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CORRECTED PROOF
Annals of Medicine and Surgery xxx (xxxx) 103734
Contents lists available at ScienceDirect
Annals of Medicine and Surgery
journal homepage: www.elsevier.com/locate/amsu
Case Report
Meckel's diverticulum causing acute intestinal obstruction: A case report
and comprehensive review of the literature
Talal Almas a,∗, Abdulla K. Alsubai a, Danyal Ahmed a, Muneeb Ullah b, Muhammad Faisal Murad b,
Khadeer AbdulKarim a, Eissa Sultan Alwheibi a, Mohamed Alansaari a, Tala Abdull atif c,
Sebastian Hadeed a, Muhammad Omer Khan a, Majid Alsufyani a, Enaam Alzadjali a, Arjun Samy a,
Mert Oruk a, Mhmod Kadom a, Fatemah Saleh Alhajri a, Ahmed Barakat a,
Maen Monketh Alrawashdeh a, Mohammad Said a, Reem AlDhaheri a, Emad Mansoor d
aRoyal College of Surgeons in Ireland, Dublin, Ireland
bMaroof International Hospital, Islamabad, Pakistan
cNational University of Ireland Galway, Galway, Ireland
dDivision of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
ARTICLE INFO
Keywords:
Meckel's diverticulum
Acute intestinal obstruction
ABSTRACT
Introduction: Meckel's diverticulum is a congenital anomaly that is often detected incidentally. When it presents
symptomatically, it causes painless gastrointestinal bleeding. Nevertheless, in rare instances, it can cause acute
intestinal obstruction, often obscuring the true clinical picture.
Case presentation: A 31-year-old male presented to the emergency department with a 24-h history of unremitting
nausea, biliary emesis, abdominal distension, and absolute constipation. After ruling out the most common eti-
ologies of acute bowel obstruction, radiological imaging was obtained and was suggestive of meckel's diverticu-
lum. Laparoscopic meckel's diverticulectomy was performed, with the subsequent histopathological analysis
confirming ectopic gastric tissue.
Discussion: Meckel's diverticulum occurs consequent to incomplete obliteration of the vitelline or omphalome-
senteric duct, which connects the developing intestines to the yolk sac. It is found in roughly 2% of the popula-
tion, of which only about 4% may become symptomatic due to any number of complications. Specifically, small
bowel obstruction (SBO) and diverticulitis secondary to ectopic gastric or pancreatic tissue are the most common
presentations of symptomatic MD.
Conclusion: Although relatively rare in adults, MD should be considered in the list of differentials in patients
with intussusception leading to SBO, especially on a background history unremarkable for the most common
etiologies causing SBO including post-operative adhesions and hernias.
1. Introduction
Acute intestinal obstruction continues to be a medical and surgical
emergency that warrants an emergency intervention. Acute bowel ob-
struction usually presents with a vague constellation of symptoms, of-
ten characterized by bilious/non-bilious emesis, nausea, vomiting,
anorexia, and abdominal pain [1]. While postoperative adhesions and
tumors afflicting the bowel remain leading causes of acute intestinal ob-
struction, rarer entities, such as Meckel's diverticulum, can seldom be
the source, often obscuring the true clinical picture [2,3]. In gastroen-
terology literature, post-operative adhesions and hernias are frequently
cited as being the leading causes of small bowel obstruction. However,
rare congenital abnormalities such as meckel's diverticulum are not
routinely thought to be the source of acute small bowel obstruction
[2,3]. Meckel's diverticulum (MD) is defined as a congenital anomaly
that ensues in the wake of partial closure and persistence of the
vitelline, or the omphalomesenteric, duct during embryogenesis [1,2].
This usually occurs in the fifth week of development and causes a true
outpouching of the small intestine, located approximately two feet from
the ileocecal valve [2,3]. It is the most common congenital abnormality
afflicting the gastrointestinal tract and has been reported in up to 1–3%
of patients [2]. MD, a true diverticulum, involves all layers of the small
∗Corresponding author. Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin, Ireland.
E-mail address: Talalalmas.almas@gmail.com (T. Almas).
https://doi.org/10.1016/j.amsu.2022.103734
Received 16 March 2022; Received in revised form 1 May 2022; Accepted 4 May 2022
2049-0801/© 20XX
Note: Low-resolution images were used to create this PDF. The original images will be used in the final composition.
CORRECTED PROOF
T. Almas et al. Annals of Medicine and Surgery xxx (xxxx) 103734
Fig. 1. An abdominal x-ray divulging multiple air-fluid levels within the colon,
thus alluding to an obstructive etiology.
intestine and is known to contain ectopic gastric mucosa [1]. It is gener-
ally asymptomatic and is usually discovered incidentally during surgi-
cal exploration of other diseases or less commonly through diagnostic
imaging [1]. However, hemorrhagic, inflammatory, and obstructive
complications can arise [1–3]. Additionally, MD can present with pain-
less bleeding due to ectopic gastric acid and pepsin production in the di-
verticulum (gastric mucosa or pancreatic differentiation in MD mu-
cosa), further complicating the clinical picture [3,4]. In patients pre-
senting with painless gastrointestinal bleeding of unknown etiology,
MD may be suspected [2,3]. Nonetheless, acute intestinal obstruction
consequent to the presence of meckel's diverticulum in the adult popu-
lation remains a clinical enigma [3,4]. Herein, we elucidate the case of
a 31-year-old male who presented with chief complaints of nausea, bil-
iary emesis, and abdominal distension on a background of unremark-
able medical and surgical history. Further investigative workup di-
vulged the presence of meckel's diverticulum, with subsequent divertic-
ulectomy resulting in prompt abatement of the patient's symptoms. The
overarching objective of the present paper is to prompt clinicians to rec-
ognize MD as a potential cause of acute small bowel obstruction. Al-
though the patient's age at presentation can yield imperative diagnostic
cues, MD should nevertheless be considered in the list of differentials in
patients presenting with acute small bowel obstruction regardless of
age.
2. Case presentation
A 31-year-old male presented to the emergency department with a
24-h history of unremitting nausea, biliary emesis, abdominal disten-
sion, and absolute constipation. Notably, the patient's last regular
bowel movement had been three days prior to the current presentation,
with the patient erroneously attributing his altered bowel habits to his
recent onset of anorexia of unknown origin. The patient reported no red
flag symptoms, affirmatively denying recent fevers, previously altered
bowel habits, infectious urinary symptoms, or weight loss. The patient's
prior medical and surgical histories were unimpressive, and he reported
no other comorbidities. Pertinently, the patient had had an episode sim-
ilar to the current one four years ago; at the time, his condition was
managed conservatively and resulted in a prompt resolution of his
symptoms within 24 hours of his presentation to the hospital. The pa-
tient remained asymptomatic thereafter with no consequent episodes
till the current presentation.
