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Published on: July 21, 2023
Strangulated internal hernia by giant Meckel diverticulum presented as acute appendicitis
Jhonny Mauricio Fuentes-Diaz1, Camilo Andrés Trujillo-Vasquez2, Ana María Parra-Vargas3
1MD, FACS - ASURG, Carrera 14A #151A-39 Bogotá, Colombia; Department of Surgery Hospital de Fontibón, Carrera 99 #16i-41, Bogotá, Colombia.
Insights
A rare case of internal hernia caused by a giant Meckel diverticulum was found in a 19-year-old male. This unusual presentation highlights the importance of considering giant Meckel diverticula in cases of bowel obstruction.
Area of Science:
- Gastroenterology
- Surgical Pathology
- Abdominal Surgery
Background:
- Internal hernias are common causes of bowel obstruction, particularly in pediatric patients.
- Giant Meckel diverticula, defined by increased dimensions, are rare, occurring in approximately 5% of patients.
- Meckel diverticula can lead to internal hernias, but this association is infrequent.
Purpose of the Study:
- To report an unusual case of internal hernia secondary to a giant Meckel diverticulum in a young adult.
- To emphasize the rarity of this combined presentation in surgical literature.
Main Methods:
- A 19-year-old male presented with symptoms suggestive of appendicitis.
- Laparotomy revealed an internal hernia and ischemic jejunum, attributed to a giant Meckel diverticulum.
- Surgical resection of the affected bowel and reduction of the hernia were performed.
Main Results:
- The patient experienced an excellent recovery following surgical intervention.
- Pathological examination confirmed the presence of a giant Meckel diverticulum as the cause of the internal hernia.
- Literature review indicated a low incidence of giant Meckel diverticula associated with internal hernias.
Conclusions:
- Giant Meckel diverticula associated with mesenteric defects causing internal hernias are uncommon pathologies.
- This case underscores the importance of considering rare etiologies in the differential diagnosis of bowel obstruction.
Introduction:
Internal hernia due to a Meckel diverticulum is a common presentation of bowel obstruction mostly seen in pediatric population. However, it has been stated that among 5% of the patients had a giant Meckel diverticulum (defined as a Meckel diverticulum with increased dimensions than the ones commonly found), being this condition very unusual.
Presentation Of Case:
We presented a 19 year old male with acute abdominal pain suggestive of appendicitis. During appendectomy we discovered ischemic and necrotic signs in a bowel segment, leading us to perform a laparotomy that revealed a portion of ischemic and necrotic jejunum, and another bowel segment with a strong adherence to the mesentery root that created an internal hernia. The internal hernia was reduced and the injured bowel portions were resected. Necrotic bowel samples were sent to the pathology department who posteriorly reported a giant Meckel diverticulum. The patient had an excellent recovery after procedure.
Discussion:
After searching in PubMed for a similar association between Meckel diverticulum and internal hernia, we found few cases that reported a giant Meckel diverticulum and a low occurrence with internal hernias making our case not so common to find.
Conclusion:
We concluded that a giant Meckel diverticulum in association with mesenteric defects producing internal hernias are not common pathologies to find together in a patient as our research and case suggest.
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