Small bowel obstruction by Meckel diverticulum and omphalomesenteric ligament

Case contributed by Dr Maria Grazia Papi

Presentation

The patient was admitted to the A&E department with acute abdominal pain, vomiting, and constipation. Her abdomen resulted distended and painful.

Patient Data

Age: 80
Gender: Female

Small bowel dilation with gas/fluid levels throughout the abdomen and pelvis.

There is lack of the normal gas distribution in the large bowel.

Ultrasound scan at the level of the umbilical area demonstrates some superficial dilated small bowel loops and a round, fluid filled structure.

The first assessment was small bowel obstruction: dilated small-bowel loops with a thickened wall and multiple gas/fluid levels suggestive of small bowel obstruction are noted. There is also evidence of stricture/compression and increased attenuation at the root of the small bowel mesentery (yellow arrow) with free fluid in the pelvis (red arrow). 

The second finding is a tubular structure arising from the ileum proximal to the ileocaecal valve at the right lower quadrant and connecting to the umbilicus by a fibrous band (green arrow). 

Case Discussion

Meckel diverticulum with or without an omphalomesenteric ligament or fibrous band connecting the umbilicus results from a partial or complete failure of involution of the omphalomesenteric duct. 

Meckel diverticulum usually is detected in the antimesenteric border of the terminal ileum within 2 feet proximal to the ileocaecal valve. It is usually is asymptomatic, however, ~2%–4% of patients are symptomatic, with complications such as bleeding, small bowel obstruction, inflammation, and neoplastic changes. Even if it is difficult to assess clearly at CT scan, the cause of small bowel obstruction (in this case a periumbilical fibrous bands connected to a tubular structure in the RIF) suggested the possibility of a Meckel diverticulum. The diagnosis of Meckel diverticulum with fibrous band causing bowell obstruction was confirmed at surgery.

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Case information

rID: 33641
Case created: 19th Jan 2015
Last edited: 16th Aug 2017
Inclusion in quiz mode: Included

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