Axial Torsion and Meckel’s Diverticulitis: A Diagnostic Conundrum

Abstract

Introduction: Meckel’s diverticulum is one the most common congenital anomalies of gastrointestinal tract that mimics acute appendicitis, gastroenteritis, peptic ulcer disease. Complications related to it can be haemorrhage, intestinal obstruction, perforation while axial torsion is one of the rarest complications. So, this paper objectifies a rare clinical scenario that we encountered in our practice and highlights on the possible management strategies. Case : An 11 year boy presented with a history of pain at peri-umbilical region for four days with 2-3 episodes of vomiting. Abdominal examination revealed tenderness at suprapubic area with a mass around 5x3 cm along hypogastrium. Ultrasonography abdomen revealed an avascular structure in central area with clumping of bowel and omentum over the lesion while computed tomography scan of abdomen revealed blind ended gas filled structure at hypogastrium with thickened enhancing irregular wall associated with adjacent mesenteric fat plane stranding and prominent adjacent axial vessels supplying inflammatory lesion. Exploratory laparotomy showed axial twisting of diverticulum about 10x5 cm arising from anti-mesenteric border around 50 cm proximal to ileo-caecal junction with a fibrous band attached to the fundus and ileum leading to gangrenous diverticulum with clumping of bowel loops along with omental covering. De-twisting and adhesiolysis along with excision of the diverticulum was done with two layered closure of the defect. Conclusion: Axial torsion is the rarest of the complication of MD and should be managed with utmost caution. Excision of the twisted diverticulum with or without wedge resection of the involved ileum is the procedure of choice.