Dual-mechanism small bowel obstruction from Meckel diverticulum in an 8-year-old: a case report.

We report a dual-etiology obstruction in an 8-year-old boy: congenital closed-loop small bowel obstruction (SBO) from a volvulized Meckel diverticulum tethered by an omphalomesenteric duct remnant, followed by early postoperative focal SBO from an omental band. He presented after one week of abdominal pain with worsening and non-bloody, non-bilious emesis. Contrast-enhanced computed tomography showed distal SBO with a mesenteric swirl. Laparoscopy confirmed a necrotic Meckel diverticulum with volvulized distal ileum; the tethering band was divided and segmental ileal resection with anastomosis performed. After transient return of bowel function, he developed recurrent distention and bilious emesis; imaging showed a discrete transition point near the anastomosis with decompressed distal bowel and colon. Symptoms persisted despite decompression and parenteral nutrition. Repeat laparoscopy revealed a single omental band proximal to the anastomosis; adhesiolysis resolved obstruction. Clinical lesson: early focal postoperative SBO with a discrete transition point may warrant prompt minimally invasive re-exploration.