Upon clinical examination, the patient appeared profusely unwell,
with excruciating, 7/10, vague, non-localized abdominal pain that
caused significant distress to the patient. Abdominal examination re-
vealed a soft, distended abdomen that was non-tender with no evidence
of rigidity, peritonitis, or guarding. Pertinently, bowel sounds were au-
dible and were noted to be tinkling in nature, raising the initial suspi-
cions for an obstructive etiology underlying the patient's clinical pre-
sentation. The murphy's sign, along with the psoas, obturator, and rovs-
ing's signs, were all negative and unimpressive, effectively ruling out
acute cholecystitis and acute appendicitis as plausible etiologies. The
patient's past surgical history was also unimpressive, further precluding
post-operative adhesions as the likely etiology. Upon clinical examina-
tion, there was no evidence of hernial protrusions, and the genital ori-
fices were unremarkable. Furthermore, clinical examination of the ab-
domen did not reveal any rigidity or guarding, and no signs of peritoni-
tis were appreciated. The patient's C-reactive protein was raised to 15;
however, his remaining labs were unremarkable for any pertinent de-
rangements. In order to better delineate the etiology underlying the pa-
tient's presentation, an abdominal x-ray was obtained and revealed
multiple air-fluid levels in the small bowel (Fig. 1).
Based on the patient's x-ray findings, an obstructive pathology was
deemed plausible. However, given that the patient demonstrated an un-
remarkable surgical history and did not show signs of a possible gas-
trointestinal malignancy, adhesions, and tumor as causes of acute in-
testinal obstruction were effectively ruled out. Further radiological in-
vestigation through the means of a computed tomography (CT) scan di-
Fig. 2. CT scan of the patient's abdomen showing a transition point in the terminal ileum (red arrow), with mesenteric band cut-off. (For interpretation of the refer-
ences to colour in this figure legend, the reader is referred to the Web version of this article.)
2
CORRECTED PROOF
T. Almas et al. Annals of Medicine and Surgery xxx (xxxx) 103734
Fig. 3. CT scan of the abdomen showing the presence of meckel's loops (red ar-
row), further alluding to the presence of meckel's diverticulum. (For interpreta-
tion of the references to colour in this figure legend, the reader is referred to the
Web version of this article.)
vulged a transition point in the terminal ileum, with mesenteric band
cut-off, strongly alluding to the presence of a diverticulum in the speci-
fied region (Fig. 2).
The CT imaging of the abdomen further revealed the presence of the
classical meckel's loops, thereby confirming the presence of meckel's di-
verticulum (Fig. 3).
Considering the impression obtained from the patient's radiological
work-up, a multidisciplinary team meeting (MDT) was conducted. The
presence of meckel's diverticulum due to an acute small bowel obstruc-
tion was deemed exceedingly plausible. Consequently, the patient was
managed using conservative measures for the next 24 hours; however,
the patient refused a nasogastric tube, which would have been pivotal
in relieving the obstruction. During this time, the patient had an
episode of nominal bowel motion once but did not pass any flatus. Con-
servative treatment was thus continued, and the patient was prepared
for a laparoscopic diverticulectomy.
During the operation, meckel's diverticulum in close proximity to
the ileocecal valve was confirmed. Per-operative evaluation divulged
meckel's diverticulitis with the tip attached to the ileal mesentery
through the means of a band (Fig. 4).
Given this intraoperative finding, tip and band release was per-
formed (Fig. 5).
Additionally, given the presence of meckel's diverticulitis and the
fact that the patient had been symptomatic four years prior to the cur-
rent episode, meckel's diverticulectomy was performed (Fig. 6).
The surgery was conducted unremarkably, with no intra- or periop-
erative complications encountered during the process. Postoperatively,
the patient remained well and symptom-free except for a minor wound
infectious from the hypogastric port used for specimen delivery during
the surgery. Daily wound dressings were advised without the need for
antibiotics.
The subsequent histopathology report confirmed the presence of dif-
fusely inflamed ectopic gastric mucosa in close proximity to the ileoce-
cal valve, reinforcing meckel's diverticulum as the culprit etiology un-
derlying the patient's episode.
The present paper was reported in line with the SCARE guidelines
[5].
3. Discussion
Meckel's diverticulum (MD) is one of several congenital abnormali-
ties that can result from incomplete obliteration of the vitelline or om-
phalomesenteric duct, which connects the developing intestines to the
yolk sac during development, and is a true diverticulum composed of
all intestinal layers [6]. It is found in roughly 2% of the population, of
which only about 4% may become symptomatic due to any number of
complications [6]. Specifically, small bowel obstruction (SBO) and di-
verticulitis secondary to ectopic gastric or pancreatic tissue are the
most common presentations of symptomatic MD [7]. When it does pre-
sent with obstructive symptoms, subsequent complications may arise in
up to 36.5% of cases via a vast myriad of mechanisms [8]. Obstruction
can commonly occur due to volvulus or torsion of the intestine around a
fibrous band from MD to the umbilicus; intussusception or inversion of
the MD into the ileum or cecum; or mesodiverticular band trapping the
small bowel under the vascular supply of the MD and potentially lead-
ing to strangulation [9]. With symptomatic MD patients representing
only 0.08% of the total population, the exceeding rarity of the condition
leads to poor rates of pre-operative diagnosis, thereby obscuring the
Fig. 4. Per-operative image delineating meckel's diverticulitis with the tip attached to the ileal mesentery through the means of a band.
3
CORRECTED PROOF
T. Almas et al. Annals of Medicine and Surgery xxx (xxxx) 103734
Fig. 5. Intraoperative image demonstrating tip and band release.
Fig. 6. Per-operative image obtained after meckel's diverticulectomy was performed.
true clinical picture [9]. Early recognition is of paramount importance
since a delay in surgery of 36 hours or more can triple the mortality rate
from 8% to 25% in patients presenting with strangulation [10]. In this
context, it is imperative that clinicians are aware of MD, its associated
clinical findings, and the best practices for its diagnosis and manage-
ment.
