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SMALL BOWEL OBSTRUCTION SECONDARY TO INTUSSUSCEPTION: A RARE PRESENTATION OF INVERTED MECKEL'S DIVERTICULUM IN AN ADULT
Jennifer F. Tapley
*, Michael Shockley, Alexander Abdurakhmanov
Surgery, Maimonides Medical Center, Brooklyn, NY
Background
Meckel’s diverticulum (MD) is a congenital abnormality arising from the incomplete obliteration of the omphalomesenteric duct in utero. It is the most common congenital gastrointestinal anomaly, with an incidence of 2–4%. MD presentations vary, including gastrointestinal bleeding (most common in children), intussusception, and small bowel obstruction (SBO). In adults, obstruction accounts for approximately 35% of cases. Here, we present a rare case of inverted MD causing intussusception and subsequent SBO.
Case Presentation
The case is that of a 20-year-old male with no significant medical history presented with a one-month history of worsening intermittent right lower quadrant pain, crampy in nature and exacerbated by eating. He denied nausea, vomiting and reported normal gas passage with his last bowel movement being two days prior. His surgical history consisted of a laparoscopic appendectomy. A computed tomography (CT) scan revealed a distal small bowel (SB) intussusception caused by a lipomatous lead point, resulting in SBO (Figure 1). Laboratory findings were within normal limits. The patient was admitted and underwent diagnostic laparoscopy with SB resection and stapled anastomosis.
During the procedure, the SB was methodically inspected proximally from the ileocecal valve to approximately 75 cm, where the intussusception was encountered. Reduction of the intussusception revealed a palpable intraluminal mass within the ileum. A 15 cm segment of the affected SB was resected. On the back table, inspection of the specimen revealed an inverted and ischemic MD (Figure 2). Examination of the remaining SB and colon revealed no additional lesions or areas of suspicion.
Pathology confirmed ischemic SB with heterotopic pancreatic tissue, consistent with an intussuscepted MD. The remainder of his post-operative course was uneventful. Bowel function returned by postoperative day 2, and he tolerated incremental dietary advancements. At follow-up, he remained symptom-free with fully healed surgical incisions.
Conclusion
This case highlights an unusual presentation of intussusception caused by an inverted MD leading to SBO in an adult. Inverted MDs, often reported through case studies, typically present with intermittent abdominal pain or bleeding. Their resemblance to lipomas on CT, due to invaginated mesenteric fat, complicates preoperative diagnosis. Thus, inverted MD should be considered as a potential lead point for adult SB intussusception.
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