Small Bowel Obstruction due to Meckel’s Diverticulum and Laparoscopic Management: A Report of Two Cases

Abstract

A giant Meckel’s diverticulum, typically defined as measuring more than 5 cm in length, is a rare entity and is more prone to complications, particularly small bowel obstruction in adults. Such obstruction may occur due to torsion, volvulus, or entrapment of adjacent bowel loops. Meckel’s diverticulum generally ranges from 1 to 10 cm in size, and approximately 4–9% of cases develop complications, with intestinal obstruction being the most common presentation in adults. Increased size and length of a giant Meckel’s diverticulum are considered significant predisposing factors for obstruction. Clinical presentation may include severe abdominal pain, abdominal distension, nausea, vomiting, and constipation. It can also mimic acute appendicitis, making preoperative diagnosis challenging. This study reports a two rare case of giant Meckel’s diverticulum causing small bowel obstruction. The first case involved a 35-year-old male presenting with acute intestinal obstruction, where diagnostic laparoscopy revealed a giant gangrenous diverticulum adherent in the pelvis causing bowel entrapment. The second case was a 40-year-old female with mechanical obstruction due to a fibrous band arising from the diverticulum. Both patients were successfully managed using laparoscopic-assisted techniques, including transumbilical laparoscopic-assisted (TULA) resection and extracorporeal anastomosis of the small intestine. In both cases, segmental ileal resection with diverticulectomy was performed, and postoperative recovery was uneventful, with discharge on postoperative day 7. In conclusion, Meckel’s diverticulum should be considered a differential diagnosis in adult patients presenting with small bowel obstruction. Laparoscopic management can be considered a feasible and effective modality, offering both diagnostic and therapeutic benefits with favorable outcomes.