Laparoscopic management of small bowel obstruction due to a mesodiverticular band of a Meckel's diverticulum: A case report

Abstract

Introduction: Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract, occurring in approximately 2 % of the population. While often asymptomatic, MD can occasionally lead to complications such as bleeding, inflammation, or small bowel obstruction (SBO). A rare cause of SBO involves a mesodiverticular band, an embryologic remnant capable of causing extrinsic compression or torsion. This condition remains under-recognized, especially in adolescents.

Case presentation: A 15-year-old male presented with acute abdominal pain, vomiting, and clinical signs of small bowel obstruction (SBO). Abdominal ultrasound and computed tomography (CT) revealed dilated small bowel loops with a distal transition point. CT imaging confirmed Meckel's diverticulitis in the right iliac fossa, associated with a mesodiverticular band, which was identified as the cause of the small bowel obstruction. Diagnostic laparoscopy confirmed the presence of a Meckel's diverticulitis with an associated mesodiverticular band causing torsion and obstruction. The band was divided with a harmonic scalpel, and the gangrenous diverticulum was resected laparoscopically using a linear endostapler. An appendectomy was also performed concurrently. The procedure was completed successfully without complications, and the patient was discharged in stable condition on postoperative day three.

Discussion: Mesodiverticular bands are an uncommon but important etiology of small bowel obstruction in pediatric and adolescent patients. Their diagnosis is often delayed due to non-specific clinical and radiologic findings. Laparoscopy provides a dual benefit in such cases, allowing both definitive diagnosis and minimally invasive treatment with reduced morbidity.

Conclusion: This case underscores the need to consider Meckel's diverticulum and its associated bands in the differential diagnosis of SBO. Early laparoscopic intervention is both safe and effective, ensuring excellent outcomes.

Keywords: Case report; Gastrointestinal congenital anomalies; Laparoscopic diverticulectomy; Meckel's diverticulum; Mesodiverticular band; Small bowel obstruction.

Fig. 1

Axial CT view of the abdomen showing small bowel obstruction caused by Meckel Diverticulitis with an associated mesodiverticular band.

Fig. 2

Coronal CT view of the abdomen showing small bowel obstruction caused by Meckel Diverticulitis with an associated mesodiverticular band.

Fig. 3

Intraoperative image demonstrating the mesodiverticular band causing small bowel obstruction.

Fig. 4

Intraoperative image showing the inflamed and gangrenous Meckel's diverticulum after Dissection from the adjacent small bowel loops.

Fig. 5

Intraoperative image showing resection of the gangrenous Meckel's diverticulum using an endostapler.