A Bolt from the “Band” - Case Report of an Unusual Mesodiverticular Band Causing Small Bowel Obstruction

Abstract

Background: Aberrations in the normal involution of the Vitello-intestinal duct results in a broad entity termed the Omphalomesenteric Duct Remnants (ODR) with the Meckel’s Diverticulum being its most popular member. This article focusses on one atypical variant of ODR, the mesodiverticular band which disrupts the apparent innocuous image of the ODRs often predisposing to life threatening situations in affected individuals as opposed to the usual ODR variants. This article brings to light the importance of such a rare entity with a brief review of available literature and attempts to invoke questions in the minds of the readers regarding several unexplored aspects of these disorders. Presentation of Case: A 28-year-old man who presented to the emergency with complaints of pain lower abdomen gradually spreading to the entire abdomen for the symptom duration of 2 days. Evaluation revealed the presence of a closed loop obstruction of the distal ileal segment with no clear etiology. The patient underwent laparotomy with resection of the obstructed gangrenous segment caused by a mesodiverticular band associated with a Meckel’s diverticulum. The post op course was uneventful and discharge of the patient was done on POD-5. Conclusion: The presence of the extremely rare mesodiverticular band with the Meckel’s diverticulum can lead to causation of devastating consequences and even death in rare occasions secondary to bowel obstruction. This article attempts to raise questions on the need for screening and identification of such Omphalomesenteric duct remnants and also wishes to alert the reading surgeon to consider this entity in patients presenting with intestinal obstruction with no apparently identifiable cause as early suspicion and prompt treatment could prove to be lifesaving in such patients.