Axial Torsion and Gangrene: An Unusual Complication of Meckel's Diverticulum

Abstract

Meckel's diverticulum (MD), a congenital abnormality of the gastrointestinal tract, is usually found in the pediatric population younger than two years of age; hence, its incidence in adults is rare. Although MD is mostly clinically silent, in adults, it may present with intestinal obstruction and diverticulitis. The complications of MD include hemorrhage, perforation, enterolith formation, torsion, Littre's hernia, ulceration and neoplasm. Among these, torsion is one of the rarely reported complications of MD. MD being attached to the ileal mesentery or umbilicus, presence of mesodiverticular band, and the length, breadth and base diameter of the diverticulum contribute as a risk factor for torsion. A similar clinical picture of acute appendicitis must be excluded.We report a case of a 25-year-old male who presented with signs of intestinal obstruction in whom intraoperative finding of a torted MD with necrotic and twisted base was found upon emergency exploratory laparotomy.

Symptoms Investigate the Frequency of Various Presentations of the Meckel’s Diverticulum and Help Identify Sign Promptly

“…Case reports of neonatal MD have been almost exclusively published on male patients [3]. Its occurrence is usually under 10 years of age and the prevalence decreases with increasing age hence, it is rarely found in adults [7]. MD Emerging due to the vitelline duct (VD)'s persistence, which is an embryonic structure that provides relevance from the yolk sac to the midgut during fetal life [3,7].…”

“…Its occurrence is usually under 10 years of age and the prevalence decreases with increasing age hence, it is rarely found in adults [7]. MD Emerging due to the vitelline duct (VD)'s persistence, which is an embryonic structure that provides relevance from the yolk sac to the midgut during fetal life [3,7]. MD is almost always placed about 2 feet of the ileocecal valve on the anti-mesenteric border at the terminal ileum and seldom on the mesenteric side due to the embryological origin [5].…”

“…The rule of Two typically explains its specifications, such as 2% in the general population's rate of prevalence, the ratio of 2:1 in male-tofemale, of 2% incidence rate for symptomatic Meckel diverticulum, symptoms' presence in younger than 2 years old cases, 2 feet distance to the ileocecal valve location, 2 inches diverticular length, and 2 common types of ectopic tissues [9]. MD is a kind of true diverticulum, containing all 3 layers of the gastrointestinal wall (mucosa, muscular, and serosa) [2,7]. The duct generally obliterates during the 7 months of embryonic development, and demolition of closure consequences in a diverticulum 98% of the time [1].…”

“…The complications of MD are comprised of haemorrhage, perforation, enterolith formation, Littre's hernia, ulceration, neoplasm, and torsion. Torsion is one of the infrequently reported complications of MD [7]. MD may remain asymptomatic or mimic disorders such as Crohn's disease, appendicitis, and peptic ulcer disease, so it is difficult to diagnose asymptomatic MD before the operation.…”

“…MD may remain asymptomatic or mimic disorders such as Crohn's disease, appendicitis, and peptic ulcer disease, so it is difficult to diagnose asymptomatic MD before the operation. The procedure of diagnosing Meckel's diverticulum depends on its clinical symptoms [7,11]. Diagnostic methods include abdominal ultrasound, abdominal CT scan, upper mesenteric artery angiography, radionuclide scan, and diagnostic laparoscopy [2].…”