Babbu Ug Manish, Vaitheeswaran Shanthini, Rahman A Khalilur, Shyam Sundar Vijayshree, Durai Balavignesh
Department of General Surgery, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND.
Cureus. 2024 Sep 26;16(9):e70293. doi: 10.7759/cureus.70293. eCollection 2024 Sep.
Meckel's diverticulum (MD) is a prevalent congenital abnormality of the gastrointestinal tract. While it may not show any symptoms, it has the potential to cause serious complications, such as intestinal obstruction. This case report presents a case of a 27-year-old male who presented to the emergency department with migrating right lower abdomen pain and vomiting. An initial diagnosis of acute appendicitis was made. An erect X-ray of the abdomen showed features of small bowel obstruction and with a clinical suspicion of Meckel's, a diagnostic laparoscopy had been planned. However, the diagnostic laparoscopy identified a gangrenous MD with axial torsion, with an ileal loop knotting at the base of Meckel's, causing small bowel obstruction. This entanglement led to an obstruction, which is a rare and challenging clinical scenario. Surgical resection of the affected bowel segment, including the MD, was performed, leading to a complete recovery of the patient. This case study emphasizes the diagnostic difficulties presented by MD, particularly when its symptoms resemble more prevalent illnesses like appendicitis. The rare incidence of axial torsion resulting in gangrene in MD with small bowel obstruction highlights the significance of including this illness in the differential diagnosis of acute abdomen.
梅克尔憩室（MD）是一种常见的胃肠道先天性异常。虽然它可能不表现出任何症状，但有引发严重并发症的可能，如肠梗阻。本病例报告呈现了一名27岁男性患者的情况，该患者因右下腹部转移性疼痛和呕吐前往急诊科就诊。初步诊断为急性阑尾炎。腹部立位X线显示小肠梗阻特征，鉴于临床怀疑为梅克尔憩室，遂计划进行诊断性腹腔镜检查。然而，诊断性腹腔镜检查发现一个坏疽性梅克尔憩室伴轴向扭转，在梅克尔憩室底部有一段回肠袢扭转打结，导致小肠梗阻。这种缠绕导致了梗阻，这是一种罕见且具有挑战性的临床情况。对包括梅克尔憩室在内的受累肠段进行了手术切除，患者完全康复。本病例研究强调了梅克尔憩室所带来的诊断困难，尤其是当其症状类似于阑尾炎等更常见疾病时。梅克尔憩室轴向扭转导致坏疽并伴有小肠梗阻的罕见发生率凸显了在急腹症鉴别诊断中考虑这种疾病的重要性。
