The Brother Who Betrayed: A Rare Case of Strangulated Ileal Obstruction Due to Perforated Meckel's Diverticulum in a Post-Gastrectomy Patient – A Case Report

Abstract

Background: Small bowel obstruction (SBO) is a common surgical emergency. In patients with a history of major abdominal surgery, postoperative adhesions account for 60–75% of cases and are routinely presumed to be the underlying etiology. However, congenital anomalies such as Meckel's diverticulum can occasionally complicate in adulthood, mimicking adhesive intestinal obstruction and posing a significant diagnostic challenge.

Case Presentation: A 66-year-old male with a history of subtotal gastrectomy with Roux-en-Y reconstruction for gastric carcinoma presented with clinical and radiological signs of acute mechanical small bowel obstruction. Given his surgical history, adhesive bands were highly suspected. Emergency exploratory laparotomy, however, revealed a perforated Meckel's diverticulum forming a constricting fibrous band around the distal ileum, leading to closed-loop strangulation, compromised bowel viability, and a localized mesenteric hematoma. Segmental ileal resection with a double-barrel ileostomy was performed. The postoperative course was uneventful.

Conclusion: This case highlights that previous abdominal surgery should not automatically rule out rare congenital etiologies like Meckel's diverticulum in adults presenting with SBO. Maintaining a broad differential diagnosis and performing a meticulous intraoperative exploration are critical to avoiding diagnostic delays and mitigating bowel ischemia.