MD is congenital and occurs in approximately 2% of the general population. In the majority of cases, MD remains asymptomatic. In all age groups, there is only a 4–6% overall lifetime risk of developing complications that require surgery [7
]. Despite advances in radiologic techniques, MD remains difficult to diagnose and preoperative diagnoses are reported in 4% of cases [1
]. Therefore, surgery tends to be delayed in cases of MD because of insignificant presentation in laboratory tests or on CT scans.
Torsion of a MD is a rare complication. The subsequent development of gangrene in a twisted MD is also reported to be extremely rare [6
]. We conducted a systematic literature search that consisted of searching the PubMed database for the key words ‘torsion’ and ‘Meckel's diverticulum’. Relevant original articles of case studies published in the English language were selected. Only 6 cases in children and less than 20 cases in adults were found. In most of these cases the preoperative diagnosis was acute appendicitis. Laparoscopy, used in 4 cases including 1 pediatric case, was reported to be helpful for both diagnosis and treatment [9
]. The preoperative diagnosis was appendicitis with or without perforation in 5 of 6 reported pediatric cases [6
]. The fact that the mean time from onset of pain to surgery was 2.2 days in a literature review of pediatric cases indicates that making a preoperative diagnosis remains challenging. The mean size of MD in the reported pediatric cases was 5 cm in diameter with a narrow base [6
The mechanisms underlying isolated torsion without involvement of the ileum, as seen in our case, remain elusive. It has been reported that twisting of MD occurs around the diverticulum's base, which is relatively narrow compared to the length of a giant diverticulum [2
]. Although making a preoperative diagnosis of MD complications is challenging, minimally invasive methods can be used for treatment [9
]. In our case, the use of diagnostic laparoscopy allowed us to make an accurate diagnosis of MD. The diverticulum was delivered via a slightly extended umbilical wound and diverticulectomy was performed extracorporeally. This method is a safe and minimally invasive technique used to treat complicated cases of MD. Diagnostic laparoscopy is also useful to avoid delayed surgery carrying substantial risks.
In conclusion, a very rare form of acute abdominal pain caused by a torsed gangrenous MD was found in the present case. The correct diagnosis of MD was made using exploratory laparoscopy in an emergent setting. Performing early surgery using diagnostic laparoscopy can help prevent significant morbidity and mortality in patients with complicated bowel pain of unclear etiology.