Neonatal intestinal obstruction secondary to a floppy Meckel's diverticulum successfully treated by minimal access surgery

Abstract

Meckel's diverticulum has several known complications including diverticulitis and perforation. The presence of mesodiverticular band or a band from the diverticulum to the anterior abdominal wall is also described and can cause obstruction or rotation of the small bowel leading to volvulus. Meckel's diverticulum is also well known as the lead point for intussusception. It may be lined by ectopic gastric mucosa and can cause life-threatening gastrointestinal bleeding. We report a neonate who presented with acute intestinal obstruction secondary to a large, mobile Meckel's diverticulum which due to a direct compression effect on the adjacent small bowel caused mechanical intestinal obstruction. Diagnosis was confirmed at laparoscopy, and treated by curative surgical resection. This is the first report of a large mobile Meckel's diverticulum causing small bowel obstruction due to direct compression that was managed by minimally invasive surgical resection.

Figure 1

Plain abdominal x-ray: a huge dilated bowel is seen on the right side of the abdomen pushing the rest of the bowel to the left.

Figure 2

Lower contrast enema study: no evidence of microcolon or colonic atresia, that is, normal calibre colon up to ileo-caecal valve.

Figure 3

Intraoperative picture after the bowel was exteriorised: MD is Meckel's diverticulum. MD and affected small bowel is very dilated and has flopped over towards the mesentry causing significant obstruction of the small bowel; area of obstruction is marked as X.