Meckel's diverticulum band adhesion causing internal hernia, small bowel obstruction complicated by peritonitis and massive ascites: a rare pediatric case

Meckel's diverticulum (MD) is one of the most common congenital anomalies of the gastrointestinal tract in children, although it may occasionally be detected in adults. It is typically located within 100 cm of the ileocecal valve in the distal ileum. The diverticulum varies in size and morphology; many patients remain asymptomatic throughout life. In children, the most common clinical presentation is painless gastrointestinal bleeding, followed by intestinal obstruction. Intussusception may also occur. Once complications develop, patients often present with acute abdomen. Failure to establish a timely diagnosis and initiate appropriate management may result in intestinal ischemia or even necrosis. Furthermore, acute intestinal obstruction may obscure the underlying pathology, increasing the risk of misdiagnosis or missed diagnosis on radiologic evaluation. We report a rare case of Meckel's diverticulum complicated by band adhesion resulting in internal hernia and small bowel obstruction, further associated with peritonitis and massive ascites. The diverticulum was located approximately 40 cm proximal to the ileocecal valve. A fibrous diverticular band adhered to adjacent bowel loops, forming a hernia orifice that caused obstruction of the neighboring small intestine and mesentery. The patient underwent surgical resection of the Meckel's diverticulum, partial ileal resection, and end-to-end ileo-ileal anastomosis. The procedure was uneventful, and postoperative recovery was satisfactory. Internal hernia caused by Meckel's diverticulum band adhesion with associated peritonitis and massive ascites is rare. This case broadens the differential diagnosis of pediatric intestinal obstruction without prior abdominal surgery.