Abstract / Summary
Background and Clinical Significance: Meckel’s diverticulum is a remnant of the omphalomesenteric duct, arising from an incomplete obliteration of the embryonic vitelline duct, which connects the fetal gut to the yolk sac, typically regressing between the fifth and seventh weeks of gestation. There are many mechanisms for bowel obstruction arising from a Meckel’s diverticulum. Therefore, early diagnosis and treatment are the keys to prevent intestinal gangrene and perforation; Case Presentation: We report the management of sigmoid volvulus associated with acute Meckel’s diverticulitis and a fibrous band in an 85-year-old patient with multiple comorbidities and very high perioperative risk. Sigmoid volvulus was the mechanical cause of intestinal obstruction, whereas an inflamed Meckel’s diverticulum associated with a fibrous band extending toward the anterior abdominal wall was identified during surgical exploration. No twisting or mechanical obstruction of the distal ileum was observed. Histopathological examination subsequently confirmed acute Meckel’s diverticulitis. The unusual coexistence of these findings, together with the diagnostic and therapeutic challenges posed by the patient’s severe comorbidities, prompted us to report this case; Conclusions: Although no direct mechanical relationship between Meckel’s diverticulum and sigmoid torsion was demonstrated, their coexistence raises a hypothesis of a potential pathophysiological interaction; however, any such relationship remains hypothesis-generating only. Identification of one apparent cause of intestinal obstruction should not preclude systematic evaluation for concomitant pathology, particularly when the clinical, radiological, operative, and inflammatory findings are not fully explained by a single diagnosis.