Abstract
Abstract Introduction This report calls attention to small bowel necrosis resulting as a complication of formation of an obstructive loop of small bowel around a band of Meckel's diverticulum. Case presentation We report a case of an adult in his 5th decade presenting with sharp, colicky abdominal pain. On presentation his vitals were within normal limits, abdomen was non-distended but tender and rigid all over, more on left lower quadrant without any rebound tenderness. Bowel sounds were hypoactive. Rectal exam showed an empty vault. White blood cell count was 9.0 x 103/mm3 with 94.5% neutrophils, Hb of 9.0 gm/dl and Hct of 31.3%, liver and pancreatic enzymes were not elevated. Arterial blood gas did not show any acidosis and lactic acid level was not elevated. X-ray showed a non-obstructive bowel pattern without any free air. Abdominal computed tomography with oral and intravenous gastrograffin showed findings consistent with complete mid to distal small bowel obstruction secondary to a closed loop obstruction. Emergent laparotomy showed a Meckel's diverticulum that had formed a band around a portion of small bowel causing it to twist upon itself and become necrotic. Conclusion Histopathology revealed Meckel's diverticulum and benign intestinal tissue with hemorrhagic necrosis.
Highlights
Introduction: This report calls attention to small bowel necrosis resulting as a complication of formation of an obstructive loop of small bowel around a band of Meckel’s diverticulum
Meckel’s diverticulum (MD) is an ileal diverticulum located 100 cm proximal to the cecum. It results from failure of the omphalomesenteric duct to obliterate completely
This failure can lead to multiple anatomical problems: omphalomesenteric fistula, an enterocyst, a fibrous band connecting the intestine to the umbilicus or a Meckel’s diverticulum with or without a fibrous band connecting to the umbilicus [1]
Summary
Meckel’s diverticulum (MD) is an ileal diverticulum located 100 cm proximal to the cecum. The majority of complicated cases of MD contain ectopic mucosa (75% gastric, 15% pancreatic) [1,2,3] This leads to ulceration and bleeding of ileal mucosa adjacent to the acidic ectopic gastric secretions. The pain started in the mid-lower abdomen and became generalized, sharp and colicky, 10/10 in intensity, non-radiating, associated with nausea but no vomiting Though he had noticed blood in his stools occasionally in the past, his last bowel movement was three days prior to presentation with semisolid stool without any blood. His past medical history was significant for hypertension and peripheral vascular disease, status post aorto-femoral bypass graft 6 years prior. Histopathology showed MD with hemorrhagic necrosis and benign intestinal tissue with necrosis
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