Axial Torsion and Meckel’s Diverticulitis: A Diagnostic Conundrum

  • Suman Baral Lumbini Medical College and Teaching Hospital
  • Raj Kumar Chhetri Lumbini Medical College and Teaching Hospital
  • Neeraj Thapa Lumbini Medical College and Teaching Hospital
Keywords: Exploratory laparotomy, Intussusception, Meckel's diverticulum


Introduction: Meckel’s diverticulum is one the most common congenital anomalies of gastrointestinal tract that mimics acute appendicitis, gastroenteritis, peptic ulcer disease. Complications related to it can be haemorrhage, intestinal obstruction, perforation while axial torsion is one of the rarest complications. So, this paper objectifies a rare clinical scenario that we encountered in our practice and highlights on the possible management strategies. Case : An 11 year boy presented with a history of pain at peri-umbilical region for four days with 2-3 episodes of vomiting. Abdominal examination revealed tenderness at suprapubic area with a mass around 5x3 cm along hypogastrium. Ultrasonography abdomen revealed an avascular structure in central area with clumping of bowel and omentum over the lesion while computed tomography scan of abdomen revealed blind ended gas filled structure at hypogastrium with thickened enhancing irregular wall associated with adjacent mesenteric fat plane stranding and prominent adjacent axial vessels supplying inflammatory lesion. Exploratory laparotomy showed axial twisting of diverticulum about 10x5 cm arising from anti-mesenteric border around 50 cm proximal to ileo-caecal junction with a fibrous band attached to the fundus and ileum leading to gangrenous diverticulum with clumping of bowel loops along with omental covering. De-twisting and adhesiolysis along with excision of the diverticulum was done with two layered closure of the defect. Conclusion: Axial torsion is the rarest of the complication of MD and should be managed with utmost caution. Excision of the twisted diverticulum with or without wedge resection of the involved ileum is the procedure of choice.


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Author Biographies

Suman Baral, Lumbini Medical College and Teaching Hospital


Department of Surgery.

Raj Kumar Chhetri, Lumbini Medical College and Teaching Hospital

Professor and Head,

Department of Surgery.

Neeraj Thapa, Lumbini Medical College and Teaching Hospital

Assistant Professor,

Department of Surgery.


Sagar J, Kumar V, Shah DK. Meckel's diverticulum: a Systematic Review. Journal of the Royal Society of Medicine. 2006;99(10):501-5. DOI:

Park JJ, Wolff BG, Tollefson MK, Walsh EE, Larson DR. Meckel diverticulum: the Mayo Clinic experience with 1476 patients (1950-2002). Ann Surg. 2005;241(3):529-33. PMID: 15729078. DOI:

Soltero MJ, Bill AH. The natural history of Meckel's Diverticulum and its relation to incidental removal. A study of 202 cases of diseased Meckel's Diverticulum found in King County, Washington, over a fifteen year period. Am J Surg. 1976;132(2):168-73. PMID: 952346. DOI:

Parab SV, Salve PG, Dahiphale A, Thakare R, Aiwale A. Axial Torsion of Meckel's Diverticulum: A Rare Case Report. J Clin Diagn Res. 2017;11(9):PD05-PD06. PMID: 29207775. DOI:

Moore GP, Burkle FM Jr. Isolated axial volvulus of a Meckel's diverticulum. Am J Emerg Med. 1988;6(2):137-42. PMID: 3281683. DOI:

Botezatu R, Marian R, Gica N, Lancu G, Peltecu G, Panaitescu AM. Axial Torsion and Infarction of Meckel's Diverticulum in the 3rd Trimester of Pregnancy. Chirurgia (Bucur). 2018;113(2):266-9. DOI:

Gallego-Herrero C, Pozo-Garcia G, Marín-Rodriguez C, Andres CI. Torsion of a Meckel's diverticulum: sonographic findings. Pediatric Radiology. 1998;28(8):599-01. DOI:

How to Cite
Baral S, Chhetri R, Thapa N. Axial Torsion and Meckel’s Diverticulitis: A Diagnostic Conundrum. J Lumbini Med Coll [Internet]. 31Dec.2019 [cited 8Jul.2020];7(2):113-5. Available from:
Case Report