A CASE OF INTESTINAL OBSTRUCTION CAUSED BY VOLVULUS OF MECKEL'S DIVERTICULUM

Abstract

A 23-year-old man was admitted to the hospital because of increasing lower abdominal pain and vomiting. He had been treated for repeated bouts of lower abdominal pain from his childhood elsewhere. His body temperature was 37.8°C. His abdomen was distended and there were muscle guarding, severe tenderness, and Blumberg's sign. Abdominal CT scan revealed multiple dilated, fluid-filled loops of the small bowel and the collapsed distal ileum. Abdominal free air was not seen. Laboratory tests showed the white cell count of 15, 400/μl and CRP of 0.1 mg/dl. From these findings, an emergency laparotomy was performed under a diagnosis of peritonitis with obstruction of the small bowel, and Meckel's diverticulum was found about 70 cm proximal to the ileocecal valve. The ileum was stenosed with an adhesional band and the diverticulum was volvulated about 180 degrees. The diverticulum lay on the stenosed part of the ileum and resultantly the ileum was obstructed. A partial resection of the ileum including Meckel's diverticulum was performed. We suggest that CT may be helpful for diagnosis when Meckel's diverticulitis is suspected.