Mimicking T- shaped giant meckel's diverticulum: another rare anatomical variant complicating small bowel obstruction by adhesions
DOI:
https://doi.org/10.18203/2349-2902.isj20184659Keywords:
Adhesions, Intestinal obstruction, T-variant Meckel’s diverticulumAbstract
We report case with Meckel's diverticulitis complicated by adhesive intestinal obstruction. An adolescent of 13-yr-old boy with history of recurrent right sided lower abdominal pain and vomiting for two days. According to his mother he had been suffering this type of pain intermittently for last three years which was treated conservatively. This time the pain was out of proportion therefore she reported in tertiary hospital. On examination patient was tender at right iliac fossa region with abdominal guarding. CT scan of abdomen revealed multiple fluid-filled, dilated proximal bowel loops. Meckel's diverticulum was not suspected until diagnostic laparoscopy was performed. Patient was converted to open laparotomy where the giant (13 cm sized), narrow base mimicking T-shaped Meckel’s diverticulum and inter bowel loop adhesions near terminal ileum were seen. About 20 cm affected ileal segment with Meckel’s diverticulum resected and primary end to end anastomosis performed. The postoperative course remained uneventful. Histopathology report confirms the inflammation of Meckel’s diverticulum. Significance of this type of Meckel’s diverticulum is its T-shaped mimicking appearance with giant size body and narrow base and was manifested with recurrent sub occlusive intestinal obstruction in the period of three years. It is the second ever reported case in English journals.
References
Prall RT, Bannon MP, Bharucha AE. Meckel's diverticulum causing intestinal obstruction. Am J Gastroenterol. 2001;96(12):3426-7.
Tenreiro N, Moreira H, Silva S, Madureira L, Gaspar J, Oliveira A. Unusual presentation of a Meckel’s diverticulum: a case report. Int J Surg Case Rep. 2015;16:48-51.
Codrich D, Taddio A, Schleef J, Ventura A, Marchetti F. Meckel’s Diverticulum masked by a long period of intermittent recurrent sub occlusive episodes. World J Gastroenterol. 2009;15(22):2809-11.
Paul V, Ramu R, Mathews KS, Thomas A, Reesha PA, Matthai A, et al. T-shaped Meckel’s diverticulum: a rare anatomical variant complicating small bowel volvulus. Int Surg J. 2018;5(8):2929-32.
Tan YM, Zheng ZX. Recurrent torsion of against Meckel’s diverticulum. Dig Dis Sci. 2005;50:1285-7.
Cartanese C, Petitti T, Marinelli E, Pignatelli A, Martignetti D, Zuccarino M, et al. Intestinal obstruction caused by torsed gangrenous Meckel’s diverticulum encircling terminal ileum. World J Gastrointest Surg. 2011;3(7):106-9.
Dumper J, Mackenzie S, Mitchell P, Sutherland F, Quan ML, Mew D. Complications of Meckel’s diverticula in adults. Can J Surg. 2006;49:353-7.
Dimitriou I, Evaggelou N, Tavaki E, Chatzitheoklytos E. Perforation of Meckel’s diverticulum by a fish bone presenting as acute appendicitis: a case report. J Med Case Rep. 2013;2(7):231.
Nose S, Okuyama H, Sasaki T, Nishimura M. Torsion of Meckel’s diverticulum in a child. Case Rep Gastroenterol. 2013;7:14-8.
Sasikumar K, Noonavath RN, Sreenath GS, Maroju NK. Axial torsion of gangrenous Meckel’s diverticulum causing small bowel obstruction. J Surgical Technique Case Rep. 2013;5(2):103-5.