The present study elucidates a case of a 31-year-old male patient
with acute onset of symptoms consistent with obstruction. The patient
presented with the classical tetrad of bowel obstruction involving nau-
sea, emesis, abdominal distension, and constipation [11]. Diagnostic
imaging showed multiple air-fluid levels, which indicate pathological
accumulation of fluid and gas and are a hallmark finding in X-ray and
CT of SBO [12]. Ultrasound for Meckel's Diverticulum is feasible and
can identify mesodiverticular bands as a hyperechoic line, particularly
in pediatric patients. However, CT scan was found to be more accurate
in determining the cause of small bowel obstruction in adults [13]. In
cases with ectopic mucosa in the diverticular outpouch, a Meckel's ra-
dionuclide scan, which injects technetium-99 m as a dye to detect gas-
tric tissue, can be performed [14]. A previous study found the transition
zone was located near the midline in 80% of patients. In our case, the
transition point was identified in the terminal or distal ileum [15].
Interestingly, volvulus of the MD was not suspected as a mechanism
of obstruction in our case as there was no fibrous band connecting the
MD to the umbilicus. We also did not suspect intussusception of the
small bowel due to the absence of inversion of the diverticular out-
pouching into the ileum or cecum. The subsequent histopathology re-
port showed unremarkable intestinal tissue. The lack of ectopic tissue
thus suggests diverticulitis as a cause of inflammation, and subsequent
obstruction was not a likely differential. Instead, the tip of the Meckel's
diverticulum with a band attached to the ileal mesentery was discov-
ered per-operatively during the diverticulectomy. Thus, mesodiverticu-
lar band (MDB) of Meckel's diverticulum was determined to be the
cause of SBO in this patient. The MDB is a remnant of the vitelline
artery, which supplies Meckel's Diverticulum and provides a bridge for
bowel loops to herniate and become strangulated, gangrenous, is-
chemic, or otherwise mechanically obstructed [16,17].
Surgery, in specific meckel's diverticulectomy, remains the mainstay
of treatment in such cases. The most common forms are diverticulec-
tomy, wedge, or segmental resection, and the rationale for which proce-
dure to form depends largely on the integrity of the diverticular base
and proximal ileum and the location of ectopic tissue if any [3]. Wedge
or segmental resection is recommended for MD with SBO; however, di-
verticulectomy was performed in our patient with full recovery and res-
olution of symptoms [3]. Generally, prophylactic removal of MD found
incidentally is still a controversial topic, with one systematic review of
4
CORRECTED PROOF
T. Almas et al. Annals of Medicine and Surgery xxx (xxxx) 103734
Table 1
Cases implicating MD as a causative etiology underlying SBO.
Author Year Age Sex Dx Imaging Imaging finding Surgery Follow up Treatment Symptoms
Shelat et al.
[18]
2011 15 F Abd & chest x-
ray and CT of
Abd and pelvis
Mild dilatation of the small
bowels, particularly in the distal
jejunum and proximal ileum
with thickening of the bowel
wall and submucosal oedema.
No transition point was seen on
the CT scan
Exploratory
laparotomy
Alive, no
complications
Segment of the terminal ileum
containing the MD and adhesion band
was resected and stapled anastomosis
with linear staples was performed
Colicky
central
abdominal
pain
associated
with loss of
appetite and
nausea.
Luu et al.
[19]
2016 34 NA CT of Abd and
pelvis
Dilated small bowel loops & non-
propulsive peristalsis and small
bowel obstruction in the right
lower abdominal quadrant
Ileo-ileostomy Alive and
well
Incision of the small intestine and
resection of ileum
Abd pain,
nausea,
vomiting
Ying et al.
[20]
2020 50 M CT of Abd and
pelvis
Several distended and fluid-filled
small bowel loops throughout
the abdomen with a transition
point within the right lower
quadrant suggestive of adhesions
Laparotomy Alive and no
issues on
follow up in
outpatient
clinic
Scarred section of MD and the adjacent
small bowel segment was resected, and
a side-to-side hand-sewn anastomosis
was proceeded
Abd pain,
nausea,
vomiting
Jabri et al.
[21]
2012 26 M CT of Abd and
Abd x-ray
dilated loops of small bowel,
with no free air under either
diaphragm
Laparotomy Alive and
recovered
IV and resection of the MD with closure
of the bowel was performed and
contents of small bowel were drained
into stomach
Abd pain,
nausea,
vomiting
Gunadi et
al. [22]
2021 0.16 F Abd x-ray Small-bowel obstruction Exploratory
laparotomy
Alive and
gradual
recuperation
Segmental small-bowel resection with
primary anastomosis
Abd
distention,
nausea,
vomiting
Gunadi et
al. [22]
2021 5 M Abd x-ray Small-bowel obstruction,
perforated MD and an inflamed
appendix
Small-bowel
resection
Alive and
recovered
gradually
Primary anastomosis and
appendectomy
Abd pain,
nausea,
vomiting
Gunadi et
al. [22]
2021 1.41 F Upper GI Series Found no abnormality in the
upper GI tract
Exploratory
laparotomy
Alive and
gradual
recovery
Segmental small-bowel resection with
primary anastomosis
Abd pain,
nausea,
vomiting
Thakor et
al. [23]
2007 74 M Supine
abdominal x-ray
and CT of
abdomen
Dilated loops of small bowel and
stricture in the terminal ileum of
unknown etiology
Laparotomy Alive and
recovered
MD was divided to release the
obstruction, mobilised and
subsequently removed
Cardinal
symptoms,
abd pain
Ebrahimi et
al. [24]
2021 24 M Abd CT Distal small bowel obstruction Diagnostic
laparoscopy
Alive and
recovered
MD was exteriorized through a
laparotomy and small bowel resection
with a side-to-side stapled anastomosis
was performed.
Crampy
abdominal
pain and
vomiting
Ebrahimi et
al. [24]
2021 56 M Abd CT Distal small bowel obstruction Diagnostic
laparoscopy
Alive and
recovered
MD was exteriorized and tethered to
the mesentery through a band
containing the diverticular blood
supply
Crampy
abdominal
pain,
vomiting
and
obstipation
Almetaher
et al. [25]
2020 3–7 M Abd CT Small bowel obstruction Laparotomy Alive and
recovered
IV given and small intestinal loops
proximal to the obstruction was
resected together with MD and the
continuity of the bowel was restored
with end-to-end anastomosis
Abd pain
and
vomiting
Bains et al.
[26]
2021 30 F Abd X-ray and
Abd CT
Dilated jejunal and proximal
ileal loops
Laparoscopic
procedure
Alive and
good health
Small midline incision at the umbilicus
and ileo-ileal anastomosis performed
GI bleeding
and acute
Abd pain
Benjelloun
et al. [27]
2009 28 M Supine
abdominal x-
rays and Abd CT
Dilated small-bowel loops with
air-fluid levels and lesion in the
left upper quadrant with dilated
small bowel loops proximally
Laparotomy Alive and
recovered
Intussusception was milked, and
localized ileal resection with MD was
undertaken
Abd pain,
nausea and
bilious
vomiting
Dutta et al.
