdominal signs became evident. Based on the suspicion of a perforated hollow viscus, an emergency laparotomy was carried out. Operative findings were of a Meckel’s diverticulum with evidence of pressure necrosis and perforation near its apex, which was distended due to a 6 cm faecolith. Resection and primary anastomosis was performed. Despite a lower respiratory tract infection, the patient was deemed clinically stable enough to be discharged on the 24th postoperative day.