Contained perforation of Meckel’s diverticulum presenting as small bowel obstruction secondary to omental band in an adult: a case report

Abstract

Meckel’s diverticulum is usually asymptomatic, but may rarely present with obstruction or perforation. An omental band simultaneously containing a perforated Meckel’s diverticulum and causing small bowel obstruction is exceptionally uncommon. A 28-year-old man presented with obstipation, abdominal distension and vomiting. Imaging suggested small-bowel obstruction without evidence of perforation. Following clinical deterioration, emergency laparotomy revealed an omental band forming a narrow aperture through which an ileal loop was passing. A Meckel’s diverticulum, located 30 cm proximal to the ileocaecal junction, was perforated at its tip, which was embedded within the inflamed omental band, limiting peritoneal contamination. Segmental ileal resection with primary anastomosis and proximal loop ileostomy was performed. Histopathology confirmed perforated Meckel’s diverticulum with transmural inflammation and omentitis. The patient recovered uneventfully and underwent successful ileostomy reversal after three months. An omental band may simultaneously cause mechanical obstruction and contain Meckel’s diverticular perforation. Contained perforation should therefore be considered despite absence of generalized peritonitis.