Congenital mesocolon anomaly, omental band, and Meckel's diverticulum: a unique case of a small bowel obstruction.

With advancements in modern imaging, unexpected intraoperative findings are increasingly rare. We present the case of a 35-year-old female with a history of systemic lupus erythematosus and obesity, on home glucagon-like peptide-1 medication for weight loss, who presented with abdominal pain and imaging findings consistent with mesenteric swirling concerning for an internal hernia and a small bowel obstruction. During exploratory laparotomy, a necrotic omental band was discovered encircling the base of the small and large bowel mesentery. In addition, the entire colon was found to be freely mobile, consistent with congenital mesocolon anomaly. An incidental Meckel's diverticulum was also identified. Fortunately, all bowel was viable. The necrotic omentum and Meckel's diverticulum were resected, and the patient recovered uneventfully. This case highlights multiple coincidental rare intraoperative findings and discusses our approach to management.