MECKELS DIVERTICULUM WITH MESENTERY AS A RARE CAUSE OF CLOSED LOOP OBSTRUCTION-A CASE REPORT

Abstract

Meckel's Diverticulum is most common congenital anomaly of gastrointestinal tract. It arises from Antimesenteric border of the small bowel [1]. In contradiction, a case encountered at our institution where a 32-y old female presented with complaints of pain abdomen since 3 days, vomiting's since 3 days, obstipation since 3 days and distention since 1 day. On examination abdomen is distended, diffuse tenderness present all over the abdomen with no bowel sounds and collapsed rectum with no fecal staining per rectally. Imaging studies on ultra-sonography shown dilated small bowel loops with max diameter of 3.1cm showing to and fro peristalsis. On CT abdomen multiple dilated small bowel loops with air uid levels with maximum diameter of 4.1cms with collapsed terminal ileum and large bowel. ?Closed Loop Obstruction. Emergency exploratory laparotomy was planned and shown Meckel's diverticulum with mesentery present on anti-mesenteric border with mesentery extending from mesenteric border to tip of Meckel's diverticulum with internal herniation of proximal ileum between the Meckel's and its mesentery causing closed loop obstruction noted at 60cms from IC junction for which herniated bowel loops was released with diverticulectomy followed by anastomoses of proximal and distal ileal loops. Resected Meckel's sent for histopathological examination and cut section showed mucosa, sub-mucosa, muscularis propria and serosa. Mucosa shows chronic nonspecic inammation, sections from the adjacent area's shows hyperplastic mucosa, hypertrophied muscularis layers and serosa with congested blood vessels with feature's consistent with Meckel's diverticulum. Patient was followed for 6 months, and the course was un-eventful.