A Case of Strangulated Ileus Attributed to Meckel's Diverticulum in Aged Patient

Koichi Kubota^{1) 2)}, Takefumi Usui^{1) 2)}, Kiyohito Yoshida^{1) 2)}, Tatuhiro Kin^{1) 2)}, Shunsuke Haga²⁾ and Tetsuro Kajiwara²⁾

¹⁾Department of Surgery, Aida Hospital

²⁾Department of Surgery, Tokyo Women's Medical University Daini Hospital

We experienced a case of an advanced age patient with extended necrosis of the small intestine (220 cm) caused by strangulation a rare structure attributed as Meckel's diverticulum. A 76-year-old man came to the hospital with abdominal pain and vomiting as the chief complaints. He was hospitalized for adhesive ileus by signs and symptoms of scar and pain on pressure after extraction of the gallbladder and by stimulation of enterokinetic sounds. However, myogenic guarding and shock were observed on the following morning, and under a diagnosis of strangulated ileus peritoneotomy was performed. However, the intraoperative findings did not reveal adhesion of intestines, restiform substance and mesenteric deficiency, but rather a large volume of hemorrhagic ascites and extended intestine with multiple twists of dark-red color. We discharged the ileus by puncture aspiration at the midsection of the sacculated mass, located at the opposite side of the mesentric attachment site at about 60 cm from the end of ileum. Histopathological diagnosed Meckel's diverticulum involving whole layers of intestine. Our own experimental case did not meet the criteria of intestinal obstruction classified by Rutherford et al. It was suggested that the neck of the Meckel's diverticulum had resulted from some unknown cause, and wrapped by the intestine in multiple twists had caused ischemia at the base of mesenterium.

Key words
Meckel's diverticulum, strangulated ileus due to Meckel's diverticulum, ileus of an advanced patient

Reprint requests
Koichi Kubota Department of Surgery, Tokyo Women's Medical University Daini Hospital 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567 JAPAN

Accepted
October 26, 1999

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