INTESTINAL OBSTRUCTION FROM MECKEL’S DIVERTICULUM IN AN ADULT; UNSUSPECTED BUT FOUND- A CASE REPORT

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O.A Ajagbe¹, M.C Okor¹, O.T Ojediran¹, O.E Dada¹, O.O Ayandipo², M.A Ajani³

1. Department of Surgery, University College Hospital, Ibadan, Nigeria.
2. Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria.
3. Department of Pathology, College of Medicine, University of Ibadan, Ibadan, Nigeria.

Abstract

Introduction: Most cases of Meckel’s Diverticulum (MD) are asymptomatic and when symptomatic, preoperative diagnosis of MD maybe a dilemma. Intestinal obstruction is a major complication in the adult population. Case presentation: We report a case of a 24-year-old female presenting with intestinal obstruction from Meckels Diverticulum.

Conclusion: MD is largely asymptomatic in adults, however may be present and should be included in our array of differential diagnoses.

Keywords: Acute intestinal obstruction, Meckel’s diverticulum, Nigeria

Introduction

The thought of Meckel’s diverticulum (MD) usually brings to mind a pathology of the pediatric population and often managed by pediatric surgeons rather than those who care for adults.¹ It is rarely symptomatic in adults however when it does present with symptoms, they are those of its complications ranging from lower GI bleeding to intestinal obstruction.² Because of its rare presentation in the adult population, it is usually missed or misdiagnosed preoperatively.³

It is almost always discovered inadvertently in adults and as such the management is based on the findings at surgical intervention. Treatment of symptomatic MD is surgery, the type of procedure depends on the integrity of diverticulum base and adjacent ileum as well as the presence and the location of ectopic tissue within it.⁴

The aim of this case report is to incite surgeons to entertain a high index of suspicion of Meckel’s Diverticulum while managing and exploring adults with acute abdomen or abdominal symptoms.

CASE PRESENTATION
The patient is a 24-year-old female nursing student who presented to the emergency department with a four-day history of constipation and progressive abdominal distention. She had an associated feeling of being unwell with 2 episodes of vomiting.

She had no co-morbidities, no prior history of abdominal surgeries, and is nulliparous.

Examination revealed a young lady, acutely ill-looking, not pale, not febrile, dehydrated, and tachycardic. Her abdomen was distended and moved with respiration, the bowel sounds were hyperactive. Rectal examination revealed an empty rectum with no palpable masses. Other aspects of the physical examination appeared normal.

A diagnosis of intestinal obstruction from small bowel volvulus was made. She was optimized for surgery, commenced on broad-spectrum antibiotics, fluids and was placed on Nil per Os (NPO) in preparation for exploratory laparotomy. The plain abdominal X-rays showed multiple air-fluid levels with dilated proximal bowel and relative gaslessness in the pelvis (Figure 1).

She had laparotomy with intra-operative findings of dilated proximal bowel loops, a constriction band over the ileum approximately 60cm from the ileocaecal junction connected to a diverticulum on the antimesenteric border of the ileum. (Figures 2 and 3). The Meckel’s diverticulum was excised at the stalk base.

On the second postoperative day, she was commenced on a clear fluid diet and this was graduated to a normal diet. The postoperative period was uneventful and she was discharged on the 5th postoperative day.

Histopathology specimen showed a true ileal diverticulum with a focal area of gastric tissue (Figures 4a and b)