Acute small bowel obstruction as a result of a Meckel's diverticulum encircling the terminal ileum: A case report
Abstract
Background:
In the developed world, small bowel obstruction accounts for 20% of all acute surgical admissions. The aetiology for majority of these cases includes postoperative adhesions and herniae. However, a relatively uncommon cause is a Meckel's diverticulum. Although this diagnosis is primarily reported in the adolescent population, it should also be considered in adults.
Case Presentation:
In the present report, we present a rare case where a fit and healthy 74- year-old gentleman, with no previous history of abdominal surgery, presented with the cardinal symptoms and signs of small bowel obstruction as the result of a Meckel's diverticulum encircling his terminal ileum. Initial investigations included a supine abdominal x-ray showing dilated loops of small bowel and computerised tomographic imaging of the abdomen, which revealed a stricture in the terminal ileum of unknown aetiology. At laparotomy, multiple loops of distended small bowel were seen from the duodeno-jeujenal junction to the terminal ileum, which was encircled by a Meckel's diverticulum. The Meckel's diverticulum was then divided to release the obstruction, mobilised and subsequently removed. Finally, the small bowel contents were decompressed into the stomach and the nasogastric tube aspirated, before returning the loops of bowel into the abdomen in sequence. The patient made a good postoperative recovery and was discharged home 5 days later.
Conclusion:
This report highlights the importance of considering a Meckel's diverticulum as a cause of small bowel obstruction in individuals from all age groups and especially in a person with no previous abdominal pathology or surgery.
Case Presentation
Background
In the developed world, small bowl obstruction accounts for 20% of all acute surgical admissions. The aetiology of small bowel obstruction includes several pathological factors, with the most common cause being postoperative adhesions followed by herniae [1]. However, in patients who present with the symptoms and signs of bowel obstruction and who have had no previous abdominal surgery, or any detectable herniae on physical examination, other causes such as a Meckel's diverticulum should be considered.
A Meckel's diverticulum is a congenital pouch on the wall of the distal ileum, usually about 2 inches from the ileocecal valve. It represents a vestigial remnant of the omphalomesenteric duct and occurs in approximately 2% of the population, found twice as frequently in males as females. Of those individuals who have a Meckel's diverticulum, only 2% are symptomatic and they tend to be typically below the age of two, thereby accounting for why this congenital gastrointestinal anomaly is comparatively better studied in adolescents compared to in adults.
The main complications caused by a Meckel's diverticulum, include intersusseption and volvulus in adolescents and acute bleeding in adults [2]. However, there are cases reported in the literature of a Meckel's diverticulum causing small bowel obstruction [3-6], but this predominantly occurs in adolescents where the bowel lumen is narrower and the intra-abdominal contents are more closely packed together.
Here, we present a case of a Meckel's diverticulum causing acute small bowel obstruction in a 74-year-old gentleman as a result of it encircling, and thus constricting, the terminal ileum. To the authors' knowledge, and from an extensive review of the literature, such an unusual presentation of a Meckel's diverticulum has not been previously reported.
