An internal hernia caused by Meckel's diverticulum: a case report

A Rare Case of Small Bowel Obstruction in a 15-Year-Old Girl: Internal Hernia Associated with Meckel's Diverticulum

BACKGROUND Meckel's diverticulum is a congenital remnant of the omphalomesenteric duct and is the most common congenital gastrointestinal malformation. Most patients are asymptomatic, but a rare presentation is with subacute small bowel obstruction (SBO) due to herniation of bowel loops through an internal hernia formed by the Meckel's diverticulum and adjacent mesentery that forms an internal hernia. This report is of a 15-year-old girl presenting as an emergency with vomiting and small bowel obstruction due to an internal hernia associated with Meckel's diverticulum. CASE REPORT We present a case of a 15-year-old girl who presented to the Children's Emergency (CE) department with persistent vomiting and abdominal distension and tenderness. X-rays demonstrated dilated small bowel loops, prompting admission under Pediatric Surgery (PAS). A subsequent computed tomography (CT) scan was performed, which demonstrated multiple dilated small bowel loops, confirming SBO, and a blind-ending "C-shaped" bowel loop at the region of the terminal ileum. A diagnostic laparotomy was performed, which confirmed the presence of a Meckel's diverticulum. The tip of the Meckel's diverticulum was adherent to part of the small bowel mesentery, forming an internal hernia defect through which a loop of proximal ileum had herniated, resulting in SBO. She then underwent a laparoscopy-assisted transumbilical Meckel's diverticulectomy (LATUM). The patient recovered uneventfully and was discharged on the 4th postoperative day. CONCLUSIONS In children presenting with SBO, the possibility of Meckel's diverticulum as an etiology should be considered as a differential diagnosis. Early diagnosis and prompt intervention will improve clinical outcomes and avoid complications.

Emergency Presentations of Meckel’s Diverticulum in Adults

Introduction

Meckel's diverticulum is the commonest congenital anomaly of the gastrointestinal tract in humans that is commonly encountered during surgical practice as the cause of the patient's presentation or as an incidental finding during other unrelated procedures. Most clinical symptoms are caused due to its complications.

Results

The mean age of the involved patients was 24.79 years with slight male predominance, 62.9% males compared to 37.1% females. The mean length of the diverticulum was 55.21 cm. The most common emergency presentation was right lower quadrant abdominal pain in 31% of the patients, intestinal obstruction in 28.6%, acute lower abdominal pain and guarding and acute abdomen in 18.6% and 15.7% of patients, respectively, bleeding per rectum in 2.9%, acute right upper quadrant abdominal pain in 1.4%, and obstructed paraumbilical hernia containing the diverticulum in one patient. Perforation of the Meckel's diverticulum was reported in 18.6%. Histopathological examination showed acute inflammation in the wall of the diverticulum in 37.1%, lymphoid hyperplasia in 24.3%, hemorrhagic necrosis in 22.9%, and chronic inflammation in 8.6%. Ectopic mucosa was detected in 50% of the cases, gastric mucosa was detected in 42.86%, ectopic pancreatic mucosa was detected in 5.71%, and both gastric and pancreatic types in 1.43%.

Conclusion

Long diverticula are more liable to develop complications. At surgery, inspection and palpation of the wall of the diverticulum must be done for any evidence of inflammation, necrosis, perforation, or abnormal thickening of the walls of the diverticulum. Resection of the segment of the bowel that contains the diverticulum with primary anastomosis is preferable to other procedures due to the risk of leaving behind an abnormal heterotopic mucosa.

Meckel's diverticulum causing acute intestinal obstruction: A case report and comprehensive review of the literature

Introduction

Meckel's diverticulum is a congenital anomaly that is often detected incidentally. When it presents symptomatically, it causes painless gastrointestinal bleeding. Nevertheless, in rare instances, it can cause acute intestinal obstruction, often obscuring the true clinical picture.

Case presentation

A 31-year-old male presented to the emergency department with a 24-h history of unremitting nausea, biliary emesis, abdominal distension, and absolute constipation. After ruling out the most common etiologies of acute bowel obstruction, radiological imaging was obtained and was suggestive of meckel's diverticulum. Laparoscopic meckel's diverticulectomy was performed, with the subsequent histopathological analysis confirming ectopic gastric tissue.

