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Paper text:
normally , a diverticulum is present in fetal life as the vitello - intestinal duct remnant , which usually disappears later on the 7th week of gestational period .
md occurs in about 2% of the population , with a male - to - female ratio of 2:1 .
it is located within two feet from the ileocecal valve , and it can be 2 in . in length and may vary based on clinical practice .
most cases of md are difficult to diagnose and are found incidentally during a surgical procedure for another reason . however ,
we describe a case of an adult female patient who presented with clinical picture of acute bowel obstruction due to md .
a 39 year old female patient known for hypothyroidism on thyroxine presented to king abdulaziz university hospital , emergency department , with a complaint of abdominal pain for 3 days .
then , it shifted to the right iliac fossa on the day of her er visit .
it was associated with vomiting , greenish in color , three times on the same day of presentation , in addition to history of constipation for 2 days .
there was no history of fever , diarrhea , bleeding per rectum , or urinary symptoms .
the abdomen was mildly distended . during palpation , the abdomen was soft and lax , with guarding in the right iliac fossa .
routine laboratory investigations were within normal limits : wbc 8.7  k/l , hb 15  g / dl , plt 240 , na 129  mmol / l , k 4.1  mmol / l , urea 4.1  mmol / l , and creatinine 41  mol / l . urine analysis was unremarkable .
erect abdominal x - ray was performed , and it revealed multiple air fluid levels with dilated small bowel loops and no free air .
she was kept npo on intravenous fluid resuscitation , nasogastric tube was inserted , and urine output was measured . in order to identify the cause of the bowel obstruction , a ct scan of abdomen and pelvis was performed as well , and it revealed multiple dilated loops of small bowel , reaching the maximum diameter of 4  cm with few air fluid levels .
there was a transitional point in the right iliac fossa , with whirling of the mesenteric vessels .
there was a diffuse wall thickening and an enchantment of the cecal wall with possible pneumatosis .
mild surrounding inflammatory changes were seen with minimal free fluid in the abdomen and pelvis .
meckel 's diverticulum was found to be perforated and adherent to the right lower abdominal wall ( fig .
a limited resection of involved part of ileum with the md was performed with subsequent primary anastomosis , in addition to appendectomy .
it was named after johann friedrich meckel , a german anatomist who described the features of md .
it is a true congenital diverticulum as it consists of all the three layers of the bowel wall and is usually found on the anti - mesenteric border of the ilium .
the average distance of the meckel 's diverticulum from the ileocaecal valve is 67  cm in adult population .
it can either be asymptomatic or mimic common abdominal disorders such as appendicitis , peptic ulcer disease and crohn 's disease .
however , they have been known to cause complications , including diverticulitis , intussusception , severe gastrointestinal hemorrhage , perforation , peptic ulceration and intestinal obstruction . yet ,
obstruction can be caused by trapping of a bowel loop by a mesodiverticular band , intussusception , a volvulus of the diverticulum around a mesodiverticular band , or an extension into a hernia sac called littre 's hernia .
the case described above presented with signs and symptoms suggestive of acute intestinal obstruction and radiological findings suggestive of cecal volvulus .
this patient had partial intestinal obstruction caused by adhesions of the diverticulum with the abdominal wall , causing cecal volvulus as discovered intraoperatively .
ct scan , technetium-99 m pertechnetate scan , abdominal ultrasound , and barium studies are all useful in the diagnosis of md . after diagnosing md , the mainstay treatment would be diverticulectomy in all symptomatic cases .
resection should always include the diverticulum or the segment of the bowel affected by the pathology . for asymptomatic md , evidence does not support elective resection of meckel 's diverticulum . in a systemic review , zani et al .
stated that  a large number of md resections would need to be performed to prevent 1 death from md  .
hence , avoiding surgery in case of asymptomatic md reduces the risk of postoperative complications caused by unnecessary surgical intervention .
although , md is the most common congenital condition of the gi tract , the clinical diagnosis of md is difficult to make .
ct scan can help identify the cause of bowel obstruction , but it may miss the diagnosis of md . hence , md is mostly identified during the operation .
appropriate knowledge of various pathophysiologies by which a meckel 's diverticulum can cause complication must be kept in mind for a better management without recurrences .
he was informed that this case will be written for publication as a case report with the accompanying images .
a copy of the written consent is available for review by the editor - in - chief of this journal on request .
dr . aref 's contribution includes writing the manuscript and collecting the relevant data and pictures .
highlightsalthough , md is the most common congenital condition of the gi tract , the clinical diagnosis of md is difficult to make.most cases of md are found incidentally during a surgical procedure for another reason.the mainstay treatment would be resection of the diverticulum or the segment of the bowel affected by the pathology .