Meso-diverticular band causing small bowel obstruction in an infant: a case report and literature review

Abstract

Introduction: Meckel's diverticulum (MD) is the embryonic remnant of the omphalomesenteric duct that occurs in approximately 2% of the population. Although usually asymptomatic, it can, in some cases, cause complications in the form of ulceration, hemorrhage, intussusception, intestinal obstruction, and perforation. Case presentation: A 3-month-old male infant presented with a 4-day history of crampy abdominal pain, bilious vomiting, abdominal distension, constipation, and poor feeding. On admission, he appeared acutely ill with signs of shock. After nasogastric decompression, fluid resuscitation, and initiation of intravenous antibiotics, his clinical status improved. Laboratory studies showed mild leukocytosis and elevated blood urea nitrogen, while abdominal radiography revealed dilated bowel loops. Urgent exploratory laparotomy was performed, and intraoperatively, an 8 cm gangrenous segment of ileum was found entrapped by a meso-diverticular band arising from a 3 cm MD located 30 cm proximal to the ileocecal valve. The gangrenous ileum along with the diverticulum was resected, followed by ileal end-to-end anastomosis. The postoperative course was uneventful, and the patient was discharged in stable condition. Discussion: Unlike in adults, intestinal obstruction is not a frequent complication of MD in children. Small-bowel obstruction due to MD can occur through several mechanisms, including intussusception, volvulus, fibrous or meso-diverticular bands, internal hernias, and other uncommon causes, often presenting with nonspecific features similar to other causes of obstruction. This case is unusual because it involves a pediatric patient in whom a short meso-diverticular band alone created an internal hernia, leading to bowel entrapment, a rare mechanism of obstruction in children. Conclusion: A mesodiverticular band is a potential cause of acute intestinal obstruction in pediatric patients. Early surgical exploration remains crucial in unstable patients, as timely intervention can be lifesaving and result in favorable outcomes.