A Rare Case of Small Bowel Obstruction Secondary to Meckel’s Torsion

Beatrice Morea, MD, Afia Wilson, MD, MPH, Jonathan Stahl, DO
1Department of Surgery, Colon & Rectal Surgery Department, MVHS, Wynn Hospital, Utica, NY

BACKGROUND
Meckel’s diverticulum is the most common congenital anomaly
of the gastrointestinal tract
• Described by German anatomist, Johann Friedrich Meckel, in 1809
• True ileal diverticulum arising from incomplete obliteration of omphalomesenteric (vitalline) duct typically follows the “rule of twos”
Symptomatic presentation in adults is uncommon
• Often discovered incidentally and may lead to complications such as:
• Gastrointestinal bleeding
• Small bowel obstruction (SBO)
• Diverticulitis
• Perforation (rare)

CASE PRESENTATION

23-year-old previously healthy female without surgical history
• Sudden-onset progressively worsening abdominal pain, nausea, vomiting, and watery diarrhea
• Physical exam: tender, non-peritonitic abdomen with diffuse distension
Initial Evaluation
• Labwork: mild leukocytosis 10.9 x 109/L [ref: 4.8-10.0.], normal lactate
1.6mmol/L [ref: 0.5-2.2]
• Contrast-enhanced computed tomography (CT) abdomen/pelvis: markedly dilated small bowel loops, colonic decompression consistent with high-grade SBO with unclear transition point
• Initially attempted conservative management with nasogastric decompression and bowel rest
Surgical Management & Operative Findings
• Diagnostic laparoscopy demonstrated markedly distended small bowel and adhesions
• Further exploration delineated transition point near terminal ileum with a torsed ~5cm Meckel’s diverticulum causing mechanical SBO
• Mini laparotomy used for specimen extraction
• Segmental small bowel resection including the diverticulum with a stapled technique, closure of the mesenteric defect, and concomitant appendectomy

DISCUSSION

Torsion of Meckel’s diverticulum causing SBO is exceptionally rare with fewer than 25 cases reported in published literature
• Complication appears more frequently in patients without prior abdominal surgery
Clinical presentation mirrors classic SBO resulting in nonspecific findings on initial presentation as seen in our case
Definitive management requires surgical intervention
• Diverticulectomy (resection of diverticulum alone)
• Segmental small bowel resection indicated when ischemic or gangrenous changed extend beyond torsed segment
• Resection due to size of the diverticulum may be considered in future literature to ensure entire specimen is removed due to possible presence of ectopic tissue
Clinical significance
• Case underscores the importance of maintaining suspicion for rare

CONCLUSIONS

Meckel’s diverticulum should be considered in the differential diagnosis of nonspecific abdominal pain, particularly in young adults without prior abdominal surgery
Early recognition and prompt surgical intervention are essential to prevent serious complications and improve patient outcomes