[28]
2009 55 M Abd X-ray and
CT Abd
Non-obstructive bowel pattern
and complete mid to distal small
bowel obstruction
Laparotomy No follow up
mentioned
MD was exteriorized Mid-lower
and sharp
Abd pain
Nunes et al.
[29]
2009 47 M Ultrasound scan Fluid filled area containing
echogenic components in the
right iliac fossa with a trace of
free fluid surrounding it and
antimesenteric diverticulum
Lower midline
laparotomy
Alive and
recovered
well
Resection of small bowel segment Colicky
central Abd
pain and
diarrhoea
(continued on next page)
5
CORRECTED PROOF
T. Almas et al. Annals of Medicine and Surgery xxx (xxxx) 103734
Table 1 (continued)
Author Year Age Sex Dx Imaging Imaging finding Surgery Follow up Treatment Symptoms
Zhang et al.
[30]
2020 45 F Abd CT Focal dilatation and thickening
of the small bowel loop
Exploratory
laparotomy
Alive and
symptom-free
and has
restored
normal
activity and
diet
Adhesiolysis and resection of the MD
with the gangrenous bowel with
anastomosis was performed
Abd pain
accompanied
by nausea
and
vomiting
Ekwunife et
al. [31]
2014 29 M Not mentioned Perforated Meckel's diverticulum
was identified
Segmental ileal
resection
Alive, healthy
but has
superficial
surgical site
infection
IV and antibiotics were given Worsening
Abd pain in
the
umbilicus
region
Pitiakoudis
et al. [32]
2009 18 M CT enteroclysis MD was found 50 cm proximal
to the ileocecal valve
Exploratory
laparoscopy
No follow up
mentioned
MD was resected by tangential excision
using an Endo-Gia-stapler and it was
removed using an Endocath
Abd
discomfort
in right
lower
quadrant,
vomiting
and fresh
blood in his
stools
Bergland
[33]
1963 73 F Abd x-ray Distended small intestinal loops
with multi-level fluid and gas-
filled segments
Diverticulectomy
and anastomosis
No follow up
mentioned
The enterolith was pushed back and
removed from the lumen of the distal
ileum and the proximal ileum was
decompressed by suction
No
symptoms
mentioned
Field [34] 1959 52 M Erect x-ray Marked distention of the small
bowel, absence of gas in the
large bowel. Fluid levels in the
small bowel
Diverticulectomy No follow up
mentioned
Fecalith manipulated proximally to MD Cramping
Abd pains
Christiansen
et al.,
[35]
1967 48 F Abd x-ray Small bowel obstruction with
possible gallstone ileus
Diverticulectomy No follow up
mentioned
MD was exteriorized NA
Marwah et
al. [36]
2016 22 M CECT Abd and
ultrasound
X-ray of Abdomen revealed
multiple air fluid levels and
CECT of the abdomen also
showed dilatation of small gut
loops up to the ileum with distal
ileal stricture
Colonoscopy and
exploratory
laparotomy
No follow up
mentioned
IV, electrolyte replacement, and
nasogastric aspiration and segmental
ileal resection including the strictured
segment and MD was done along with
ileo-ileal anastomosis
Abd
distension
after meals
Tenreiro et
al. [37]
2015 18 M CT of Abd Revealed wall thickening and
air-fluid levels compatible with
small bowel obstruction, without
apparent mechanical cause
Laparotomy Alive,
remained
asymptomatic
Performed a segmental ileal resection
with primary anastomosis
Right lower
quadrant
pain
Capelao et
al. [38]
2017 51 M Abd x-ray and
CT of Abd
Small bowel with air fluid levels
and paucity of gas in the colon
and abrupt stop of the small
bowel without a clear cause
Laparotomy No follow up
mentioned
IV and MD was ligated Abd
distension,
vomitus, and
epigastric
pain
Newme et
al. [39]
2020 24 M X-ray and USG
Abd
Showed distended small bowel
loops and to and fro movement
of bowel loops
Laparotomy No follow up
mentioned
Terminal ileum was constricted and
indurated; MD was untwirled and
segmental resection of the necrosed
terminal ileum and Meckel's
diverticulum were done
Acute abd
pain and
vomiting
Sarkardeh
and Sani
[40]
2020 92 F Abd X-ray Small bowel with air-fluid levels
and dilated bowel loops
Laparotomy No follow up
mentioned
IV and Segmental small bowel resection
including the diverticulum was
performed with a primary end to end
anastomosis
Abd pain,
vomitus, and
distention
Jabri and
Sherbini
[41]
2012 26 M Abd x-ray and
CT of Abd
Dilated loops of small bowel,
with no free air under either
diaphragm and stricture in the
ileum and collapse of the distal
ileum and large bowel
Laparotomy Alive, no
complications
IV and during surgery the meso-
diverticular band was separated from
the mesentery, the ileal loop was
released from the diverticulum.
Resection of the Meckel's diverticulum
with closure of the bowel was
performed. The small bowel was then
decompressed, and the content was
gently milked into the stomach before
being aspirated via the nasogastric tube
Abd pain,
vomitus, and
distention
(continued on next page)
6
CORRECTED PROOF
T. Almas et al. Annals of Medicine and Surgery xxx (xxxx) 103734
Table 1 (continued)
Author Year Age Sex Dx Imaging Imaging finding Surgery Follow up Treatment Symptoms
Takura et
al. [42]
2021 56 F Abd CT Small intestine was generally
dilated, and there was a closed
loop-like appearance near the
end of the ileum and
surrounding fatty tissue opacity.
A strangulated bowel obstruction
was suspected
Laparotomy Alive, good
progress
MD was resected Abd pain
and
vomiting
Sumer et al.
[43]
2010 17 M Abd x-ray Small intestine exhibited an air
fluid level
Exploratory
laparotomy
Alive,
recovered
well
Resection of the MD Abd pain
and
vomiting
Yazgan et
al. [44]
2016 35 M Abd x-ray and
CECT of Abd
Markedly dilated loops of the
middle and distal small bowel
with multiple air-fluid levels.
Tubular fluid containing
structure found in LQ, deemed
MD. Collapsed distal ileum
Laparotomy Alive, no
complications
Segmental resection and primary end-
to-end anastomosis were performed
Abd pain,
vomiting
and nausea.
Abdomen
distended.
