Small bowel obstruction precipitated by intussusception of Meckel’s diverticulum

Abstract

Small bowel obstruction (SBO) secondary to intussusception of Meckel’s diverticulum (MD) is a rare cause of acute abdominal pain that may warrant urgent surgical treatment. Volvulus or intussusception of the small bowel with presence of MD as the lead point is the most commonly reported etiology of Meckel’s related obstructions. We report an interesting case of a small bowel obstruction caused by the intussusception of an MD within its own lumen. The case involves a 30-year-old male who presented to the emergency room with acute, severe abdominal pain with an abdominal computed tomography (CT) showing a distal high-grade SBO. Decision was made to take the patient to the operating room urgently due to his clinical examination and radiologic imaging, specifically CT scan. Diagnostic laparoscopy was performed and subsequently converted to an exploratory laparotomy, which revealed the intussuscepted MD with focal necrosis into the distal small bowel causing an SBO. A segmental small bowel resection with hand sewn primary anastomosis was performed. The case presents an interesting challenge in deciding when to take a patient with an SBO to the operating room versus initial conservative management and what the treatment should be if an MD is encountered. In addition, the case emphasizes the importance of history and physical exam findings in coordination with radiologic imaging in helping to make appropriate decisions in a timely manner for operative vs conservative management of an SBO. It reminds us that, Meckel’s diverticulum, although less commonly the cause of a small bowel obstruction in the adult population, needs to be on the differential diagnosis and we need to have a high clinical suspicion for this possibility to ensure appropriate treatment in a timely manner.

Meckel's diverticulum causing acute intestinal obstruction: A case report and comprehensive review of the literature

“…The literature search in our search was conducted using the terms(s): “small bowel obstruction” AND “meckel's diverticulum” OR “diverticulitis” OR “volvulus” OR “intussusception”. The symptomatology, imaging findings, treatment employed, and the follow-up are delineated by Table 1 below [ [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] ].…”

“… Exploratory laparotomy Alive, no complications The diverticulum was resected using a GIA stapler, without small bowel resection lower quadrant and suprapubic pain and several episodes of vomiting without flatus. Zorn et al [ 53 ] 2022 30 M Abd & chest X-ray. CT of Abd Showed dilated loop sof small bowel and a distal high-grade SBO with multiple dilated loops of small bowel throughout the abdomen measuring up to 3.5 cm in diameter.…”

Intestinal intussusception of Meckel’s diverticulum, a case report and literature review of the last five years

“…Although in the literature, children up to 10 years of age represent more than 50% of symptomatic MD cases, ( 3 ) the incidence in the reports reviewed in this discussion proved to be slightly different. Two patients were less than 6 months of age, ( 6 , 10 ) three between 1 and 6 years of age, ( 14 , 16 , 17 ) five between 15 and 30 years of age ( 5 , 7 , 13 , 18 , 19 ) and five between 40 and 50 years of age. ( 8 , 9 , 11 , 12 , 15 )…”

“…From a geographical perspective, we observed that 15 publications came from five continents. One was from America (United States), (5) four from Europe (Italy, (6) France, (7) Spain (8) and the United Kingdom), (9) one from Africa (Tunisia), (10) seven from Asia (Japan, (11)(12)(13)(14) South Korea, (15) China (16) and Syria) (17) and two from Oceania (Australia). (18,19) Regarding the age of the patients included in this sample, there was a range from newborns to 49 years of age.…”

Emergency Presentations of Meckel’s Diverticulum in Adults

“…Some authors document that resection of the segment of the bowel that contains the diverticulum followed by primary anastomosis is preferable to wedge resection or tangential mechanical stapling due to the risk of leaving behind an abnormal heterotopic mucosa. [ 4 , 5 , 8 , 9 ].…”