STRANGULATION OF SMALL BOWEL DUE TO
MECKEL DIVERTICULUM: CT FINDINGS
RYUSUKE MURAKAMI,
MD
, KEN-ICHI SUGIZAKI,
MD
,
YUKO KOBAYASHI,
MD
, JUNKO OGURA,
MD
,
KANAE YAMAMOTO,
MD
, AKIRA KUROKAWA,
MD
,
AND TATSUO KUMAZAKI,
MD
We report an unusual case of small bowel strangula- case of small bowel strangulation due to a long
Meckel diverticulum, which was detected preopera-tion due to long Meckel diverticulum. CT demonstra-
tion of the bundle-like segment contiguous with the tively by CT.
distended fluid-filled loops of bowel contributed to
the prompt preoperative diagnosis. Elsevier Sci-
ence Inc., 1999 CASE REPORT
A 21-year-old man with no previous medical or sur-
KEY WORDS:
gical history presented with a 2-day history of inter-
Meckel diverticulum; Gastrointestinal tract abnormalities;
mittent sharp abdominal pain and nausea. On physi-
Computed tomography
cal examination, the abdomen was distended with
minimal tenderness. Results of a rectal examination
were unremarkable, and a stool guaiac test was nega-
INTRODUCTION
tive. The white blood cell count was 19400/mm
3
; all
other laboratory parameters were normal.Meckel diverticulum of the small bowel is the most
common congenital anomaly of the gastrointestinal Supine and erect abdominal radiography demon-
strated multiple dilated loops of small bowel withtract, occurring in 0.3–3.0% of the general popu-
lation (1). The majority of the patients are asymp- air-fluid levels and a minimal amount of air in the as-
cending colon, suggesting small bowel obstruction.tomatic, but 17–22% manifest various symptoms
including bleeding, abdominal pain and intestinal Abdominal and pelvic CT was performed after the
intravenous injection of non-ionic contrast material;obstruction (2,3). Small bowel obstruction is the
most common presentation in adults, accounting for no oral contrast material was administered. There were
multiple dilated low-attenuation fluid-filled loops ofone third of all symptomatic diverticula, and is fre-
quently due to intussusception, volvulus around an the small bowel. The loops extended into the upper
pelvis and exhibited bowel-wall thickening and homo-associated fibrous or omphalo-mesenteric band, ad-
hesions from an inflammatory process, or incarcera- geneous enhancement. There was minimal ascites.
Contiguous with the dilated small bowel loops, ation within a hernia sac (4,5). We present an unusual
bundle-like segment was demonstrated, suggesting
that this was the cause of the small bowel obstruction
Department of Radiology (R.S., K.-I.S., Y.K., J.O., K.Y., T.K.), Nip-
pon Medical School, Tama-Nagayama Hospital, Tokyo, 2068512
(Figure 1). The distal bowel was collapsed and did
Japan
not contain any material with this CT appearance.
Department of Emergency Medicine (A.K.), Nippon Medical
At emergency laparotomy, strangulation was seen
School, Tama-Nagayama Hospital, Tokyo, 2068512 Japan
Address correspondence to: Dr. R. Murakami, Nippon Medical
about 3 cm from the ileocecal valve, where an encir-
School, Tama-Nagayama Hospital, Department of Radiology, 1-7-1
cling Meckel diverticulum was identified. Both the
Nagayama, Tama-city, Tokyo, 2068512, Japan. Tel: 81-42-371-2111;
diverticulum and the strangulated bowel were re-
Fax: 81-42-372-7374
Received February 19, 1999; accepted March 12, 1999.
sected. The resected specimen consisted of an 80-cm
CLINICAL IMAGING 1999;23:181–183
Elsevier Science Inc., 1999. All rights reserved. 0899-7071/99/$–see front matter
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