# Meckel’s Diverticulum Mimicking a Postoperative Flange with Acute Intestinal Obstruction and Midgut Volvulus: A Case Report

## TL;DR

A rare case of Meckel’s diverticulum mimicking a postoperative flange and causing intestinal obstruction and midgut volvulus is reported in a 17-year-old male.

## Contribution

This case highlights the rare association of Meckel’s diverticulum with midgut volvulus and intestinal obstruction.

## Key findings

- Meckel’s diverticulum can mimic a postoperative flange and cause acute intestinal obstruction.
- Midgut volvulus was associated with a 90° rotation stop of the midgut, requiring a Ladd procedure.
- Morpho-pathological analysis confirmed benign findings in both the diverticulum and appendix.

## Abstract

The interest of this case lies in the exceptional and rare character of the observed association.: Meckel’s diverticulum (MD) mimicking a postoperative flange complicated by acute intestinal obstruction and malrotation by midgut volvulus.

A 17-year-old black male student, with a body mass index of 28 kg/m2 was admitted to the emergency department of a 4th category rural hospital, with paroxystic abdominal pain and vomiting. Medical history revealed an abdominal surgery for an umbilical hernia 3 years earlier. There was no malformation such as imperforate anus, Hirschsprung's disease, esophageal tracheal fistula, or cardiac anomaly in the medical history. An abdominal X-ray confirmed an acute intestinal obstruction showing hydroaeric levels. The diagnosis of acute intestinal obstruction on a flange was retained. A median laparotomy was performed; a solid mass-like lengthy structure mimicking postoperative flange was seen associated with midgut volvulus, while a malposition of the intestine was observed with a mesenteric band, as well as a hyperemic appendix. A 90° rotation stop of the midgut also called a complete common mesentery was in place; we then carried out a Ladd procedure. Morpho-pathological examination of the surgical specimens revealed the following: richly vascularized fibro-adipose tissues with no evidence of malignancy in the diverticular specimen, and acute pan-appendicitis with no evidence of malignancy in the appendicular specimen. The patient started to ingest food orally on the third postoperative day, and he was discharged uneventfully on the fifth day.

MD, although generally a tubular structure, may sometimes appear as a non-tubular mass during clinical examination. Intestinal obstruction due to MD associated with midgut volvulus is exceptional. Management of this association should be based on accurate knowledge of the morpho-embryological specificities during gut development.