Fatal septic shock caused by axially torsed Meckel’s diverticulum: A rare convergence of obstruction and necrotizing colitis

A previously healthy 44 year old man presented to the emergency department with a 3 day history of diffuse abdominal pain, nausea,vomiting, and absence of flatus or bowel movements. At the time of presentation, he was lethargic and appeared acutely ill, with unrecordable blood pressure, marked tachycardia, and hypoxemia, consistent with septic shock. Contrast-enhanced computed tomography of the abdomen revealed a closed-loop small bowel obstruction involving distal ileal loops, with poor enhancement of the bowel wall and moderate free intraperitoneal fluid. Emergent exploratory laparotomy identified axial torsion of a Meckel’s diverticulum, resulting in ischemic necrosis, intestinal obstruction, and secondary peritonitis. Segmental resection of the affected ileal segment, including the necrotic Meckel’s diverticulum, was performed. Despite intensive resuscitative efforts postoperatively, the patient died due to refractory septic shock. This case highlights a rare but catastrophic complication of Meckel’s diverticulum and underscores the importance of early recognition and prompt surgical intervention in patients presenting with signs of closed-loop obstruction and hemodynamic compromise.