Intestinal Obstruction due to Meckel’s Diverticulum: A rare presentation

Abstract

Meckel's diverticulum occurs in about 1-3% of general population. The majority of them are asymptomatic and incidentally found at laparotomy. The most common complication due to Meckel's diverticulum in adults is intestinal obstruction. The frequency of symptoms decreases with age. Enteroliths are rarely formed in a Meckel's diverticulum and are known to cause intestinal obstruction. These should be considered in the differential diagnosis of radioopaque shadows in the plain abdominal films. We describe a rare presentation of Meckel's diverticulum in an elderly woman.

Large Enterolith in a Meckels Diverticulum Causing Perforation and Bowel Obstruction: An Interesting Case with Review of Literature

“…Calcifications at abdominal radiography may be due to biliary and urinary calculi, calcified lymph nodes, mesenteric teratoma, fat necrosis, calcified fibroids, and enteroliths [3]. In our case, CT demonstrated that the calcification was within a structure connected to the small bowel.…”

“…In our case, CT demonstrated that the calcification was within a structure connected to the small bowel. The possible location of an enteric enterolith could be in a blind pouch after a side-to-side anastomosis [8], urinary calculi in an ileal conduit, areas of dilated, and the chronically obstructed small bowel above a site of stricture as in Crohn disease or tuberculosis [3]. The presence of distended bowel loops and associated chronic inflammatory changes did not exclude these possibilities in our case.…”

“…Enteroliths, a rare complication of Meckel's diverticula, are formed in situations of stasis of intestinal contents in blind pouches, side-to-side anastomosis, proximal to a stricture and/or presence of enteric alkaline environment [3]. Though Meckel's diverticula have wide necks, and the wall is capable of peristalsis, enteroliths are formed in narrow neck diverticula with absent ectopic tissues, which usually create an acid environment and precipitate calcium salts [3][4][5].…”

“…Though Meckel's diverticula have wide necks, and the wall is capable of peristalsis, enteroliths are formed in narrow neck diverticula with absent ectopic tissues, which usually create an acid environment and precipitate calcium salts [3][4][5]. The presence of stones in Meckel's diverticula predisposes to intestinal obstruction by promoting local inflammation of the diverticulum [6], external compression of other loops of bowel [7], and intussusception or impaction following extrusion from the diverticulum; they might be multiple in 65 % of the instances [8].…”

“…Generally, operative management includes enterolith fragmentation, milking into the proximal colon, and removal through an enterotomy [3]. The Meckel's diverticulum also has to be resected to prevent recurrent complications.…”