A Rare Cause of Intestinal Obstruction: Mesodiverticular Band
Journal Title: Turkish Journal of Colorectal Disease - Year 2020, Vol 30, Issue 2
Abstract
Meckel’s diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. Some of the major complications of MD are bleeding, intestinal obstruction and diverticulitis. So, we aim to indicate in this case report that intestinal obstruction can occur secondarily to the MD and mesodiverticular band. A 63-year-old male patient with no known previous history of medical problem or abdominal surgery came to the emergency department with a severe abdominal pain, nausea and vomiting that had started the previous day. Physical exam showed an increase in bowel sounds, distention and generalised sensitivity largely on the epigastric region. An Erect abdominal plain radiograph revealed a few distended small bowel loops and multiple air-fluid levels. Even though the patient was initially thought to suffer from a mechanical intestinal obstruction, the subsequent abdomen computed tomography of the patient, which was taken urgently, showed fluid accumulation in the intestinal loops and local dilatation, favouring an obstruction. The patient who developed acute abdomen in the follow-up was taken to the surgery immediately. It was observed that small intestine was strangled 60 cm proximity to the ileocecal valve. This strangulation was observed to be resulted from the mesodiverticular band of the inflamed MD. The mesodiverticular band extended from the vertex of the MD to the mesentery and significantly compressed the distal ileum. Once the mesodiverticular band was detached from the mesentery by electrocautery, the ileal loop became free. Since the free ileal bowel loop was observed to be ischemic, 15 cm segmental small intestine was resected including the MD and the inflamed, fragile mesentery of the intestinal loop. Histologic analyses confirmed that the diverticulum was MD. As the preoperative diagnosis of intestinal obstruction which is caused by mesodiverticular band is difficult, it is associated with high mortality and morbidity. Early diagnosis and immediate surgery will prevent the strangulation and bowel gangrene therefore, mesodiverticular band which is one of the complications of MD should be kept in mind in the differential diagnosis of the patients referring with the symptoms of an intestinal obstruction.
Authors and Affiliations
Hüseyin Emre Arslan, Sezgin Zeren, Mehmet Fatih Ekici, Mustafa Cem Algın
Keywords
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- EP ID EP684938
- DOI 10.4274/tjcd.galenos.2020.2020-1-4
- Views 149
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