Meckel's diverticulum leading to axial torsion and volvulus of the small bowel.

Abstract

A Meckel's diverticulum is a blind-ending pouch that arises on the antimesenteric border of the terminal ileum. It is the most common gastrointestinal anomaly and the result of an incomplete obliteration of the vitelline duct during the first 8 weeks of gestation. The 'rule of two' is a mnemonic which refers to key characteristics of Meckel diverticula: it is found in 2% of the population, it is 2 inches long, 2 feet from the ileocaecal valve and twice as common in males. Only 2%-4% of those with a Meckel's develop complications in their lifetime. The majority present in early childhood with complications such as intussusception, bleeding and diverticulitis. Here we present a rare case of a giant Meckel's diverticulum measuring 22 cm×11 cm×9.8 cm, causing mass effect, small bowel volvulus and obstruction. The patient required an emergent laparotomy, resection and primary anastomosis.