A Rare Case of Gangrenous Meckel's Diverticulum and Acute Appendicitis Presenting As Closed-Loop Obstruction in a...

Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, arising from incomplete obliteration of the vitelline duct. Although often asymptomatic, it can present with life-threatening complications such as inflammation, bleeding, intestinal obstruction, and perforation. Closed-loop obstruction secondary to Meckel's diverticulum is rare, and its coexistence with acute appendicitis is exceptionally uncommon, posing a diagnostic challenge. We report the case of a 22-year-old male who presented to the emergency department with a two-day history of diffuse abdominal pain and one day of bilious vomiting. Clinical examination revealed abdominal distension, diffuse tenderness, and bowel sounds that were sluggish, suggestive of intestinal obstruction. Contrast-enhanced computed tomography (CECT) of the abdomen and pelvis demonstrated clustering of small bowel loops medial to the caecum, raising suspicion for a paracaecal internal hernia with features of closed-loop obstruction involving mid-ileal loops, though bowel wall enhancement was preserved. Exploration revealed an inflamed appendix and a gangrenous Meckel's diverticulum associated with interloop adhesions, resulting in a closed-loop obstruction of the adjacent ileal segment. Surgical management included resection of the gangrenous ileal segment along with the Meckel's diverticulum, followed by a side-to-side ileo-ileal anastomosis using a linear stapler. Appendicectomy was performed concurrently. The postoperative course was uneventful, and the patient remained asymptomatic during a six-month follow-up period. This case highlights the rare coexistence of gangrenous Meckel's diverticulum and acute appendicitis presenting as closed-loop obstruction, underscoring the importance of maintaining a high index of suspicion and a broad differential diagnosis in young patients presenting with an acute abdomen. Early surgical intervention remains crucial to prevent morbidity and ensure favourable outcomes.