Discussion

Meckel's diverticulum occurs consequent to incomplete obliteration of the vitelline or omphalomesenteric duct, which connects the developing intestines to the yolk sac. It is found in roughly 2% of the population, of which only about 4% may become symptomatic due to any number of complications. Specifically, small bowel obstruction (SBO) and diverticulitis secondary to ectopic gastric or pancreatic tissue are the most common presentations of symptomatic MD.

Conclusion

Although relatively rare in adults, MD should be considered in the list of differentials in patients with intussusception leading to SBO, especially on a background history unremarkable for the most common etiologies causing SBO including post-operative adhesions and hernias.

Axially torsional Meckel's diverticulum accompanied by small bowel volvulus: a case report

Small bowel volvulus secondary to Meckel’s diverticulum is rare, and a delayed diagnosis results in disastrous outcomes. Computed tomography is conducive to early differential diagnosis. In particular, a blind-ending pouch structure on CT always indicates Meckel’s diverticulum. Diverticulectomy with or without adjacent partial small intestinal resection is the standard treatment for symptomatic Meckel’s diverticulum. However, the therapy for asymptomatic Meckel’s diverticulum is controversial. Here, we report the case of a 20-year-old man who suffered intestinal obstruction secondary to small bowel volvulus caused by an axially torsional, gangrenous, and giant Meckel’s diverticulum. Diverticulectomy with partial intestinal resection was performed.

Intestinal obstruction caused by the strangulation of a Treves' field pouch hernia from a Meckel's diverticulum - A case report

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Treves’ field pouch hernial Intestinal obstruction from a Meckel’s diverticulum and a Treves’s field pouch hernia.

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Intestinal obstruction from a Meckel’s diverticulum with tip adherent causing strangulation of a Treves’s field pouch hernia.

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Meckel’s diverticulum and Treves’ field pouch hernia are both rare congenital abnormalities of the digestive tract.

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An abdominal sonography of an encapsulated segment of bowel suggestive of a Treves’ field pouch hernia.

Introduction

The etiology for intestinal obstruction is often difficult to determine especially in a young patient with a virgin abdomen. Differential diagnosis may include congenital abnormalities such as a more common Meckel’s diverticulum but also a rarer mesenteric type internal hernia. Although the definite diagnosis is not as important in an acute setting and diagnosis is often made postoperatively, the preoperative differential diagnosis including the two should be considered for successful management.

Presentation of case

We report a case of a 16-year-old young female who has a history of abdominal complaints but treated successfully conservatively. She eventually presented to us with suspicion of intestinal obstruction and image study confirmed an internal hernia. Operative findings showed a Meckel’s diverticulum with tip adherent leading to the strangulation of a Treves’ field pouch hernia. The encapsulated small bowel resulted in an intestinal obstruction of the terminal ileum.

Discussion

Meckel’s diverticulum is a common congenital abnormality but often asymptomatic. Treves’ field of the mesentery is also a congenital abnormality but a much rarer finding often only impressed if herniation of the bowel is involved. However, both can lead to an abdominal emergency.

Conclusion

Intestinal obstruction is often an emergent situation and prompt surgery is usually required. The exact etiology may not be obvious preoperatively especially in a young patient with a virgin abdomen, but differential diagnosis like Meckel’s diverticulum and Treves’ filed hernia should be important for successful management.

Unusual presentation of rare complication following endoscopic gastroplasty: case report

A 35-years-old female post-endoscopic gastroplasty presented to the emergency department complaining of epigastric abdominal pain. The abdominal examination showed epigastric and tenderness. On abdomen computerized axial tomography (CAT) scan she had small bowel obstruction with twisting of mesenteric vessel. The patient taken to the operating room for diagnostic laparoscopy and proceed, laparoscopic examination showed proximal dilatation of small intestine with collapse of distal part of jejunum, the obstruction identified, as fibrous band originating from the stomach to the proximal part of jejunum, this band caused by suture penetrating the stomach wall, which is going with the previous history of the endoscopic gastroplasty, reduction of the internal hernia done by releasing of the fibrous band, the herniated segment was healthy. Internal hernia can present with variety of complications. To the best of our knowledge from the literature review, this is the first case to be reported as internal abdominal hernia secondary to endoscopic gastroplasty.