IJSR International Journal of Scientific Research 2277 - 8179 Indian Society for Health and Advanced Research ijsr-8-3-18351 Original Research Paper Laparoscopic Management of Distal Ileal Obstruction Caused by Phytobezoar Complicating Congenital Meckel's Band Narrowing: A Case Report Vignesh M. Dr. March 2019 8 3 01 02 ABSTRACT

Background: Congenital Meckel’s Band with distal ileal narrowing causing obstruction is a rare phenomenon. We present here a case where a phytobezoar complicating a Meckel’s band obstruction was managed laparoscopically. This is the first such reported case. Case Presentation: A 34 year–old male presented to the Emergency Department with complaints of pain abdomen and progressive vomiting for 2 days. Plain X–ray abdomen showed evidence of Acute Intestinal Obstruction. A contrast enhanced CT of the abdomen revealed dilated proximal and mid–ileal loops with transition zone seen in the right lumbar region. Hence the patient was taken up for diagnostic laparoscopy which revealed a Meckel’s Band from the distal ileum causing luminal narrowing. Hence an extracorporeal segmental resection and anastamosis of the affected distal ileum was done through a small incision and the bowel was pushed back inside. Rest of the surgery was uneventful. On opening the specimen, we found a ball of fibrous strands mixed with faeces plugging the Meckel’s band narrowing region. Post–operatively, we were able to ascertain the history from the patient that he had consumed two full oranges two days ago. Thus we came to our diagnosis of a phytobezoar. Histopathological examination further confirmed both the Meckel’s band and that of a phytobezoar. On post–operative day 2, soft solid diet was initiated and the patient was discharged once he became symptomatically better. On follow–up, the patient has had no similar complaints. Conclusions: Phytobezoars are a rarity causing mechanical intestinal obstruction. Harmless walls of orange segments had lead to this patient’s undoing because of a pre–existing congenital Meckel’s band narrowing. Meckel’s band without a diverticulum causing luminal narrowing of the ileum is very rare. Identification of this anomaly is difficult with imaging studies. Hence laparoscopy helps in managing such scenarios with less morbidity as compared to open procedures.