Diagnostic pitfalls in tuberculosis-endemic settings: Meckel’s diverticulum presenting as acute intestinal obstruction

Meckel’s diverticulum, although the most prevalent congenital gastrointestinal anomaly, rarely presents with intestinal obstruction in adults. In tuberculosis-endemic regions, abdominal symptoms in patients with pulmonary tuberculosis are frequently attributed to abdominal tuberculosis, potentially leading to diagnostic bias. We report a case highlighting the importance of avoiding diagnostic anchoring in such settings. A young male with microbiologically confirmed pulmonary tuberculosis, on antitubercular therapy (ATT) for 2 months in the intensive phase, presented with an acute onset of abdominal pain, vomiting, and constipation. Clinical examination revealed a distended, tense abdomen with diffuse tenderness and absent bowel sounds. Radiography suggested small bowel obstruction. Contrast-enhanced computed tomography (CECT) demonstrated dilated small bowel loops with a distal ileal transition point, without evidence of ileocecal thickening, necrotic lymphadenopathy, ascites, or peritoneal enhancement suggestive of abdominal tuberculosis. Emergency exploratory laparotomy revealed a Meckel’s diverticulum with an adjacent ileal loop entrapped within a mesodiverticular band, causing mechanical obstruction. Segmental ileal resection with diverticulectomy and double-barrel ileostomy was performed. Histopathological examination showed no evidence of tubercular granulomas. This case underscores the importance of avoiding diagnostic anchoring toward tuberculosis and maintaining a broad differential diagnosis in acute abdomen, even in patients with active pulmonary tuberculosis.