Small Bowel Obstruction due to Mesodiverticular Band of Meckel's Diverticulum: A Case Report

A case report of small bowel occlusion due to Meckel diverticulum causing a life-threatening condition

INTRODUCTION AND IMPORTANCE

Meckel's diverticulum is a common congenital abnormality. In this study, we reported a case of small bowel occlusion due to Meckel's diverticulum causing a small bowel obstruction and a life-threatening condition.

CASE PRESENTATION

28-year-old man complaining of abdominal pain for 3 days. The physical examination found the patient appeared profusely unwell with a blood pressure of 80/40 mmHg. The abdominal examination found abdominal rigidity suggesting peritonitis. The patient's C-reactive protein was 210 mg/l with normal white blood cell count. Consequently, the patient was operated on using a laparotomy. A mechanical bowel obstruction due to a gangrenous Meckel's diverticulum was confirmed during the operation. Meckel's diverticulitis with the tip attached to the ileal mesentery through a band. A section of the band was performed followed by a resection of the Meckel's diverticulum and an ileo-ileal anastomosis. The postoperative follow-up was uneventful.

CASE DISCUSSION

Meckel's diverticulum results from yolk sac persistence during embryonic development, often remaining asymptomatic. However, it can lead to symptoms like abdominal pain, diarrhoea, and fever when inflamed or infected. Treatment involves surgery (diverticulectomy) for severe cases with complications, with good prognosis but associated surgical risks.

CONCLUSION

The diverticulum can present a life-threatening condition. The treatment is essentially surgical. This surgery should be performed emergently to enhance the prognosis.

Incomplete common mesentery with Ladd's band and Meckel's diverticulum: A rare cause of small bowel obstruction

INTRODUCTION AND IMPORTANCE

The common mesentery is an abnormal rotation of the primitive intestinal loop or omphalomesenteric loop. It is not necessarily symptomatic, but a clinical presentation of acute bowel obstruction on the band or volvulus can reveal it. We report a case of small bowel obstruction due to Ladd's band and Meckel's diverticulum on the incomplete common mesentery.

PRESENTATION OF CASE

We report a case of a 54-year-old man with no previous abdominal surgery who experienced periumbilical abdominal pain and vomiting. Physical examination revealed a diffusely tender and distended abdomen. Laboratory data showed a biological inflammatory syndrome. An abdominal CT scan revealed a small bowel mechanical obstruction with a double transitional level under the umbilical without a loop enhancement. An emergent laparotomy was performed. We found an incomplete common mesentery. The small bowel obstruction was due to a Ladd's band attrapping the Meckel's diverticulum. This association was responsible for dilating ileal loops at the superior part of the mechanical obstruction with necrosis of 30 cm of the small bowel. We have sectioned the congenital band and resected the necrotic segment, followed by an intestinal anastomosis. The postoperative follow-up was uneventful.

CLINICAL DISCUSSION

Incomplete common mesentery with Ladd's band and Meckel's diverticulum is an extremely rare association. Causing a small bowel obstruction remains an uncommon complication and circumstance of discovery. This complication presents a life-threatening condition. An abdominal CT scan could help for the diagnosis in some cases. Surgery is the standard treatment in most cases.

CONCLUSION

The association of incomplete common mesentery with Ladd's band and Meckel's diverticulum is uncommon and should be known to avoid intraoperative misdiagnose.

Intestinal obstruction caused by mesodiverticular band in children: a cohort study

OBJECTIVE

To explore clinical characteristics, pathogenesis, diagnosis and treatment of intestinal obstruction due to mesodiverticular band (MDB) in children in a single center in China.

METHODS

The clinical data of 20 children with acute intestinal obstruction due to MDB between 1998 and 2020 were retrospectively analyzed.

RESULTS

The male-to-female ratio was 14:6 in 20 cases. Except one case of 7-month pregnant stillbirth, the cases were aged from 7 days to 14 years, at the median age of 4.31 years. The common symptoms were vomiting, abdominal pain and/or abdominal distension. About 40% (8/20) of patients had both MDB and Meckel's Diverticulum (MD), while 60% (12/20) of patients had MDB only. Only one case died because of total colonic aganglionosis, while other children recovered after surgery treatment. MDB led to the strangulation of necrotic bowel in six cases, intestinal perforation in one case, and intestinal rupture in one case. Pathologic examination showed thick-walled arteries and or thick venous vascular structures in the cord. All cases had no complications during 1-year follow-up.

