Axial torsion of Meckel's diverticulum on imaging: a rare but important complication to consider

Abstract

A 38-year-old male presented to the emergency department with right iliac fossa pain of 1 day duration. There was no history of fever, nausea and vomiting and no significant past medical history was noted.He was afebrile on examination with normal blood pressure and heart rate. Abdominal examination demonstrated right iliac fossa tenderness with rebound tenderness. There was no guarding or signs of peritonism. He had a raised total white count of 14.9 Â 10 9 /L and an elevated neutrophil count of 12.8 Â 10 9 /L with neutrophilia.Computed tomography (CT) of the abdomen and pelvis performed in the portal venous revealed a dilated blind-ending fluidfilled structure arising from the anti-mesenteric border of the ileum with a narrow base and relatively hypoenhancing walls, compared to the rest of the bowel loops, suggestive of torsion and ischaemia Fig. 1. Computed tomography of the abdomen and pelvis revealed a dilated blind-ending fluid-filled structure arising from the anti-mesenteric border of the ileum with a narrow base and relatively hypoenhancing walls, suggestive of torsion and ischaemia (white arrows). Surrounding inflammatory fat-stranding is also seen. (a) axial section, (b) coronal section and (c) sagittal section, best demonstrating the narrow pedicle.