Phytobezoar Impaction Within Meckel's Diverticulum Causing Distal Small Bowel Obstruction: A Case Report With Characteristic Computed Tomography Small Bowel Feces Sign

Phytobezoar impaction within a Meckel's diverticulum is an exceptionally rare cause of mechanical small bowel obstruction and presents a diagnostic challenge because of its nonspecific clinical manifestations. We report the case of a 24-year-old previously healthy man who presented with a three-day history of progressive colicky abdominal pain, bilious vomiting, abdominal distension, and absolute constipation. Laboratory investigations revealed mild leukocytosis without evidence of systemic sepsis or biochemical evidence of bowel ischemia. Contrast-enhanced computed tomography demonstrated markedly dilated small bowel loops with an abrupt transition point in the distal ileum and a characteristic small bowel feces sign immediately proximal to the transition point, supporting the diagnosis and localization of mechanical obstruction. Emergency exploratory laparotomy identified an impacted phytobezoar within a Meckel's diverticulum causing complete luminal obstruction. No adhesions, congenital bands, volvulus, internal hernias, or gross bowel ischemia were identified. Segmental resection of approximately 30 cm of the distal ileum, including the Meckel's diverticulum and phytobezoar, followed by primary hand-sewn end-to-end anastomosis was successfully performed. Histopathological examination confirmed a Meckel's diverticulum with an impacted phytobezoar causing mechanical obstruction without transmural necrosis or established bowel ischemia. The patient had an uncomplicated postoperative recovery and remained asymptomatic during follow-up. This case highlights phytobezoar impaction within a Meckel's diverticulum as an uncommon cause of small bowel obstruction, particularly in young patients without previous abdominal surgery. It also illustrates the role of computed tomography in identifying and localizing mechanical obstruction and emphasizes the importance of timely surgical management when complete obstruction is present.