Department of General Surgery, Maulana Azad Medical College, New Delhi, India.
J Med Case Rep. 2021 May 22;15(1):264. doi: 10.1186/s13256-021-02736-2.
Inverted Meckel's diverticulum refers to the condition in which the diverticulum inverts on itself. The reasons for such an inversion are poorly understood due to the rarity of the condition. We present a case of inverted Meckel's diverticulum, an uncommon finding, as a cause of recurrent intussusception.
A 30-year old Indian woman presented with complaints of pain in the central abdomen for 3 days, accompanied with vomiting and loose stools. Computed tomography images were suggestive of intussusception with intestinal obstruction. Intra-operative findings were suggestive of an intussuscepted segment of ileum measuring 10 cm in length, proximal to ileocecal junction. Ileo-ileal anastomosis was performed after appropriate resection. Upon opening the specimen, we were surprised to find an inverted Meckel diverticulum with lipoma at one end causing the intussusception. The patient made an uneventful recovery and was discharged after 5 days.
The reasons for inversion include abnormal peristalsis around the diverticulum and non-fixity of the diverticulum itself. The inverted diverticulum itself can cause luminal compromise and acts as a lead point for intussusception leading to obstruction. Computed tomography remains the diagnostic tool of choice for identifying intestinal obstruction and intussusception. Although pathological signs, such as lipoma, can be identified, the identification of any inversion will require a proficient radiologist. Inverted Meckel's diverticulum is a rare condition which is difficult to diagnose preoperatively. Treatment is surgical, whether diagnosed pre-operatively or intra-operatively, and includes segmental resection and anastomosis. This uncommon condition should be noted as one-off differential diagnosis for intussusception and intestinal obstruction.
倒置 Meckel 憩室是指憩室自身反转的情况。由于这种情况很少见，因此导致这种反转的原因尚不清楚。我们报告了一例倒置 Meckel 憩室，这是一种罕见的发现，是复发性肠套叠的原因。
一名 30 岁的印度女性因腹痛 3 天、呕吐和稀便就诊。计算机断层扫描图像提示为肠套叠伴肠梗阻。术中发现回肠 10cm 长的套叠段，位于回盲部近端。适当切除后行回肠-回肠吻合术。打开标本时，我们惊讶地发现一个倒置 Meckel 憩室，一端有脂肪瘤导致肠套叠。患者恢复顺利，5 天后出院。
倒置的原因包括憩室周围异常蠕动和憩室本身的不固定。倒置的憩室本身可导致管腔狭窄，并作为肠套叠的引发点导致梗阻。计算机断层扫描仍然是识别肠梗阻和肠套叠的首选诊断工具。虽然可以识别病理迹象，如脂肪瘤，但任何倒置都需要熟练的放射科医生来识别。倒置 Meckel 憩室是一种罕见的疾病，术前难以诊断。治疗是手术，无论是术前还是术中诊断，包括节段切除和吻合术。这种罕见的情况应作为肠套叠和肠梗阻的一次性鉴别诊断。
