Ischaemic Meckel's Diverticulum, Mesodiverticular Band, and Small Bowel Volvulus With Closed Loop Obstruction: A Laparoscopic Approach and Literature Review.

Meckel's diverticulum (MD) is the most common congenital abnormality of the gastrointestinal tract. It usually lies on the antimesenteric side of the ileum, about 60 cm from the ileocecal valve. Histologically, it is a true diverticulum comprising all four layers of the intestinal tract. Complications associated with MD include bleeding, bowel obstruction, intussusception, and inflammation (diverticulitis). A 12-year-old boy presented to the emergency department with a one-day history of right iliac fossa pain. He had rebound tenderness and localized peritonism. The inflammatory markers were raised. He was listed for an emergency laparoscopic appendicectomy. Intraoperatively, a large necrotic MD was identified, twisted on its pedicle. In addition, a fibrous band extended from the tip of the diverticulum to the posterior aspect of the anterior abdominal wall. A closed-loop, discoloured terminal ileal volvulus with proximal small bowel dilatation was noted. The band was released by sharp dissection, and the terminal ileum volvulus was freed with the return of normal colour and circulation. The gangrenous Meckel's diverticulum was excised at its pedicle by ECHELON FLEX™ ENDOPATH® staplers (Ethicon, Inc., a Johnson & Johnson company, Raritan, NJ). The postoperative recovery was uneventful. Early laparoscopic intervention prevented irreversible small bowel ischaemia that may have resulted in resection of the terminal ileum in a child.