S5998 Remnants of the Past: A Rare Case of Small Bowel Obstruction Caused by Meckel’s Diverticulum in a 92-Year-Old Patient

Introduction: Meckel’s diverticulum (MD) is a congenital outpouching of the ileal wall caused by incomplete obliteration of the omphalomesenteric duct. It is among the most common congenital gastrointestinal anomalies and is typically discovered in children who present with symptoms such as painless rectal bleeding or intestinal obstruction. Most Meckel’s diverticula discovered in adulthood are found incidentally. It is rare for an elderly patient to have symptomatic presentation with small bowel obstruction (SBO) due to an underlying undiagnosed MD. Case Description/Methods: We present a 92-year-old woman with a history of hypertension, hyperlipidemia, paroxysmal atrial fibrillation, and hypothyroidism who presented to the emergency department after being found on the floor at home by her family. She reported 5 days of preceding nausea, vomiting, fatigue, abdominal pain, and poor oral intake. On admission, she was found to be hypotensive, hypothermic, and tachypneic. Initial labs revealed elevated creatinine consistent with severe acute kidney injury (AKI), elevated creatinine kinase consistent with rhabdomyolysis, and lactic acidosis. Computed tomography scan of the abdomen and pelvis revealed an SBO. Conservative management was initially attempted. Unfortunately, her SBO did not spontaneously resolve. Exploratory laparotomy was pursued which revealed 2 loops of adhesions and a purulent MD that was subsequently resected. Surgical specimen was sent for pathology which ultimately confirmed the diagnosis of MD. Postoperatively, the patient made a full recovery. Discussion: Upon comprehensive literature review, we find that this case is the oldest documented patient at 92 years old to present with an undiagnosed MD causing SBO that made full recovery post operatively. While MD is not a particularly uncommon congenital anomaly, it is usually diagnosed in children and is seldom symptomatic in the elderly. When found incidentally in elderly patients, observation and conservative management are often pursued to avoid unnecessary procedural complications. Ultimately, surgical intervention was necessary in this case for definitive treatment of her SBO as conservative management was unsuccessful. Our patient’s atypical presentation with sepsis, rhabdomyolysis, and severe AKI complicated diagnosis of the underlying cause of her SBO. This case emphasizes the importance of a broad differential for abdominal pain and non-specific symptoms in elderly patients, and highlights MD as a rare but clinically significant cause of SBO.