A Rare Presentation of Small Bowel Volvulus Secondary to Meckel's Diverticulum-Induced Intussusception in an...

Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, yet it remains asymptomatic in the majority of cases. When complications occur, they typically include bleeding, obstruction, or inflammation. The combination of intussusception leading to a subsequent small bowel volvulus is an exceedingly rare presentation, particularly in the adolescent population, and poses a significant diagnostic challenge, often mimicking more common conditions such as acute appendicitis. We present the case of a 15-year-old female who presented to the emergency department with a one-day history of sudden-onset, severe right iliac fossa (RIF) pain. She had no associated nausea, vomiting, or changes in bowel habits. Physical examination revealed localized tenderness in the RIF. An initial abdominal ultrasound reported a cecal intussusception with reactive mesenteric lymph nodes, and the appendix was not visualized. Given the clinical and radiological findings, the patient was taken to the operating theater for a diagnostic laparoscopy. Intraoperatively, an ileoileal intussusception was identified, which, upon reduction, revealed a Meckel's diverticulum acting as the lead point. This segment had also caused a 360-degree midgut volvulus. The volvulus was detorsed, and the bowel was found to be viable. The procedure was completed with resection of the Meckel's diverticulum and transverse closure of the antimesenteric border of the small bowel via a mini-laparotomy, along with an incidental appendectomy. The patient had an uneventful postoperative recovery and was discharged on day 7. This case highlights a rare and complex cause of acute abdominal pain in an adolescent. It underscores the importance of maintaining a high index of suspicion for complicated Meckel's diverticulum in young patients presenting with features of intussusception or atypical appendicitis. Early surgical intervention is crucial to prevent bowel ischemia and associated morbidity. Laparoscopy proved to be an invaluable tool for both diagnosis and initial management in this case.