Meckel’s Diverticulum associated with a thin fibrous band causing strangulated small bowel obstruction.

Abstract

We report a case of an infant, three and half month old who presented with acute abdomen. Investigations including complete blood count and X-ray abdomen were non informative apart from showing evidence of intestinal obstruction. On abdominal exploration, there was a thin fibrous band attached to the apex of Meckel’s Diverticulum [MD] and the umbilicus. The band caused strangulated terminal small bowel loops resulting in bowel gangrene and obstruction which is a rare presentation. Resection of the gangeranous loops was performed and the patient made uneventful recovery. However, fear of having B12 and bile salts malabsorption is a real future concern. On abdominal exploration, there was a thin fibrous band attached to the apex of the MD and the umbilicus, causing tight pressure on many loops of small bowel. A long segment of the small bowel, about 30cm, was found to be strangulated. The infarct segment includes the MD and divided into a proximal and distal segment to the MD. The proximal segment about 10cm and the distal segment about 20cm. so a large segment of the terminal ileum was excised, leaving only a segment about 10cm at the iliocaecal junction. End to end anastomosis was done by a single layer and the patient had uneventfully postoperative recovery.
Conclusion: MD is a cause of serious gastrointestinal tract complications in all age groups, from neonate to adult life. Band associated with MD may cause pressure on the terminal ileum and may lead to obstruction and strangulation of terminal ileum which important for vitamin B12 and bile salts absorption.

Keywords: iliocaecal, anastomosis, malabsorption, gangeranous.