Intestinal obstruction caused by torsed gangrenous Meckel’s diverticulum encircling terminal ileum

Abstract

Meckel's diverticulum (MD) is considered the most prevalent congenital anomaly of the gastrointestinal tract. It may result in a number of complications including hemorrhage, obstruction, and inflammation. Obstruction of various types is the most common presenting symptom in the adult population. Loop formations with the end of an MD and adjacent mesentery constricting the distal ileum is an uncommon cause of obstruction. Axial torsion and gangrene of MD is the rarest of the complications. The correct diagnosis of complicated MD before surgery is often difficult because this condition may mimic other acute abdominal pathologies. Delay in the diagnosis of a complicated MD can lead to significant morbidity and mortality. Here we describe the case of a patient with a very rare form of acute small bowel obstruction secondary to giant torsed gangrenous MD encircling the terminal ileum. To our knowledge, this co-occurrence of axial torsion and a loop-forming mechanism of obstruction has been reported only once in English medical literature.

Giant Meckel’s diverticulum: An exceptional cause of intestinal obstruction

“…The most commonly diagnosed congenital anomaly of the gastrointestinal tract is Meckel's diverticulum (MD), which occurs upon failure of the vitelline (also known as the omphalomesenteric) duct to regress and involute [1][2][3] . Accumulated experience with surgical treatment of MD (using both open and laparoscopic procedures) has led to the clinical "rule of 2" for symptomatic cases, whereby the anatomical deformity (with estimated prevalence in 2% of the population) is most frequently located 2 feet from the ileocaecal junction and is 2 inches long [2] .…”

Axial torsion and gangrene of a giant Meckel's diverticulum causing small bowel obstruction

“…Meckel's diverticulum was first described by Fabricius Hildanus in 1598 and later named after Johann Friedrich Meckel, a German comparative anatomist who first recognized its developmental origin in 1809 [3]. It is a true diverticulum containing all the layers of the small bowel wall [3].…”

“…It results from incomplete obliteration of the most proximal portion of the vitelline or omphalomesenteric duct [2]. Bleeding, obstruction, and inflammation are the three most common complications of Meckel's diverticulum [3]. Here, we report a case of axial torsion and gangrene of Meckel's diverticulum which is the rarest complication.…”

Axial Torsion of Meckel's Diverticulum Causing Small Bowel Obstruction in Adult: A Case Report

“…Fibrous band that is the partially obliterated omphalomesenteric duct, increases the chance of torsion (4,5). Other reported risk factors are the diverticular length and width of the diverticular sac; longer and wider diverticular sac frequently results in complications such as perforation or small bowel obstruction (5,7,8). Particularly, a narrow neck connecting the diverticulum and the ileum, increases the risk of torsion (5,8).…”

“…Other reported risk factors are the diverticular length and width of the diverticular sac; longer and wider diverticular sac frequently results in complications such as perforation or small bowel obstruction (5,7,8). Particularly, a narrow neck connecting the diverticulum and the ileum, increases the risk of torsion (5,8). In addition, primary neoplasm arising within MD is another risk factor.…”