EP914 - Small bowel obstruction secondary to Meckel’s diverticulum in a patient with extensive abdominal surgical history

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Purpose/Background: Meckel’s diverticulum (MD), affecting 2% of the population, is a congenital anomaly of the gastrointestinal tract and results from incomplete obliteration of the omphalomesenteric duct. MD is more commonly found in men. MD is usually asymptomatic, with a lifetime complication rate of 6% that usually presents under the age of 10. Because MD is asymptomatic and the risk of complications decreases with aging, MD in adult patients is often overlooked as a differential diagnosis. Missed diagnoses may lead to mismanagement or delays in treatment, particularly in cases presenting with nonspecific symptoms.
Very few cases of small bowel obstruction (SBO) secondary to MD in adult women have been reported in the literature to date. This complication is rare to encounter, especially in low-risk patients such as women greater than 40 years old. Herein, we present the case of a 60-year-old female patient who suffered from SBO due to MD that was definitively diagnosed only after exploratory laparoscopy.

Methods/Interventions: We reviewed a case from our practice where a 60-year-old female with history of COPD, and multiple abdominal surgeries presented with small bowel obstruction with transition point in right lower quadrant at the level of the distal ileum which was found to be thickened on imaging. Upon failing medical management, patient was taken to the operating room for diagnostic laparoscopy. Intra-operatively, the terminal ileum was found to be strictured and an ileocecectomy was performed. Surgical pathology reported that upon opening the resected cecum and terminal ileum, a marked diverticulum measuring 1.5 cm in depth by 1.5 cm in length was revealed, adjacent to an area of stricture that reduced the lumen to a circumference of 2.5 cm and on histopathologic analysis, surgical specimen showed preserved villous and crypt architecture, normal folding, and multifocal erythema, but was negative for dysplasia or malignancy essentially showing a Meckel’s diverticulum.

Results/Outcomes: Our patient with small bowel obstruction secondary to Meckel’s diverticulum stricture managed with ileocecectomy had post-operative course complicated by ileus managed with bowel rest and decompression and was successfully discharged on post-operative day 11. Patient was followed for 1 month post-operatively and was recovering well without any long term post-operative complications.

Conclusion/Discussion: Meckel’s diverticulum, an incomplete obliteration of the omphalomesenteric duct, is rare in adulthood and most commonly presents as a small bowel obstruction. Much of the existing literature on SBO due to MD occurs in high-risk patients without a prior abdominal surgical history. This report highlights the importance of considering MD in the setting of SBO in a patient with a history of abdominopelvic surgeries and chronic nonspecific abdominal symptoms. The workup would most likely remain the same - imaging, diagnostic laparoscopy, and resection if symptoms do not improve with conservative management. In clinical practice, higher suspicion of Meckel’s diverticulum as source of bowel obstruction and expediting surgical intervention or consideration of prophylactic diverticulectomy would benefit and could improve outcomes in this subset of population.