Axial volvulus of the small bowel caused by Meckel's diverticulum.

BACKGROUND: A mechanism where the presence of a Meckel's diverticulum might cause bowel obstruction by twisting the small bowel along its long axis has been described. The developmental anatomy of the Meckel's diverticulum and its blood supply has been traced. Various other ways a Meckel's diverticulum can cause an obstruction have been enumerated. METHODS: We have reported two cases where the presence of a Meckel's diverticulum was the cause of bowel obstruction in a fashion hitherto not described. One patient had intermittent bouts of obstruction; the second patient had an acute obstruction. RESULTS: Preoperative investigations for a Meckel's diverticulum are not always fruitful, and most of the time the diagnosis is made at operation. When a Meckel's diverticulum is encountered at operation, division of its mesentery, the mesodiverticular band, rather than diverticulectomy, to relieve the volvulus described might devitalize the Meckel's diverticulum and should be avoided. CONCLUSIONS: A new mechanism by which the presence of a Meckel's diverticulum can cause an obstruction has been described. A short mesodiverticular band causes the bowel to twist along its long axis, precipitating the obstruction. This condition should be kept in mind in patients with a bowel obstruction who have not undergone any previous abdominal operation.