Axial torsion of gangrenous Meckel′s diverticulum causing small bowel obstruction

Sasikumar, K; Noonavath, Ravinder Naik; Sreenath, GS; Maroju, Nanda Kishore

doi:10.4103/2006-8808.128752

Cited by 9 publications

(5 citation statements)

References 8 publications

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“…However, small bowel obstruction induced by axial torsion of the MD and MDB is rare. Eighteen previous reports in the English-language literature describing small bowel obstruction by axial torsion of the MD are listed in Table 1 (according to a PubMed search for "Meckel's diverticulum," "axial torsion or torsion," and "small bowel obstruction or obstruction") [1,[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. The sex ratio (male, n = 12; female, n = 5; not available {NA}, n = 1) is consistent with a previous report indicating that symptomatic MD is more common in male than female patients [20].…”

Section: Discussionmentioning

confidence: 99%

Small Bowel Obstruction Due to Axial Torsion of Meckel’s Diverticulum: A Case Report and Literature Review

Kawai,

Omura,

Hirabayashi

et al. 2023

Cureus

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Meckel's diverticulum (MD) is a commonly encountered congenital gastrointestinal abnormality. Although the frequency of MD-related complications such as inflammation or bleeding is relatively high, small bowel obstruction induced by axial torsion of the MD is rare. Therefore, we herein report such a case along with a review of the literature. A 34-year-old female with right lower quadrant pain, nausea, and vomiting was admitted to our hospital with the diagnosis of adhesive small bowel obstruction due to a cesarean section performed five years previously. A long intestinal tube was placed, and the patient's clinical symptoms and X-ray findings showed relief of the small bowel obstruction. However, she developed severe right lower quadrant pain after contrast examination through the long intestinal tube despite the fact that the contrast agent had smoothly reached the terminal ileum. Blood tests and enhanced computed tomography (CT) showed a remarkable elevation of inflammatory markers, the appearance of ascites, and closed-loop-like and abscess-like appearances near the site of the caliber change. With a diagnosis of internal hernia, the patient underwent emergency laparotomy by means of a midline incision. Purulent ascites was observed within the abdominal cavity. Small bowel obstruction caused by a single band was observed in the right lower quadrant. Further exploration revealed an inflammatory MD with neck torsion and a mesodiverticular band (MDB). Simple mesodiverticular band resection by electrocautery and diverticulectomy by linear stapler were performed. The postoperative course was uneventful, and the patient was discharged on postoperative day 7. In the case of juvenile-onset small bowel obstruction, axial torsion of the MD should be considered as a differential diagnosis. Herein, we report such a difficult diagnostic case and the first English literature review of small bowel obstruction due to axial torsion of the MD.

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Section: Discussionmentioning

confidence: 99%

Small Bowel Obstruction Due to Axial Torsion of Meckel’s Diverticulum: A Case Report and Literature Review

Kawai,

Omura,

Hirabayashi

et al. 2023

Cureus

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“…The treatment of symptomatic MD is surgical resection through laparoscopy or laparotomy. A wedge resection of MD is usually sufficient; occasionally some ileum segment resection and endto-end anastomosis is necessary [1,[3][4][5]9].…”

Section: Discussionmentioning

confidence: 99%

“…The common complications caused by MD are rectal bleeding due to ileal peptic ulceration secondary to ectopic mucosa; intestinal obstruction caused by intussusception, small bowel volvulus around a diverticular band, herniation or tumor formation, and acute inflammation leading to perforation and hemorrhage [1,2,[4][5][6][7][8]. Axial torsion of MD, an extremely rare complication, refers to being axial around its base [1,3,4,8,9]. This can occur around attachment of the diverticulum to the umbilicus or to the ileal mesentery or with a free-ended diverticulum around a narrow base.…”

Section: Introductionmentioning

confidence: 99%

Gangrene of Meckel’s Diverticulum Secondary to Axial Torsion in a Child: An Unusual Complication

Suzen¹

2016

Ann Clin Anal Med

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Meckel Divertikülünün (MD) aksiyel torsiyon ve gangreni sonucu gelişen ince barsak obstrüksiyonu, bu konjenital anomalinin en nadir komplikasyonudur. Literatürde sadece 8 çocuk ve 29 civarında erişkin vaka bildirilmiştir. Olgumuz pediatriye gastroenterit nedeni ile başvuran 2 yaşında bir erkek olgudur. Bir sonraki gün safralı kusma ve kolik tarzı karın ağrısı başladı. Klinik ve laboratuar bulgular akut intestinal obstrüksiyon veya apendisit lehine idi. Laparatomide divertikülden, bitişik olmayan ince barsak mezenterine uzanan iki peritoneal banda bağlı MD'nin aksiyel torsiyonu ve ince barsakların bantların altından herniasyonu saptandı. MD'nin wedge rezeksiyonu yapıldı. Komplike MD'nin spesifik bir bulgusu yoktur. Preoperatif tanı çok zordur. Erken cerrahi, doğru tanı ve barsağın strangülasyonunu önlemek için önemlidir.

