Unusual Presentation of Meckel's Diverticulitis Causing Small Bowel Obstruction Masquerading as Appendicitis

Abstract

Meckel's diverticulum (MD) is a prevalent congenital abnormality of the gastrointestinal tract. While it may not show any symptoms, it has the potential to cause serious complications, such as intestinal obstruction. This case report presents a case of a 27-year-old male who presented to the emergency department with migrating right lower abdomen pain and vomiting. An initial diagnosis of acute appendicitis was made. An erect X-ray of the abdomen showed features of small bowel obstruction and with a clinical suspicion of Meckel's, a diagnostic laparoscopy had been planned. However, the diagnostic laparoscopy identified a gangrenous MD with axial torsion, with an ileal loop knotting at the base of Meckel's, causing small bowel obstruction. This entanglement led to an obstruction, which is a rare and challenging clinical scenario. Surgical resection of the affected bowel segment, including the MD, was performed, leading to a complete recovery of the patient. This case study emphasizes the diagnostic difficulties presented by MD, particularly when its symptoms resemble more prevalent illnesses like appendicitis. The rare incidence of axial torsion resulting in gangrene in MD with small bowel obstruction highlights the significance of including this illness in the differential diagnosis of acute abdomen.

Keywords: appendicitis; case report; meckel's diverticulum; small bowel obstruction; torsion abnormality.

Figure 1. Erect X-ray of the abdomen showing multiple air fluid levels suggesting small bowel obstruction.

Figure 2. Gangrenous Meckel's diverticulum found intraoperatively prior to unwinding of the bowel loops at the base.

Figure 3. Ileal loop seen encircling the Meckel's Diverticulum, thereby compromising the vascularity of the Meckel's diverticulum.

Figure 4. Encountered diverticulum that was untwisted and placed prior to resection.

Figure 5. Histopathological features of Meckel's diverticulum with small bowel specimen with sections showing full thickness areas of transmural ischemic necrosis along with numerous congested blood vessels and hemorrhage.