Axial Torsion of Gangrenous Meckel’s Diverticulum Causing Small Bowel Obstruction

Abstract

Meckel’s diverticulum (MD) is a commonly encountered congenital anomaly of the small intestine. We report an extremely unusual case of an axially torted, gangrenous MD presenting as acute intestinal obstruction. A  26-year-old male patient presented to our emergency department with 3 days history of abdominal pain, distention and bilious vomiting. On  laparotomy, there was minimal hemorrhagic fluid localized in right iliac fossa and small bowel loops were dilated. A MD was seen attached to the mesentery of nonadjacent small bowel by a peritoneal band. The diverticulum was axially torted and  gangrenous. In addition, there was compression of ileum by the peritoneal band resulting in intestinal obstruction, which was relieved on dividing the band. Resection and anastomosis of the small bowel including the MD was performed. We hereby report a rare and unusual complication of a MD. Although treatment outcome is generally good, pre-operative diagnosis is often difficult.

Key words: Axial torsion, Meckel’s diverticulum, small bowel obstruction