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Published on: July 21, 2023
Obstructive acute abdomen due to Meckel's diverticulum in adult: Case report
Edirany Dos Santos Villalaz1, Juan Eduardo Rios Rodriguez1, Zuriel Rodrigues Seixas Nunes2
1Getulio Vargas University Hospital, General Surgery Division, Manaus, AM, Brazil.
Introduction:
Meckel's diverticulum is anatomically considered as a true diverticulum, with its embryological origins arising from a persistent omphalomesenteric duct. In adults, the disease is usually asymptomatic, often being accidentally diagnosed during imaging tests or surgery to treat other diseases, or due to further complications.
Presentation Of The Case:
We report the case of a 26-year-old female patient was admitted to the emergency room complaining of pain and abdominal distension for 3 days, progressing to cessation of the elimination of gas for 1 day together with nausea and vomiting. Since the cause of the obstruction was not clearly identified, the patient's clinical status did not improve with non-operative measures and laparoscopy was not available, an exploratory laparotomy was conducted. In the cavity inventory, an approximately 20 cm wide MD was found in the terminal ileum adhered to the distal portion of the anterior abdominal wall.
Discussion:
MD is the most common congenital anomaly of the gastrointestinal tract, with an estimated prevalence of between 0.3 % and 2.9 % in the general population. The clinical picture is usually asymptomatic, with the diagnosis made either via imaging tests performed to investigate other diseases, or during surgery to treat complications.
Conclusion:
MD is the most common anomaly of the digestive tract, despite its low prevalence. It presents even rarer complications, including obstruction, digestive bleeding, or diverticulitis. It is important to consider the diverticulum as a diagnostic hypothesis in cases of obstruction without apparent causes, but it does not alter the initial management of the patient.
Insights
Meckel's diverticulum (MD) is a common congenital anomaly, often asymptomatic. This case highlights a rare complication of intestinal obstruction due to a large MD, emphasizing its diagnostic importance in unexplained cases.
Area of Science:
- Gastroenterology
- Surgical Pathology
- Embryology
Background:
- Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract, originating from the omphalomesenteric duct.
- While typically asymptomatic in adults, MD can present with serious complications or be incidentally discovered.
Observation:
- A 26-year-old female presented with acute abdominal pain, distension, nausea, and vomiting, indicative of bowel obstruction.
- Non-operative management failed, and an exploratory laparotomy revealed a large Meckel's diverticulum causing the obstruction.
Findings:
- Meckel's diverticulum, a true diverticulum, is a frequent congenital abnormality with a prevalence of 0.3-2.9%.
- Complications such as obstruction, bleeding, and diverticulitis are rare but significant.
- The case underscores the diagnostic challenge of MD in acute abdominal obstruction.
Implications:
- Consider Meckel's diverticulum in cases of unexplained bowel obstruction.
- Early diagnosis and surgical intervention are crucial for managing symptomatic MD complications.
- This case contributes to understanding the varied clinical presentations of Meckel's diverticulum.
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