Intestinal obstruction and ischemia by necrotic annular Meck
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Meckel’s diverticulum (MD) is the most common congenital malformation of the gastrointestinal tract. Annular MD is an extremely rare cause of intestinal obstruction and ischemia in adults. Preoperative diagnosis of MD is a challenge because of its rarity and the absence of specific radiological findings and clinical presentation. Surgery represents the appropriate treatment of complicated MD.

A 70-year-old Caucasian male was admitted to the Emergency Department with a two-day history of abdominal pain associated with the inability to pass gas or stool, nausea, and vomiting. Physical examination revealed abdominal distension and abdominal pain without Blumberg’s sign.

Abdominal contrast-enhanced computed tomography (CECT) showed small bowel obstruction caused by suspected MD. Laboratory tests reported high serum levels of glycemia, LDH, C-reactive protein, and leukocytosis. After the diagnosis of intestinal obstruction, the patient underwent exploratory laparotomy: a segmental resection of ischemic distal ileum bearing a necrotic MD was performed. The postoperative course of the patient was uneventful.

MD is mostly asymptomatic and incidentally discovered if not complicated; a debate exists about the management of asymptomatic MD. Surgery represents the definitive treatment of complicated MD.

International Journal of Surgery Case Reports
Source: https://doi.org/10.1016/j.ijscr.2021.105897
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