Internal Herniation Beneath an Omphalomesenteric Band Arising from Meckel’s Diverticulum: A Rare Case Report of Small Bowel Obstruction in A Six-Year-Old Child

Abstract

Meckel’s diverticulum is the most common congenital anomaly of the gastrointestinal tract and is usually asymptomatic, making preoperative diagnosis difficult in children. We report a 6-year-old boy with a 4-5-day history of progressively worsening periumbilical abdominal pain accompanied by non-bilious vomiting and acute obstipation, with no passage of stool or flatus by the time of presentation. On admission, he appeared ill with abdominal distension, focal periumbilical tenderness, rebound, and involuntary guarding. Laboratory studies did not reveal significant abnormalities. Erect and supine abdominal x-ray showed multiple air-fluid levels, and ultrasound revealed markedly dilated small-bowel loops with collapsed colonic segments, consistent with a high-grade mechanical obstruction. Urgent exploratory laparotomy identified Meckel’s diverticulum with a non-patent tip that was tethered to the umbilicus by a narrow fibrotic omphalomesenteric band; several ileal loops were entrapped beneath this band, producing complete obstruction without volvulus or ischemia. The band was divided, controlled decompression through the diverticular tip was performed, and wedge resection of the diverticulum with transverse ileal closure was completed. The patient resumed oral intake on postoperative day 3 and was discharged in good condition on day 6. This case highlights internal herniation beneath an omphalomesenteric band as an important but easily overlooked mechanism of small-bowel obstruction in children. Early recognition of this mechanism and timely operative exploration are essential to prevent delays in definitive management.