Small Intestine Volvulus Due to Meckel's Diverticulum in an Adult Patient: A Case Report

Öz

Small bowel volvulus (SBV) in adults is a very rare disease and it is a life-threatening emergency that requires surgery. Therefore, early diagnosis and treatment of SBV is important. Meckel's diverticulum is the most common malformation of the digestive tract. Gastrointestinal bleeding is the most common presentation of Meckel's diverticulum with an incidence of up to 40.2% in children. However, intestinal obstruction is the most common symptom in adults, accounting for 14% to 40% of symptomatic Meckel's diverticulum cases. Small bowel volvulus due to Meckel's diverticulum is rare. Although some articles have been published about SBV secondary to meckel’s diverticulum, most of them are case reports. We present a 40-year-old female patient who had no previous surgical history and underwent emergency surgery due to ileus and had a bowel obstruction secondary to small bowel volvulus due to Meckel's diverticulum on exploration. In this case, Meckel's diverticulum was attached to the uterus, and the patient had right ovarian cyst and inflamed tuba on exploration. One case in which ovarian structures were shown as the etiology of small bowel volvulus was reported in the literature. The aim of this case report is to describe the diagnosis and clinical management and to review the literature.

Anahtar Kelimeler

• Ileus
• Meckel
• ovarian cyst
• volvulus
• Ileus, Meckel's diverticulum, ovarian cyst, volvulus

Erişkin Hastada Meckel Divertikülüne Bağlı İnce Barsak Volvulusu: Olgu Sunumu

Öz

Erişkinlerde ince bağırsak volvulusu (İBV) çok nadir görülen bir hastalıktır ve hayatı tehdit eden bir cerrahi acildir. Bu nedenle İBV'nin erken teşhisi ve tedavisi önemlidir. Meckel divertikülü sindirim sisteminin en sık görülen malformasyonudur. Gastrointestinal kanama, Meckel divertikülünün çocuklarda %40,2'ye varan insidansı ile en sık görülen prezentasyonudur. Bununla birlikte, bağırsak tıkanıklığı yetişkinlerde en sık görülen belirtidir ve semptomatik Meckel divertikülü vakalarının %14 ila %40'ını oluşturur. Meckel divertikülüne sekonder ince barsak volvulusu ise nadirdir. İBV ve özellikle meckel divertikülüne sekonder İBV ile ilgili bazı makaleler yayınlanmış olsa da bunların çoğu vaka raporlarıdır. Bu sunumda, daha önce cerrahi öyküsü olmayan ve ileus tablosuyla acil ameliyata alınan ve eksplorasyonda Meckel divertikülü nedeniyle ince barsak volvulusuna sekonder barsak obstrüksiyonu olduğu görülen 40 yaşında bir kadın hastayı sunuyoruz. Ayrıca bu vakada meckel divertikülü uterusa yapışık ve sağ over kisti ve inflame tuba mevcuttu. İnce barsak volvulusuna ovaryan yapıların etyoloji olarak gösterildiği literatürde bir vaka tespit edildi. Amaç, tanı ve klinik yönetimi tanımlamak ve literatürü gözden geçirmektir.

Anahtar Kelimeler

• İleus
• Meckel Divertikülü
• Over kisti
• Volvulus

Kaynakça

1. 1. X Li , J Zhang at all. Diagnosis, treatment and prognosis of small bowel volvulus in adults: A monocentric summary of a rare small intestinal obstruction. PLoS One. 2017; 12(4): e0175866.
2. 2. Yang C, Yongzhi L, at all. Axially torsional Meckel's diverticulum accompanied by small bowel volvulus: a case report. J Int Med Res. 2021 Oct; 49(10)
3. 3. Chatterjee A, Harmath C, Vendrami CL, et al.. Reminiscing on remnants: imaging of Meckel diverticulum and its complications in adults [J]. AJR Am J Roentgenol 2017; 209: W287–W296.
4. 4. Liviu M, Raouf FG at all. Meckel Diverticulum Causing Intestinal Volvulus. Case Rep Surg. 2020; 2020: 8872668.
5. 5. Brinda MA, Manjunath S, Balasubramanya KS, Nanjaiah B. An unusual case of small bowel volvulus. J Clin Diagn Res. 2015;9:PD08–10.
6. 6. Mano B, Srinidhi M at all. An Unusual Case of Small Bowel Volvulus. Journal List J Clin Diagn Res v.9(11); 2015 Nov
7. 7. Zheng ZH, Huang JL, Wei HB, Liu JP, Huang Y. Adult congenital intestinal malrotation accompanied by midgut volvulus: report of eight cases. Int J Clin Exp Med. 2014;7:1614–8.
8. 8. Vijayaraghavan SB, Ravikumar VR, Srimathy G. Whirlpool sign in small-bowel volvulus due to a mesenteric cyst. J Ultrasound Med. 2004 Oct; 23(10):1375-7.

9. 9. Duran A, Duran FY, Cengiz F, Duran O. Intestinal Necrosis due to Giant Ovarian Cyst: A Case Report. Case Rep Surg. 2013; 2013():831087.
10. 10. Sivaslioglu AA, Aksut H, Iri R. Small bowel necrosis secondary to three times torsion of an ovarian dermoid cyst in a 55-year-old woman: a case report. J Cases Obstet Gynecol. 2014;1(1):5–7.