A Case Report and Literature Review: Grape Seeds Causing Meckel’s Diverticulitis, Perforation and Small Bowel Obstruction in a Young Adult Patient

Abstract

Background: Meckel’s diverticulum is a true diverticulum consisting of a 3-layered outpouching of the bowel wall along the antimesenteric border. It is a remnant of the omphalomesenteric duct and the most common congenital gastrointestinal disorder. It has a male predilection and remains asymptomatic in the majority of cases. It constitutes a diagnostic challenge to physicians, as it can present with gastrointestinal bleeding in the pediatric population, and as an intestinal obstruction in adults. While the management of an asymptomatic Meckel’s diverticulum is on a case-by-case basis, when symptomatic, prompt surgical intervention is necessary, and a laparoscopic approach allows both in-situ diagnosis and treatment.

Case Report: A 23-year-old previously healthy female patient, presented with diffuse abdominal pain, vomiting, and obstipation. Abdominal X-Ray and abdominopelvic Computed Tomography showed an intra-abdominal inflammatory process and evidence of bowel obstruction but were not conclusive. The patient was admitted to the hospital for management, and on the third day of hospitalization physical examination showed abdominal guarding suggestive of peritonitis. An urgent exploratory laparotomy identified a Meckel’s Diverticulum obstructed with phytobezoar grape seeds, and an inflamed and perforated bowel wall, with adhesive bands to proximal small bowel loops, necrosis, and resultant small bowel obstruction. We resected the Meckel’s diverticulum and the necrotic bowel and performed an end-to-end primary anastomosis of the small bowel. The postoperative course was uneventful, and the patient was discharged on the fourth postoperative day.

Conclusion: The diagnosis of Meckel’s diverticulum remains a challenge as it has a myriad of clinical presentation and radiological imaging sometimes fails to provide a definite diagnosis. It must be systematically included in the differential diagnosis of small bowel obstruction in adult patients, as it requires prompt surgical intervention for both diagnosis and treatment.