Axial Torsion of Gangrenous Meckel's Diverticulum Causing Small Bowel Obstruction
The present case is about a 26-year-old male patient who presented to our emergency department with 3 days history of abdominal pain, distention and bilious vomiting. He had no previous surgery and did not recollect similar episodes in the past. On examination, he was afebrile and hemodynamically stable. Blood counts and biochemical values were within the normal limits. On clinical examination, abdomen was distended with visible intestinal peristalsis, but without any guarding. There were no surgical scars and hernial orifices were free. Plain X-ray abdomen showed dilated small bowel loops with multiple air fluid levels []. Ultrasound abdomen suggested the possibility of an appendicular mucocele. He was taken up for urgent laparotomy with a clinical diagnosis of acute intestinal obstruction. Intra-operatively there was minimal hemorrhagic fluid localized in right iliac fossa and small bowel loops were dilated. A MD was seen attached to the mesentery of nonadjacent small bowel by a peritoneal band, which was arising from its tip. The diverticulum was axially torted and gangrenous. In addition there was compression of ileum by the peritoneal band resulting in intestinal obstruction, which was relieved on dividing the band []. Resection and anastomosis of the small bowel including the MD was performed. Recovery was quick and uneventful and patient was discharged within a week.