Band of cacophony - abdominal catastrophe caused by the fibrous band of Meckel’s diverticulum: a case report

INTRODUCTION This report calls attention to small bowel necrosis resulting as a complication of formation of an obstructive loop of small bowel around a band of Meckel's diverticulum. CASE PRESENTATION We report a case of an adult in his 5th decade presenting with sharp, colicky abdominal pain. On presentation his vitals were within normal limits, abdomen was non-distended but tender and rigid all over, more on left lower quadrant without any rebound tenderness. Bowel sounds were hypoactive. Rectal exam showed an empty vault. White blood cell count was 9.0 x 10(3)/mm(3) with 94.5% neutrophils, Hb of 9.0 gm/dl and Hct of 31.3%, liver and pancreatic enzymes were not elevated. Arterial blood gas did not show any acidosis and lactic acid level was not elevated. X-ray showed a non-obstructive bowel pattern without any free air. Abdominal computed tomography with oral and intravenous gastrograffin showed findings consistent with complete mid to distal small bowel obstruction secondary to a closed loop obstruction. Emergent laparotomy showed a Meckel's diverticulum that had formed a band around a portion of small bowel causing it to twist upon itself and become necrotic. CONCLUSION Histopathology revealed Meckel's diverticulum and benign intestinal tissue with hemorrhagic necrosis.