CONCLUSION

MDB results from the remnant of vitelline vessel, and often causes acute intestinal obstruction without special clinical symptoms. Unexplained abdominal pain and distension without surgery history should be paid attention, especially for strangulated intestinal obstruction. Timely surgical exploration is beneficial to avoid intestinal necrosis or even sudden death, and the pathological examination is important for the diagnosis.

Food ileus secondary to citrus fruit associated with a Meckel's diverticulum: a case report and review of the literature

The case of an 11-year-old boy with an orange-associated ileus in the setting of a mesodiverticular band from a Meckel’s diverticulum is reported herein. Computed tomography showed a small bowel feces sign. He underwent laparoscopic-assisted surgery, and intraoperative findings revealed a Meckel’s diverticulum associated with a mesodiverticular band distal to dilated small bowel. After resection of the Meckel’s diverticulum and inspection of the intestinal contents proximal to the obstruction, it was apparent that undigested food material was impacted proximal to the obstruction. Upon questioning postoperatively, it was revealed that the patient ate two citrus fruits with locular membranes several days prior to his clinical presentation. It was speculated that the combination of the citrus fruit impaction with the Meckel’s band led to his obstruction. He was discharged uneventfully on postoperative Day 13. It is important to avoid eating large quantities of fruit rich in fiber and also to masticate well.

Congenital Jejunal Diverticular Bleeding in a Young Adult

Diverticular bleeding of the small bowel is rare and occurs primarily in adults aged more than 60 years. In younger adults, Meckel’s diverticulum, a true diverticulum that congenitally occurs in the distal ileum, is the most common cause of diverticular bleeding of the small bowel. Unlike Meckel’s diverticula, other kinds of small bowel diverticula are not congenital and their incidence is related to age. Furthermore, congenital true diverticular bleeding of the jejunum in adults is very rare. We report the case of a 24-year-old man with subepithelial tumor-like lesion accompanied with obscure overt gastrointestinal bleeding. This lesion was initially suspected to be a subepithelial tumor based on radiologic tests and capsule endoscopy. He was finally diagnosed with a congenital true diverticulum in the jejunum with the appearance of a Meckel’s diverticulum after surgical resection.

Congenital Vitelline Band Causing Intestinal Obstruction in an Adult with a Double Inferior Vena Cava

Introduction. Vitelline artery remnants are rare causes of intra-abdominal bands leading to bowel obstruction. These bands may be associated with Meckel's diverticulum. Double inferior vena cava (IVC) is a rare presentation and is usually identified incidentally. Case Presentation. A sixty-year-old male presented with progressive vomiting for five days and he was clinically diagnosed with intestinal obstruction. Plain X-ray abdomen showed evidence of small bowel obstruction. CT scan of the abdomen revealed dilated small bowel loops with a small outpouching in the distal ileum with a band like structure attached to it. In the CT, left sided patent IVC draining into the left renal vein was identified. Left external iliac vein was in continuity with the left IVC. Left internal iliac vein was draining into the right IVC. Exploratory laparotomy revealed a Meckel's diverticulum with a band identified as the vitelline remnant attached to its apex and inserting at the anterior abdominal wall near the umbilicus. Discussion. Meckel's diverticulum with vitelline bands, although rare, should be borne in mind in adult patients with intestinal obstruction. Identification of this anomaly can be difficult in imaging studies. Presence of double IVC should be mentioned in the imaging findings to prevent possible catastrophic complications during surgery.

Unusual cause of small bowel obstruction: mesodiverticular band of Meckel's diverticulum demonstrated by CT

Small bowel obstruction resulting from the mesodiverticular band is a rare complication of Meckel’s diverticulum and usually presents a diagnostic challenge. We present a case of small bowel obstruction due to the mesodiverticular band of Meckel’s diverticulum with CT scan findings.

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

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.