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“…Osborne et al [6] 30 M Acute abdomen Laparotomy Gangrenous MD Diverticulectomy McAneny et al [7] 35 M Hemoperitoneum Laparotomy Viable SBR D'Souza et al [8] 23 F SBO Laparotomy Viable SBR Mukherjee et al [9] 68 M Hemoperitoneum Laparotomy Viable MDB division Prall et al [10] 31 M SBO (recurrent) Laparotomy Viable Diverticulectomy Yoo et al [11] 74 F SBO Laparotomy Viable SBR Vork et al [12] 48 M SBO -Gangrene Postmortem You et al [13] 42 M SBO Laparotomy Viable Diverticulectomy Kazemi et al [14] 36 M Hemoperitoneum Laparotomy Viable SBR Sethi et al [15] 18 M SBO Laparotomy Ischemic SBR Dutta et al [16] 55 M SBO Laparotomy Ischemic SBR Sengul et al [17] 42 F Strangulated umbilical hernia Laparotomy Ischemic SBR Cartanese et al [18] 42 M SBO Laparotomy Gangrenous MD Diverticulectomy Al Jabri et al [19] 26 F SBO Laparotomy Viable Diverticulectomy Sasikumar et al [20] 26 M SBO Laparotomy Gangrenous MD SBR Michopoulou et al [21] 35 M SBO Laparotomy Viable Diverticulectomy Tutar et al [22] 36 M SBO Laparoscopy Viable SBR Sommerhalder et al [3] 51 M Hemoperitoneum Laparotomy Viable SBR Matsumoto et al [23] 26 F SBO Laparoscopy Viable Diverticulectomy Yazgan et al [24] 35 M SBO Laparotomy Ischemic SBR F indicates female; M, male; MD, Meckel's diverticulum; MDB, mesodiverticular band; SBO, small bowel obstruction; SBR, small bowel resection.…”

Section: Referencesmentioning

confidence: 99%

“…SBO is usually caused by the entrapment of a loop of the small bowel under the band. Less frequently, we may encounter an axial torsion of MD and segmental small bowel volvulus secondary to axial rotation of the ileum possibly related to short MDB [6,8,15,20] . Sasikumar et al [20] report SBO due to ileal compression by the band associated with axial torsion of MD.…”

Section: Referencesmentioning

confidence: 99%

Systematic review of mesodiverticular band: a rare cause of small bowel strangulation and hemoperitoneum in adults

et al. 2021

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Introduction: Mesodiverticular band (MDB) is a rare congenital intestinal malformation. It originates from the embryonic remnant of the vitelline artery and is usually associated with Meckel’s diverticulum (MD). Persistent MDB may cause small bowel obstruction by trapping a loop of bowel, hemoperitoneum due to aneurysmal or traumatic rupture of MDB. The purpose of this article is to review the literature of MDB and identify the patterns of presentation, complications, and management options. Methods: We searched PubMed for articles containing terms: “Mesodiverticular band,” “Vitelline band,” and “Vitelline artery remnant.” Abstracts were reviewed in detail and we included all the case reports available in full-text and in English language. We excluded all case reports of patients younger than 18 years of age. Results: Only 20 case reports were included. Only adult patients were included. The male to female ratio was 3:1. The most common presentation was small bowel obstruction followed by hemoperitoneum. The majority required exploratory laparotomy with more than half requiring small bowel resection. One death report secondary to undiagnosed internal hernia. Conclusion: MDB with MD is a rare cause of intestinal obstruction or hemoperitoneum in adults. It remains a diagnostic dilemma as it is usually diagnosed intraoperatively.

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Axial torsion of gangrenous Meckel′s diverticulum causing small bowel obstruction

Cited by 9 publications

References 8 publications

Small Bowel Obstruction Due to Axial Torsion of Meckel’s Diverticulum: A Case Report and Literature Review

Small Bowel Obstruction Due to Axial Torsion of Meckel’s Diverticulum: A Case Report and Literature Review

Gangrene of Meckel’s Diverticulum Secondary to Axial Torsion in a Child: An Unusual Complication

Systematic review of mesodiverticular band: a rare cause of small bowel strangulation and hemoperitoneum in adults

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