Meckel’s Diverticulum-Mediated Congenital Band Causing Small Bowel Obstruction in an Adult Without Previous Abdominal Surgery: A Case Report

Abstract

Meckel’s diverticulum is the most common congenital anomaly of the gastrointestinal tract; however, it is usually asymptomatic. Small bowel obstruction caused by a Meckel’s diverticulum–related congenital band is rare and presents a diagnostic challenge in adults with no previous abdominal surgery. We report such a case and describe the surgical management performed. A 46-year-old man, a chronic smoker with no prior abdominal surgery, presented with one day of diffuse abdominal pain and a single episode of vomiting while still passing stool and flatus. He was afebrile and haemodynamically stable, with mild abdominal distension and diffuse tenderness but no peritoneal signs. Investigations showed a marked inflammatory response (C-reactive protein 208.5 mg/L; white cell count 14.4 × 10³/μL with neutrophilia). Computed tomography showed small bowel dilatation (up to 48 mm) with a beak-shaped transition at the umbilicus and no bowel-wall abnormality, pneumoperitoneum or effusion, suggesting mechanical obstruction due to a probable band. At laparotomy, a Meckel’s diverticulum, whose tip was adherent to the sigmoid mesentery, formed a fibrous band beneath which a loop of small bowel had herniated and become obstructed, producing a closed loop. The band was divided, the bowel was decompressed, and segmental resection with primary anastomosis, including the diverticulum, was performed. Recovery was uneventful. A Meckel’s diverticulum–related band should be considered in adults with mechanical obstruction and no surgical history. A marked inflammatory response may signal early ischaemia despite reassuring imaging. Early exploration with band division and resection of the diverticulum is the definitive treatment and can result in favourable outcomes.