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Emergency laparoscopic intervention for fibrous band-induced intestinal obstruction and ischemia associated with
Ramiro A Vargas Aignasse1, Diana A Pantoja Pachajoa1, Florencia Llahi1
1General Surgery Department, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Oncativo 1248, Córdoba Capital, Argentina.
Introduction And Importance:
Meckel's diverticulum (MD) is a common congenital malformation of the digestive tract, often asymptomatic but occasionally leading to complications such as bowel obstruction and ischemia. Timely recognition and treatment of these complications are crucial.
Presentation Of Case:
We report the case of a 27-year-old male patient presenting with complete intestinal obstruction and ischemia of the ileum due to a fibrous band associated with MD. The patient presented with severe abdominal pain lasting for 10 h. Physical examination revealed a distended abdomen, antalgic position, and positive decompression. Laboratory tests showed leukocytosis and elevated lactic acid levels. Computed tomography revealed dilated small bowel loops with signs of intestinal ischemia. Emergency exploratory laparoscopy confirmed a complete ileum with ischemia and identified a fibrous band originating from the mesentery, strangulating the affected loop. The fibrous band was dissected and sectioned, confirming its association with the MD, which was resected with subsequent recovery of peristalsis and vascularization of the compromised segment. The patient had a favorable postoperative recovery without complications.
Discussion:
MD is a rare cause of bowel obstruction, requiring a high index of suspicion for diagnosis. Despite the challenges in preoperative identification, early surgical intervention is crucial to prevent adverse outcomes. This case emphasizes the importance of promptly recognizing and managing MD-related complications to optimize patient outcomes.
Conclusion:
MD should be considered in cases of acute occlusive abdomen, despite its infrequent occurrence. Early diagnosis and timely surgical intervention are essential to minimize morbidity and mortality associated with MD-related complications.
Insights
Meckel's diverticulum (MD) can cause rare but serious bowel obstructions. Prompt surgical intervention for MD complications is vital for patient recovery and preventing adverse outcomes.
Area of Science:
- Gastroenterology
- Surgical Pathology
- Congenital Malformations
Background:
- Meckel's diverticulum (MD) is a common congenital anomaly of the small intestine.
- While often asymptomatic, MD can lead to severe complications like bowel obstruction and ischemia.
Observation:
- A case of a 27-year-old male with complete ileal obstruction and ischemia caused by a fibrous band linked to MD is presented.
- Clinical presentation included severe abdominal pain, distension, leukocytosis, and elevated lactic acid.
Findings:
- Computed tomography indicated dilated small bowel loops with signs of ischemia.
- Laparoscopy revealed a fibrous band from the mesentery strangulating the ileum, associated with MD.
Implications:
- This case highlights MD as a rare but critical cause of acute abdominal obstruction.
- Early diagnosis and surgical management of MD complications are essential to improve patient outcomes and reduce morbidity.
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