Case Report
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World J Gastrointest Surg. Oct 27, 2014; 6(10): 204-207
Published online Oct 27, 2014. doi: 10.4240/wjgs.v6.i10.204
Torsion of Meckel's diverticulum as a cause of small bowel obstruction: A case report
Marko Murruste, Geidi Rajaste, Karri Kase
Marko Murruste, Geidi Rajaste, Department of General and Plastic Surgery, Surgery Clinic, Tartu University Hospital, Tartu 51014, Estonia
Karri Kase, Surgery Clinic, Tartu University Hospital, Tartu 51014, Estonia
Author contributions: Murruste M, Rajaste G and Kase K contributed to the study concept and design; Rajaste G and Kase K contributed to the acquisition and analysis of data; Murruste M and Kase K contributed to the drafting of the manuscript; Kase K critically revised the manuscript; Murruste M contributed to the study supervision; all authors have read and approved the final manuscript.
Correspondence to: Marko Murruste, MD, Department of General and Plastic Surgery, Surgery Clinic, Tartu University Hospital, Puusepa str 8, Tartu 51014, Estonia. marko.murruste@kliinikum.ee
Telephone: +372-73-18065 Fax: +372-73-18205
Received: June 4, 2014
Revised: August 1, 2014
Accepted: September 6, 2014
Published online: October 27, 2014
Abstract

Axial torsion and necrosis of Meckel’s diverticulum causing simultaneous mechanical small bowel obstruction are the rarest complications of this congenital anomaly. This kind of pathology has been reported only eleven times. Our case report presents this very unusual case of Meckel’s diverticulum. A 41-year-old man presented at the emergency department with complaints of crampy abdominal pain, nausea and retention of stool and gases. Clinical diagnosis was small bowel obstruction. Because the origin of obstruction was unknown, computer tomography was indicated. Computed tomography (CT)-scan revealed dilated small bowel loops with multiple air-fluid levels; the oral contrast medium had reached the jejunum and proximal parts of the ileum but not the distal small bowel loops or the large bowel; in the right mid-abdomen there was a 11 cm × 6.4 cm × 7.8 cm fluid containing cavity with thickened wall, which was considered a dilated bowel-loop or cyst or diverticulum. Initially the patient was treated conservatively. Because of persistent abdominal pain emergency laparotomy was indicated. Abdominal exploration revealed distended small bowel loops proximal to the obstruction, and a large (12 cm × 14 cm) Meckel’s diverticulum at the site of obstruction. Meckel’s diverticulum was axially rotated by 720°, which caused small bowel obstruction and diverticular necrosis. About 20 cm of the small bowel with Meckel’s diverticulum was resected. The postoperative course was uneventful and the patient was discharged on the fifth postoperative day. We recommend CT-scan as the most useful diagnostic tool in bowel obstruction of unknown origin. In cases of Meckel’s diverticulum causing small bowel obstruction, prompt surgical treatment is indicated; delay in diagnosis and in adequate treatment may lead to bowel necrosis and peritonitis.

Keywords: Meckel’s diverticulum, Axial torsion, Gangrene, Bowel obstruction, Emergency surgery

Core tip: Axial torsion and necrosis of Meckel’s diverticulum causing simultaneous mechanical small bowel obstruction are the rarest complications of this congenital anomaly. This kind of pathology has been reported only eleven times.