Bouassida et
al. [45]
2011 22 M Abd x-ray Displayed air fluid levels of the
small bowel, no
pneumoperitoneum. Diagnosed
as an acute small bowel
obstruction.
Laparotomy Alive, no
complications
Segmental small bowel resection and
hand-sewn anastomosis was performed
Abd pain
and
vomiting.
Abd was
hard &
tender
Ying and
Yahng
[46]
2020 50 M Abd & chest x-
ray CT of Abd
and pelvis
Dilated stomach and multiple
air-fluid levels respectively.
multiple markedly distended and
fluid-filled small bowel loops
throughout the abdomen with a
transition point within the right
lower quadrant suggestive of
adhesions
Laparotomy Alive, no
complications
Extensively scarred section of MD along
with the adjacent small bowel segment
was resected and a side-to-side hand-
sewn anastomosis
Vomiting,
abdominal
pain and
distension
Murruste et
al. [47]
2014 41 M Abd CT Markedly dilated small-bowel
loops with multiple air-fluid
levels
Laparotomy Alive, no
complications
Approximately 20 cm of the small
bowel with Meckel's diverticulum was
resected
Crampy and
intermittent
abdominal
pain, nausea
and
retention of
stool and
gases
Ramnath et
al. [48]
2018 16 F Erect X-ray Abd
& CT Abd
Narrow lumen of terminal ileum
two feet from ileo-cecal junction
Exploratory
laparotomy
Alive, no
complications
Release of constricting band and
resection of diverticulum along with
segment of ileum was done and end to
end anastomosis of ileum was done.
Abd pain,
vomiting
and
constipation
Skarpas et
al. [49]
2020 63 F Abd x-ray and
CT of Abd
Small bowel obstruction Exploratory
laparotomy
Alive, no
complications
MD band caused obstruction by
trapping of bowel loop. After
separating the band from the
mesentery, the ileal loop was released
from the diverticulum. Resection of the
Meckel's diverticulum and closure of
the bowel were done using a TA
stapler.
Distended
Abd, pain in
the lower
right
abdominal
quadrant,
fever 37 °C
Gupta and
Singh
[50]
2011 32 M Ultrasonography
(USG) of the
Abd, Erect Abdo
x-ray
Revealed hyperperistaltic dilated
small bowel loops and multiple
air fluid levels situated in the
central abdomen and to the left
Exploratory
laparotomy
Alive, no
complications
MD and adhesion were excised, and the
small bowel freed and decompressed.
Abd pain,
nausea,
vomiting
Arslan et al.
[51]
2020 63 M Erect X-ray Abd
& CT Abd
Few distended small bowel loops
and multiple air-fluid levels. CT
showed fluid accumulation in
the intestinal loops and local
dilatation, favoring an
obstruction
Exploratory
laparotomy
Alive, no
complications
A 15 cm segmental small intestine was
resected, including the MD and the
inflammatory and fragile mesentery of
the bowel loops. Then, double end-to-
end anastomosis was performed
manually.
Abd pain,
nausea,
vomiting
Cartanese et
al. [52]
2011 42 M CECT Abd and
ultrasound
A transition point between
dilated and collapsed small
bowel in the right lower
quadrant consistent with a high-
grade small bowel obstruction
was found.
Exploratory
laparotomy
Alive, no
complications
The diverticulum was resected using a
GIA stapler, without small bowel
resection
lower
quadrant
and
suprapubic
pain and
several
episodes of
vomiting
without
flatus.
(continued on next page)
7
CORRECTED PROOF
T. Almas et al. Annals of Medicine and Surgery xxx (xxxx) 103734
Table 1 (continued)
Author Year Age Sex Dx Imaging Imaging finding Surgery Follow up Treatment Symptoms
Zorn et al.
[53]
2022 30 M Abd & chest X-
ray. CT of Abd
Showed dilated loop sof small
bowel and a distal high-grade
SBO with multiple dilated loops
of small bowel throughout the
abdomen measuring up to 3.5
cm in diameter. Mild Ascites
Exploratory
laparotomy
Alive, no
complications
A segmental small bowel resection with
hand sewn primary anastomosis was
performed.
Abd pain,
vomiting
and nausea
Malderen
and
Camilleri
[54]
2018 49 F CT of Abd 15-cm long dilated segment,
diagnosed as localized ileal
dilatation close to the Meckel's
diverticulum
Laparotomy No follow up
mentioned
resection of the Meckel's diverticulum
and appendix
Bloody
stools
Kuru et al.
[55]
2013 17 M Abd x-Ray and
USG
Mildly distended small bowel
loops. Dilated small bowel loops
with a small amount of fluid in
the right lower quadrant
Exploratory
laparotomy
Alive,
recovered
well
MD was resected along the flange of
ileum that encompassed the vascular
territory of inflamed and friable
mesentery. A manual two-layer, end-to-
end anastomosis was performed to
restore the continuity of the small
bowel
Abd pain,
nausea,
vomiting
Marascia
[56]
2019 29 F Abd x-ray and
CT of Abd
Diffuse distention of small bowel
loops without evidence of free
gas within the peritoneum. high-
grade distal SBO with transition
point in the left iliac fossa and
signs suggestive of ileo-ileal
intussusception
Diagnostic
laparotomy
Alive, no
complications
A segmental resection of the distal
ileum 10 cm proximal to the cecum
with a side-to-side anastomosis was
performed
Abd pain
with
associated
vomiting,
abdominal
bloating,
constipation,
and anorexia
Benhamou
[57]
1979 78 M Abd x-ray Small bowel obstruction with
opacity in the right iliac fossa
Laparotomy No follow up
mentioned
Diverticulectomy No
symptoms
mentioned
Hayee et al.
[58]
2003 79 F Abd x-ray Opacity on the left side
Gastro-graffin study: numerous
small bowel diverticula of
varying sizes and minimal
passage of barium beyond the
mid-jejunum
Enterotomy No follow up
mentioned
The stone was found impacted in the
middle of the jejunum and was
removed via a small enterotomy
No
symptoms
mentioned
DiGiacomo
et al. [59]
1993 9 M Abd x-ray Local ileus, multiple dilated
bowel loops
Appendectomy
and
diverticulectomy
No follow up
mentioned
Fecalith was manipulated distally to the
cecum
No
symptoms
mentioned
MD: Meckel's diverticulum.
SBO: Small bowel obstruction.
Abd: Abdominal.
244 cases divulging reduced postoperative consequences for uncompli-
cated and asymptomatic Meckel's Diverticulum left alone [13].
