Small Bowel Obstruction Secondary to Intussuscepted Meckel’s Diverticulum in an Adult

Abstract

Intussusception secondary to inverted Meckel's diverticulum resulting in intestinal obstruction is rare. The following is a case report that discusses a 29-year-old female who posed diagnostic uncertainty for the treating surgical team and ultimately underwent emergency surgery for the management of intestinal obstruction. Small bowel intussusception was diagnosed preoperatively on abdominal computer tomography (CT). At operation, it was found to be secondary to inverted Meckel's diverticulum with histopathology confirming the diagnosis.

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] ].…”

“…Dilated small bowel loops with a small amount of fluid in the right lower quadrant Exploratory laparotomy Alive, recovered well MD was resected along the flange of ileum that encompassed the vascular territory of inflamed and friable mesentery. A manual two-layer, end-to-end anastomosis was performed to restore the continuity of the small bowel Abd pain, nausea, vomiting Marascia [ 56 ] 2019 29 F Abd x-ray and CT of Abd Diffuse distention of small bowel loops without evidence of free gas within the peritoneum. high-grade distal SBO with transition point in the left iliac fossa and signs suggestive of ileo-ileal intussusception Diagnostic laparotomy Alive, no complications A segmental resection of the distal ileum 10 cm proximal to the cecum with a side-to-side anastomosis was performed Abd pain with associated vomiting, abdominal bloating, constipation, and anorexia Benhamou [ 57 ] 1979 78 M Abd x-ray Small bowel obstruction with opacity in the right iliac fossa Laparotomy No follow up mentioned Diverticulectomy No symptoms mentioned Hayee et al [ 58 ] 2003 79 F Abd x-ray Opacity on the left side Gastro-graffin study: numerous small bowel diverticula of varying sizes and minimal passage of barium beyond the mid-jejunum Enterotomy No follow up mentioned The stone was found impacted in the middle of the jejunum and was removed via a small enterotomy No symptoms mentioned DiGiacomo et al [ 59 ] 1993 9 M Abd x-ray Local ileus, multiple dilated bowel loops Appendectomy and diverticulectomy No follow up mentioned …”

A Pediatric Case of Inverted Meckel’s Diverticulum Presenting with Cyclic Vomiting-like Symptoms: A Case Report and Literature Review

“…In the literature review including the present case, bloody stool was observed in 55/74 (74.3%) of adults and 3/9 (33.3%) of children, with a significant difference ( p = 0.019) ( Table 1 ). Although it may not be sufficient to conclude that the diagnosis of inverted Meckel’s diverticulum is usually delayed in pediatric cases because of the absence of bloody stool, eight pediatric cases, excluding the present case, resulted in ileus due to intussusception, and imaging findings of intussusception were observed significantly more often in children than in adults ( p = 0.001) [ 2 , 3 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. On the other hand, adult cases may have significantly more anemia due to chronic intestinal hemorrhage ( p < 0.0001) ( Table 1 ), because the adult cases do not present with the acute onset of intussusception, unlike the pediatric cases.…”

“…In total, 94 related articles were retrieved. There were 29 articles for 74 adult [ 3 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ] and 9 pediatric (age < 18 years) [ 2 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ] cases including the present case] that reported the course of each case in detail. These included 55 male and 28 female patients with onset ages of 2 to 78 years.…”

Small bowel obstruction precipitated by intussusception of Meckel’s diverticulum

“…This management of intussusception secondary to Meckel's diverticulum having a definite indication for diverticulectomy or segmental resection has gained consensus throughout the literature and in clinical application at this time in practice. 13,15…”