Emergent Laparotomy Reveals Possible Meckel's Diverticulum: A Case Report

Abstract

Small bowel obstruction (SBO) remains the most common diagnosis encountered by general surgeons, with 70% of cases related to adhesions from previous abdominal surgeries. Less common etiologies include Crohn's disease, gallstone ileus, and Meckel's diverticulum (MD). While MD is the most common congenital anomaly of the gastrointestinal tract, it is less frequently considered as a cause in adults. Nonetheless, it remains crucial to consider MD as a potential cause of SBO in adults, especially when evaluating patients with unexplained SBO and recurrent idiopathic abdominal pain, especially in those without a history of abdominal surgery. We present a case of a 74-year-old male presenting with right upper quadrant abdominal pain, constipation, and bilious vomiting, with a presumed diagnosis of SBO and perforation, potentially attributed to MD. This case highlights the differential challenges posed by small bowel diverticula and their complications, underscoring the need for vigilance in recognizing these complications and optimizing clinical management.

Keywords: abdominal laparotomy; meckel's diverticulum complications; perforated meckel's diverticulum; small bowel diverticula; small bowel obstruction.

Figure 1. Transverse section of CT abdomen with IV contrast from emergency department showing dilated loops of small bowel.

Figure 2. Transverse section of CT abdomen with IV contrast from emergency department showing free air in the abdomen anterior to the liver.

Figure 3. Transverse section of CT abdomen with IV contrast from emergency department showing small bowel obstruction with complex free fluid near the area of obstruction.

Figure 4. Surgical view of the small bowel showing necrosis of small bowel diverticula.

Figure 5. Small bowel diverticula discovered during an exploratory laparotomy.