In order to better elucidate the etiology underlying the obstructive
symptoms seen in our case, we conducted a literature search using the
digital databases (PubMed/MEDLINE, CINAHL, and Web of Science) to
search for relevant material and articles implicating MD as a cause of
SBO. The literature search in our search was conducted using the terms
(s): “small bowel obstruction”AND “meckel's diverticulum”OR “diver-
ticulitis”OR “volvulus”OR “intussusception”. The symptomatology,
imaging findings, treatment employed, and the follow-up are delin-
eated by Table 1 below [18–59].
4. Limitations
The present study discusses a case report and delineates a single-
center experience dealing with an unusual etiology underlying acute
small bowel obstruction. While the study yields important evidence sur-
rounding this etiology and prompts the clinicians to aptly recognize this
congenital aberration as a cause of acute small bowel obstruction, it is
limited by its sample size. Further multi-centric cross-sectional studies
evaluating the true, unadjusted incidence of MD as the causative etiol-
ogy underlying acute small bowel obstruction will further yield robust
data to support the presented conclusions.
5. Conclusion
MD is the most common congenital abnormality of the gastrointesti-
nal tract, presenting in 1–3% of patients, of which about 4% may be-
come symptomatic. When asymptomatic, it is discovered incidentally
during surgical exploration or through diagnostic imaging. Various he-
morrhagic, inflammatory, and obstructive complications can arise,
leading to an array of presentations. Nevertheless, the presence of MD
as the causative etiology underlying acute SBO remains a clinical
enigma, with most cases erroneously attributed to post-operative adhe-
sions and/or abdominal hernias. Early diagnosis and a high index of
suspicion are imperative to deliver the most optimal treatment. Al-
though relatively rare in adults, MD should be considered in the list of
differentials in patients with intussusception leading to SBO, especially
on a background history unremarkable for the most common etiologies
causing SBO.
Disclosure
None.
Provenance and peer review
Not commissioned, externally peer-reviewed.
Ethical approval
NA.
Sources of funding for your research
NA.
8
CORRECTED PROOF
T. Almas et al. Annals of Medicine and Surgery xxx (xxxx) 103734
Author contribution
TA, AKA, DA, MU, ESA: conceived the idea, designed the study, and
drafted the manuscript.
KA, MA, TA, OK, MA, EA: conducted comprehensive literature
search, screened the studies for relevant content, and created the litera-
ture review table.
AS, MO, FSA, MK: revised the manuscript critically and refined the
literature review table.
AB, MMA, MS, RA: drafted the discussion part of the manuscript, re-
vised the final version of the manuscript critically based on the re-
viewer and editorial comments.
TA, SH, MFM, EM: Conceived the initial study idea, diagnosed the
case, and gave the final approval for publication.
Registration of research studies
Name of the registry: NA
Unique Identifying number or registration ID: NA
Hyperlink to your specific registration (must be publicly accessible
and will be checked): NA
Consent
Written informed consent was obtained from the patient for publica-
tion of this case report and accompanying images. A copy of the written
consent is available for review by the Editor-in-Chief of this journal on
request.
Guarantor
Talal Almas.
RCSI University of Medicine and Health Sciences.
123 St. Stephen's Green.
Dublin 2, Ireland.
Talalalmas.almas@gmail.com.
Declaration of competing interest
NA.
References
[1] J. Javid, P. MD, M. Pauli, E. MD, UpToDate, Uptodate.com (2022), Retrieved 2
March 2022, from. https://www.uptodate.com/contents/meckels-diverticulum.
[2] A. Tavakkoli, Meckel diverticulum, BMJ best practice (2022), Retrieved 2 March
2022, from. https://bestpractice.bmj.com/topics/en-us/804.
[3] Chee S. Wong, Leanne Dupley, Haren N. Varia, Darek Golka, Thu Linn, Meckel’s
diverticulitis: a rare entity of Meckel’s diverticulum, J. Surg. Case Rep. 1 (January
2017) rjw225, https://doi.org/10.1093/jscr/rjw225.
[4] Meckel’s Diverticulum, Cincinnatichildrens.org, Retrieved 2 March 2022, from.
https://www.cincinnatichildrens.org/health/m/meckels-diverticulum, 2019.
[5] R.A. Agha, T. Franchi, C. Sohrabi, G. Mathewfor the SCARE Group, The SCARE
2020 guideline: updating consensus surgical CAse REport (SCARE) guidelines, Int.
J. Surg. 84 (2020) 226–230.
[6] E.K. Yahchouchy, A.F. Marano, J.C. Etienne, A.L. Fingerhut, Meckel’s
diverticulum, J. Am. Coll. Surg. 192 (5) (2001 May) 658–662, https://doi.org/
10.1016/s1072-7515(01)00817-1, PMID: 11333103.
[7] K. Blouhos, K.A. Boulas, K. Tsalis, et al., Meckel’s diverticulum in adults: surgical
concerns, Front. Surg. 5 (2018) 55, https://doi.org/10.3389/fsurg.2018.00055,
Published 2018 Sep 3.
[8] M. Ymaguchi, S. Takeuchi, S. Awazu, Meckel’s diverticulum. Investigation of 600
patients in Japanese literature, Am. J. Surg. 136 (2) (1978) 247–249, https://
doi.org/10.1016/0002-9610(78)90238-6.
[9] D. Frager, Intestinal obstruction role of CT, Gastroenterol. Clin. N. Am. 31 (3)
(2002) 777–799, https://doi.org/10.1016/s0889-8553(02)00026-2.
[10] S.R. Rami Reddy, M.S. Cappell, A systematic review of the clinical presentation,
diagnosis, and treatment of small bowel obstruction, Curr. Gastroenterol. Rep. 19
(6) (2017) 28, https://doi.org/10.1007/s11894-017-0566-9.
[11] E.K. Paulson, W.M. Thompson, Review of small-bowel obstruction: the diagnosis
and when to worry, Radiology 275 (2) (2015) 332–342, https://doi.org/10.1148/
radiol.15131519.
[12] C. Sun, X. Hu, L. Huang, Intestinal obstruction due to congenital bands from
vitelline remnants: sonographic features and review of the literature, J. Ultrasound
Med. 31 (12) (2012) 2035–2038, https://doi.org/10.7863/jum.2012.31.12.2035.
[13] K.M. Elsayes, C.O. Menias, H.J. Harvin, I.R. Francis, Imaging manifestations of
Meckel’s diverticulum, AJR Am. J. Roentgenol. 189 (1) (2007) 81–88, https://
doi.org/10.2214/AJR.06.125.
