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Intestinal Obstruction by Giant Meckel's Diverticulum

Gustavo Capelão1, Miguel Santos1, Sandra Hilário1

  • 1General Surgery Department, Centro Hospitalar de Leiria/Pombal, Leiria, Portugal.

GE Portuguese Journal of Gastroenterology
|December 20, 2017
PubMed
Abstract

Insights

A rare case of internal ileum hernia causing small bowel obstruction due to a giant Meckel's diverticulum is presented. This condition, involving a mesodiverticular artery, is challenging to diagnose and often requires exploratory surgery.

Area of Science:

  • Gastroenterology
  • Surgical Pathology
  • Congenital Anomalies

Background:

  • Meckel's diverticulum, the most common congenital small bowel anomaly, arises from incomplete omphalomesenteric duct obliteration.
  • It represents a remnant of the embryonic midgut, typically located within 2 feet of the ileocecal valve.

Observation:

  • A 51-year-old male presented with symptoms of high intestinal obstruction, including epigastric pain, vomiting, and abdominal distension.
  • Computed tomography scans revealed no mechanical cause for the obstruction, leading to a proposed median laparotomy.

Findings:

  • Exploratory surgery identified an internal ileum hernia twisted around a giant (15 cm) Meckel's diverticulum.
  • A mesodiverticular artery coursing from the mesenteric base to the diverticulum was also noted.
  • Histological examination confirmed the absence of heterotopic mucosa within the resected diverticulum.

Implications:

  • This case highlights a rare cause of internal ileum hernia and small bowel obstruction.
  • Diagnosis requires a high index of suspicion due to the rarity and often non-specific presentation.
  • Surgical exploration remains crucial for definitive diagnosis and management of such complex cases.
Keywords:
Internal herniaIntestinal obstructionMeckel's diverticulumMesodiverticular artery

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