Bowel obstruction due to an incarcerated Meckel's diverticulum within a minor omphalocele: a case report

Abstract

The coexistence of omphalocele and Meckel's diverticulum (MD) is rare, and even more exceptional when the diverticulum is strangulated within the omphalocele sac. While several reports describe cases involving perforation or fistulization, this specific presentation remains unusual and may be overlooked. A full-term, two-day-old male newborn was referred for a minor (≈3 cm) omphalocele not detected prenatally. On admission he was hemodynamically stable and afebrile with mild abdominal distension; the anus was patent and a nasogastric tube drained bilious fluid. Laboratory tests were unremarkable. Abdominal ultrasound confirmed a narrow fascial ring (∼1 cm) within a 3 cm omphalocele sac containing a bowel loop; echocardiography showed no cardiac anomalies. After stabilization, surgical exploration of the omphalocele sac identified a 5 cm × 3 cm MD strangulated at its base within the neck of the omphalocele, 25 cm proximal to the ileocecal valve, with significant upstream small-bowel dilatation and no perforation or fistula. Segmental ileal resection including the diverticulum with end-to-end ileo-ileal anastomosis was performed; the abdominal wall defect was closed primarily. Postoperatively, the patient was kept nil per os with nasogastric decompression; feeds were started on day 3 and well tolerated. He was discharged on day 5. Histopathology confirmed MD without ectopic mucosa. At 6-month follow-up, growth and gastrointestinal function were normal. Newborns with a minor omphalocele can develop a bowel obstruction secondary to incarceration of a Meckel's diverticulum through the omphalocele defect. • Rare cause of neonatal obstruction: incarcerated Meckel's diverticulum within a minor omphalocele. • Bilious emesis or progressive distension in “small” omphalocele should trigger suspicion. • Imaging may be inconclusive; early surgical exploration prevents ischemia and bowel loss. • Definitive management is segmental ileal resection including the diverticulum with primary anastomosis. • Awareness of this mechanism improves timely diagnosis and outcomes in newborns with minor omphalocele.