A Rare Case of Gangrenous Meckel's Diverticulum and Acute Appendicitis Presenting As Closed-Loop Obstruction in a Young Adult.

Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, arising from incomplete obliteration of the vitelline duct. Although often asymptomatic, it can present with life-threatening complications such as inflammation, bleeding, intestinal obstruction, and perforation. Closed-loop obstruction secondary to Meckel's diverticulum is rare, and its coexistence with acute appendicitis is exceptionally uncommon, posing a diagnostic challenge. We report the case of a 22-year-old male who presented to the emergency department with a two-day history of diffuse abdominal pain and one day of bilious vomiting. Clinical examination revealed abdominal distension, diffuse tenderness, and bowel sounds that were sluggish, suggestive of intestinal obstruction. Contrast-enhanced computed tomography (CECT) of the abdomen and pelvis demonstrated clustering of small bowel loops medial to the caecum, raising suspicion for a paracaecal internal hernia with features of closed-loop obstruction involving mid-ileal loops, though bowel wall enhancement was preserved. Exploration revealed an inflamed appendix and a gangrenous Meckel's diverticulum associated with interloop adhesions, resulting in a closed-loop obstruction of the adjacent ileal segment. Surgical management included resection of the gangrenous ileal segment along with the Meckel's diverticulum, followed by a side-to-side ileo-ileal anastomosis using a linear stapler. Appendicectomy was performed concurrently. The postoperative course was uneventful, and the patient remained asymptomatic during a six-month follow-up period. This case highlights the rare coexistence of gangrenous Meckel's diverticulum and acute appendicitis presenting as closed-loop obstruction, underscoring the importance of maintaining a high index of suspicion and a broad differential diagnosis in young patients presenting with an acute abdomen. Early surgical intervention remains crucial to prevent morbidity and ensure favourable outcomes.