[14] Y. Won, H.W. Lee, Y.M. Ku, et al., Multidetector-row computed tomography
(MDCT) features of small bowel obstruction (SBO) caused by Meckel’s
diverticulum, Diagn. Interv. Imag. 97 (2) (2016) 227–232, https://doi.org/
10.1016/j.diii.2015.09.006.
[15] V.R. Manning Jr, E.F. McLaughlin, Persistent omphalomesenteric (vitelline)
artery causing intestinal obstruction and gangrene of Meckel’s diverticulum, Ann.
Surg. 126 (3) (1947) 358–365, https://doi.org/10.1097/00000658-194709000-
00012.
[16] S. Bamarni, S. HungFong, J. Mino, et al., Systematic review of mesodiverticular
band: a rare cause of small bowel strangulation and hemoperitoneum in adults, Int.
J. Surg.: Short Rep. 6 (4) (2021) 33, https://doi.org/10.1097/
SR9.0000000000000033.
[17] A. Zani, S. Eaton, C.M. Rees, A. Pierro, Incidentally detected Meckel
diverticulum: to resect or not to resect? Ann. Surg. 247 (2) (2008) 276–281,
https://doi.org/10.1097/SLA.0b013e31815aaaf8.
[18] V.G. Shelat, K. Kelvin Li, A. Rao, T. Sze Guan, Meckel’s diverticulitis causing
small bowel obstruction by a novel mechanism, Clin. Pract. 1 (3) (2011) e51,
https://doi.org/10.4081/cp.2011.e51, Published 2011 Jul 1.
[19] Andreas Luu, Kirsten Meurer, Torsten Herzog, Waldemar Uhl, Andrea Tannapfel,
Chris Braumann, Small bowel obstruction due to a giant Meckel’s diverticulum,
Visc. Med. 32 (2016), https://doi.org/10.1159/000450589.
[20] L. Ying, J.J. Yahng, A rare case of Meckel’s diverticulum causing small bowel
obstruction in a 50-year-old man, Int. J. Surg. Case Rep. 68 (2020) 107–110,
https://doi.org/10.1016/j.ijscr.2020.01.047.
[21] K.A. Al Jabri, A. El Sherbini, Small bowel obstruction due to Meckel’s
diverticulum: a case report [retracted in: Oman Med J. 2020 Jul 12;35(4):e148].
Oman Med. J. 27 (1) (2012) e029, https://doi.org/10.5001/omj.2012.18.
[22] Gunadi, W. Damayanti, R.P. Saputra, et al., Case report: complicated meckel
diverticulum spectrum in children, Front. Surg. 8 (2021), 674382, https://doi.org/
10.3389/fsurg.2021.674382, Published 2021 May 25.
[23] A.S. Thakor, S.S. Liau, D.C. O’riordan, Acute small bowel obstruction as a result
of a Meckel’s diverticulum encircling the terminal ileum: a case report, J. Med.
Case Rep. 1 (2007) 8, https://doi.org/10.1186/1752-1947-1-8, Published 2007
Mar 23.
[24] N. Ebrahimi, R. Quinn, Y. Liang, R. Curran, A Tale of Two Meckel’s: small bowel
obstruction secondary to Meckel’s Diverticulum, J. Surg. Case Rep. 2021 (3)
(2021), rjab037, https://doi.org/10.1093/jscr/rjab037, Published 2021 Mar 15.
[25] H.A. Almetaher, M.A. Mansour, Acute abdomen in children due to different
presentations of complicated Meckel’s diverticulum: a case series, Ann. Pediatr.
Surg. 16 (2020) 45, https://doi.org/10.1186/s43159-020-00055-7.
[26] L. Bains, R. Bhatia, R. Kaushik, et al., Inverted Meckel’s diverticulum: a case
report, J. Med. Case Rep. 15 (2021) 264, https://doi.org/10.1186/s13256-021-
02736-2.
[27] B. Benjelloun el, A. Ousadden, K. Ibnmajdoub, K. Mazaz, K.A. Taleb, Small bowel
intussusception with the Meckel’s diverticulum after blunt abdominal trauma: a
case report, World J. Emerg. Surg. 4 (2009) 18, https://doi.org/10.1186/1749-
7922-4-18, Published 2009 May 6.
[28] G. Dutta, A.S. Chowdhury, M. Panda, Band of cacophony - abdominal
catastrophe caused by the fibrous band of Meckel’s diverticulum: a case report,
Cases J. 2 (2009) 7160, https://doi.org/10.4076/1757-1626-2-7160, Published
2009 Jul 27.
[29] Q.M. Nunes, A. Hotouras, S. Tiwari, et al., Gangrene due to axial torsion of a
Giant Meckel’s Diverticulum containing multiple stones in the lumen: a case report,
Cases J. 2 (2009) 7141, https://doi.org/10.1186/1757-1626-2-7141.
[30] Y. Zhang, Y. Guo, Y. Sun, Y. Xu, An internal hernia caused by Meckel’s
diverticulum: a case report, BMC Gastroenterol. 20 (1) (2020) 69, https://doi.org/
10.1186/s12876-020-01211-4, Published 2020 Mar 12.
[31] C.N. Ekwunife, T.N. Mbadugha, U.N. Ogbue, Isolated Meckel’s diverticulum
perforation as a sequel to blunt abdominal trauma: a case report, J. Med. Case Rep.
8 (2014) 111, https://doi.org/10.1186/1752-1947-8-111, Published 2014 Apr 2.
[32] M. Pitiakoudis, G. Vaos, M. Kirmanidis, S. Gardikis, E. Tsalkidou, C. Simopoulos,
Technetium-99m scan in the laparoscopic management of a misdiagnosed Meckel’s
diverticulum: a case report, J. Med. Case Rep. 3 (2009) 6981, https://doi.org/
10.1186/1752-1947-3-6981, Published 2009 Apr 29.
[33] R.M. Bergland, F. Gump, J.B. Price Jr, AN unusual complication OF MECKEL’S
diverticula seen IN older patients, Ann. Surg. 158 (1) (1963) 6–8, https://doi.org/
10.1097/00000658-196307000-00002.
[34] R.J. Field, R.J. Field, Intestinal obstruction produced by fecalith arising in
Meckel’s diverticulum, AMA Arch. Surg. 79 (1) (1959) 8–9, https://doi.org/
10.1001/archsurg.1959.04320070012002.
[35] K. Christiansen, R.P. Cancelmo, Meckel’s stone ileus, Am. J. Roentgenol. 99
(1967) 139–141, 1.
[36] S. Marwah, P. Singla, N. Marwah, S. Gupta, V.P. Singh, Ileal stricture following
Meckel’s diverticulitis: a rare cause of intestinal obstruction, Clin. J. Gastroenterol.
