Complications from a Meckel's diverticulum include diverticulitis, bleeding, intussusception, bowel obstruction, a volvulus, a vesicodiverticular fistula, perforation or very rarely as a tumour. We report a case where a Meckel's diverticulum presented with a terminal ileal volvulus in a 32-year-old man without the presence of a typical vitelline band or axial torsion of the diverticulum causing the volvulus. It was successfully managed laparoscopically.
KEYWORDSMeckel's diverticulum -Ileal volvulus -Small bowel obstruction -Minimally invasiveLaparoscopic Meckel's diverticulum (MD) is the most common congenital malformation of the gastrointestinal tract.1 Although it presents more commonly in a paediatric age group, a diverticulum can become symptomatic in adults, presenting as diverticulitis, bleeding, intussusception, bowel obstruction, a volvulus, a vesicodiverticular fistula, perforation or very rarely as a tumour. We report a case where a MD presented with a terminal ileal volvulus without the existence of the typical vitelline band or axial torsion of the diverticulum causing the volvulus that was successfully managed laparoscopically.
Case HistoryA 32-year-old man presented with colicky right-sided abdominal pain associated with vomiting and absolute constipation for the preceding 24 hours. He reported many previous episodes of similar abdominal pain, associated with vomiting and constipation, that were followed by diarrheoa, which resolved spontaneously. The patient had required admission two years previously with similar symptoms, at which point a computed tomography of the abdomen and pelvis (CTAP) demonstrated small bowel obstruction with a transition point at the distal ileum, suggestive of ileal volvulus. As the patient's symptoms resolved spontaneously, he was discharged within 24 hours. Owing to persistent epigastric pain, outpatient ultrasonography of the upper abdomen and upper gastrointestinal endoscopy were requested, both of which were unremarkable. The patient was reviewed in the outpatient clinic at three months and as he was symptom free, he was discharged with advice to return if symptoms recurred.On examination, there were no hernias. The patient was tender to deep palpation in the epigastrium and right side of the abdomen. The inflammatory markers were elevated (white cell count 11.5 Â 10 9 /l, C-reactive protein 16mg/l). Urgent CTAP was requested, which demonstrated similar findings to the previous imaging with high grade small bowel obstruction secondary to volvulus of terminal ileum with the whirlpool sign of the small bowel mesentery (Fig 1).A diagnostic laparoscopy was performed. The infraumbilical Hasson technique was used to generate the pneumoperitoneum. Two further ports were inserted under vision: a 12mm port for the left iliac fossa and a 5mm port in the right upper quadrant. The intraoperative findings were twisted small bowel mesentery adherent to the anterior abdominal wall at the right iliac fossa (Fig 2) and minimal adhesions in the left iliac fossa. On further di...