Meckel’s Diverticulum with a Mesodiverticular Band Causing Massive Bowel Gangrene—A Case Report

Basil Babu, Satish Subbiah Nagaraj, Swastika Sharma
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Abstract

Meckel’s diverticulum is the most common congenital anomaly of the gastrointestinal tract. The anatomy of Meckel’s diverticulum varies, and when it is attached to the abdominal wall or mesentery by means of fibrous cords, it can cause obstruction including massive bowel gangrene which has not yet been reported in the literature. A middle-aged man presented to the emergency wing with a history of obstipation and vomiting for 2 days. A CECT (Contrast Enhanced Computed Tomography) abdomen revealed dilated ileal bowel loops with multiple strictures, mesenteric lymph nodes, and mild ascites. With a provisional diagnosis of tuberculosis of the abdomen, he was taken for emergency laparotomy. Around 200 cm of distal ileum was found gangrenous due to the herniation of it beneath a mesodiverticular band which was connected to the apex of Meckel’s diverticulum found 50 cm from the ileocolic junction. The gangrenous bowel along with the gangrenous Meckel’s diverticulum was resected, and an end ileostomy and distal mucosal fistula were made. Meckel’s diverticulum must be kept as a differential in any young patients presenting with acute intestinal obstruction with no previous history of abdominal surgery, TB abdomen, or inflammatory bowel disease. While recommendations suggest resection of symptomatic Meckel’s diverticulum with a narrow base and wide body due to its propensity to rotate along its axis and cause gangrene of Meckel’s diverticulum, we believe Meckel’s diverticulum with a band attaching it to umbilicus or with ileal mesentery must be considered for resection to prevent grave complications.

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梅克尔憩室伴中憩室带引起大面积肠坏疽--病例报告
梅克尔憩室是最常见的先天性胃肠道畸形。梅克尔憩室的解剖结构各不相同,当它通过纤维索附着在腹壁或肠系膜上时,可引起梗阻,包括尚未见文献报道的大面积肠坏疽。一名中年男子因便秘和呕吐 2 天来急诊就诊。腹部对比增强计算机断层扫描(CECT)显示回肠肠襻扩张,多处狭窄,肠系膜淋巴结肿大,并有轻度腹水。初步诊断为腹腔结核,他被送去进行急诊开腹手术。在距回结肠交界处 50 厘米处发现了梅克尔憩室的顶端,该憩室与肠系膜憩室相连。切除了坏疽的肠道和坏疽的梅克尔憩室,并进行了回肠末端造口术和远端粘膜瘘。对于既往无腹部手术史、结核性腹部病史或炎症性肠病史的急性肠梗阻年轻患者,必须将梅克尔憩室作为鉴别病例。虽然建议切除有症状的窄底宽体梅克尔憩室,因为它容易沿轴线旋转并导致梅克尔憩室坏疽,但我们认为必须考虑切除有带子连接到脐部或有回肠系膜的梅克尔憩室,以防止严重并发症。
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