9 (3) (2016) 118–123, https://doi.org/10.1007/s12328-016-0647-6.
[37] N. Tenreiro, H. Moreira, S. Silva, L. Madureira, J. Gaspar, A. Oliveira, Unusual
presentation of a Meckel’s diverticulum: a case report, Int. J. Surg. Case Rep. 16
(2015) 48–51, https://doi.org/10.1016/j.ijscr.2015.09.013.
[38] G. Capelão, M. Santos, S. Hilário, M. Laureano, J. Nobre, I. Gonçalves, Intestinal
obstruction by giant Meckel’s diverticulum, GE Port J. Gastroenterol. 24 (4) (2017)
183–187, https://doi.org/10.1159/000452690.
9
CORRECTED PROOF
T. Almas et al. Annals of Medicine and Surgery xxx (xxxx) 103734
[39] K. Newme, R. Hajong, D. Khongwar, Meckel’s diverticulum causing acute
intestinal obstruction: report of two cases, J. Fam. Med. Prim. Care 9 (8) (2020)
4409–4411, https://doi.org/10.4103/jfmpc.jfmpc_1130_20, Published 2020 Aug
25.
[40] M. Sarkardeh, S.J.D. Sani, Intestinal obstruction by Meckel’s diverticulum in a 92
Years old woman, Case Rep. Surg. 2020 (2020), 9303059, https://doi.org/
10.1155/2020/9303059, Published 2020 May 30.
[41] K.A. Al Jabri, A. El Sherbini, Small bowel obstruction due to Meckel’s
diverticulum: a case report [retracted in: Oman Med J. 2020 Jul 12;35(4):e148].
Oman Med. J. 27 (1) (2012) e029, https://doi.org/10.5001/omj.2012.18.
[42] K. Takura, S. Takayama, H. Kani, M. Sakamoto, K. Ishikawa, T. Katada, A case of
intestinal obstruction caused by a mesodiverticular band in Meckel’s diverticulum
with ectopic pancreas treated by laparoscopic surgery, Int. J. Surg. Case Rep. 88
(2021) 106557, https://doi.org/10.1016/j.ijscr.2021.106557.
[43] A. Sumer, O. Kemik, A. Olmez, et al., Small bowel obstruction due to
mesodiverticular band of Meckel’s diverticulum: a case report, Case Rep. Med.
2010 (2010) 901456, https://doi.org/10.1155/2010/901456.
[44] C. Yazgan, T. Sahin, M. Ozmen, Unusual cause of small bowel obstruction:
mesodiverticular band of Meckel’s diverticulum demonstrated by CT, BJR Case
Rep. 3 (1) (2016), 20150255, https://doi.org/10.1259/bjrcr.20150255, Published
2016 Oct 25.
[45] M. Bouassida, B. Feidi, M. Ben Ali, et al., Intussusception caused by an inverted
Meckel’s diverticulum: a rare cause of small bowel obstruction in adults, Pan Afr.
Med. J. 10 (2011) 57.
[46] L. Ying, J.J. Yahng, A rare case of Meckel’s diverticulum causing small bowel
obstruction in a 50-year-old man, Int. J. Surg. Case Rep. 68 (2020) 107–110,
https://doi.org/10.1016/j.ijscr.2020.01.047.
[47] M. Murruste, G. Rajaste, K. Kase, Torsion of Meckel’s diverticulum as a cause of
small bowel obstruction: a case report, World J. Gastrointest. Surg. 6 (10) (2014)
204–207, https://doi.org/10.4240/wjgs.v6.i10.204.
[48] G. Ramnath, B. Rao Ar, K. Kishore, et al., Strangulated meckel’s diverticulum
causing intestinal obstruction, Int. J. Health Sci. Res. 8 (2018) 6.
[49] A. Skarpas, P. Siaperas, A. Zoikas, et al., Meckel’s Diverticulitis. A rare cause of
small bowel obstruction, J. Surg. Case Rep. 2020 (9) (2020), rjaa339, https://
doi.org/10.1093/jscr/rjaa339, Published 2020 Sep 30.
[50] S. Singh Gupta, O. Singh, Loop formation of Meckel’s diverticulum causing small
bowel obstruction in adults: report of two cases, Ulus Travma Acil Cerrahi Derg 17
(6) (2011) 567–569, https://doi.org/10.5505/tjtes.2011.54533.
[51] Arslan HE, Zeren S, Ekici MF, et al. A Rare Cause of Intestinal Obstruction:
Mesodiverticular Band
[52] C. Cartanese, T. Petitti, E. Marinelli, et al., Intestinal obstruction caused by torsed
gangrenous Meckel’s diverticulum encircling terminal ileum, World J. Gastrointest.
Surg. 3 (7) (2011) 106–109, https://doi.org/10.4240/wjgs.v3.i7.106.
[53] J. Zorn, S. Zhang, S. Brandt, et al., Small bowel obstruction precipitated by
intussusception of Meckel’s diverticulum, SAGE Open Med. Case Rep. 10 (2022),
https://doi.org/10.1177/2050313X211072663.
[54] K. van Malderen, M. Camilleri, Large Meckel’s diverticulum and dilated adjacent
small intestine presenting with intestinal obstruction, Clin. Gastroenterol. Hepatol.
16 (1) (2018) A33, https://doi.org/10.1016/j.cgh.2017.09.003.
[55] S. Kuru, H. Bulus, K. Kismet, et al., Mesodiverticular band of meckel’s
diverticulum as a rare cause of small bowel obstruction: case report and review of
the literature, Visc. Med. 29 (6) (2013) 401–405, https://doi.org/10.1159/
000357533.
[56] D.J. Marascia, Small bowel obstruction secondary to intussuscepted Meckel’s
diverticulum in an adult, Case Rep. Surg. 2019 (2019), 3241782, https://doi.org/
10.1155/2019/324178, Published 2019 Nov 29.
[57] G. Benhamou, Small intestinal obstruction by an enterolith from a Meckel’s
diverticulum, Int. Surg. 64 (1) (1979) 43–45.
[58] B. Hayee, H.N. Khan, T. Al-Mishlab, J.F. McPartlin, A case of enterolith small
bowel obstruction and jejunal diverticulosis, World J. Gastroenterol. 9 (4) (2003)
883–884, https://doi.org/10.3748/wjg.v9.i4.883.
[59] J.C. DiGiacomo, F.J. Cottone, Surgical treatment of Meckel’s diverticulum,
South. Med. J. 86 (6) (1993) 671–675, https://doi.org/10.1097/00007611-
199306000-00017.
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