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Small Bowel Obstruction Due to Axial Torsion of Meckel's Diverticulum: A Case Report and Literature Review
Hironari Kawai1, Nobuo Omura1, Tsuyoshi Hirabayashi1
1Surgery, Nishisaitama-Chuo National Hospital, Tokorozawa, JPN.
Abstract:
Meckel's diverticulum (MD) is a commonly encountered congenital gastrointestinal abnormality. Although the frequency of MD-related complications such as inflammation or bleeding is relatively high, small bowel obstruction induced by axial torsion of the MD is rare. Therefore, we herein report such a case along with a review of the literature. A 34-year-old female with right lower quadrant pain, nausea, and vomiting was admitted to our hospital with the diagnosis of adhesive small bowel obstruction due to a cesarean section performed five years previously. A long intestinal tube was placed, and the patient's clinical symptoms and X-ray findings showed relief of the small bowel obstruction. However, she developed severe right lower quadrant pain after contrast examination through the long intestinal tube despite the fact that the contrast agent had smoothly reached the terminal ileum. Blood tests and enhanced computed tomography (CT) showed a remarkable elevation of inflammatory markers, the appearance of ascites, and closed-loop-like and abscess-like appearances near the site of the caliber change. With a diagnosis of internal hernia, the patient underwent emergency laparotomy by means of a midline incision. Purulent ascites was observed within the abdominal cavity. Small bowel obstruction caused by a single band was observed in the right lower quadrant. Further exploration revealed an inflammatory MD with neck torsion and a mesodiverticular band (MDB). Simple mesodiverticular band resection by electrocautery and diverticulectomy by linear stapler were performed. The postoperative course was uneventful, and the patient was discharged on postoperative day 7. In the case of juvenile-onset small bowel obstruction, axial torsion of the MD should be considered as a differential diagnosis. Herein, we report such a difficult diagnostic case and the first English literature review of small bowel obstruction due to axial torsion of the MD.
Insights
Axial torsion of Meckel's diverticulum (MD) is a rare cause of small bowel obstruction. This case highlights the importance of considering MD torsion in patients with unexplained abdominal pain and obstruction symptoms.
Area of Science:
- Gastroenterology
- Surgical Pathology
Background:
- Meckel's diverticulum (MD) is a common congenital gastrointestinal anomaly.
- Complications like inflammation and bleeding are frequent, but small bowel obstruction due to MD axial torsion is rare.
Observation:
- A 34-year-old female presented with symptoms mimicking adhesive small bowel obstruction.
- Despite initial relief, severe pain, elevated inflammatory markers, ascites, and CT findings suggested a closed-loop obstruction.
- Laparotomy revealed an inflammatory MD with neck torsion and a mesodiverticular band causing obstruction.
Findings:
- The patient underwent successful resection of the mesodiverticular band and diverticulectomy.
- Postoperative recovery was uneventful, with discharge on day 7.
Implications:
- Axial torsion of Meckel's diverticulum should be considered in the differential diagnosis of juvenile-onset small bowel obstruction.
- This case and literature review underscore the diagnostic challenges and rarity of MD axial torsion as a cause of obstruction.
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