Surgical management of intestinal obstruction due to a Mazuji III adhesion in a geriatric patient: dilemma in the management of an incidental Meckel's diverticulum

Abstract

The management of an incidentally discovered Meckel's diverticulum (MD) during emergency surgery poses a significant dilemma in unstable geriatric patients. We report the case of a 77-year-old critically ill female with multiple comorbidities who underwent emergency laparotomy for an intestinal obstruction caused by a Mazuji type III band adhesion. An uncomplicated MD was found incidentally. Given the patient's hemodynamic instability and severe metabolic acidosis, and adhering to damage control surgery principles, the decision was made not to resect the MD to avoid prolonging operative stress. This case highlights the conflict between classic teaching advocating for prophylactic resection and a conservative, individualized approach in high-risk patients. We discuss the literature, which suggests a low long-term risk of complication from incidental MD in adults, potentially even lower in the elderly, and argue that in such scenarios, the immediate surgical risk outweighs the potential future benefit. This report reinforces the principle of "first, do no harm" and underscores the necessity of tailored surgical decision-making that prioritizes physiological stabilization in complex emergency settings.