Abstract
Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract, arising from incomplete obliteration of the vitelline duct. MD contains all layers of the intestinal wall and often remains asymptomatic. Gastrointestinal bleeding, bowel obstruction, and acute diverticulitis occur in a few cases. Risk factors for symptomatic MD include male sex, age < 50 years, diverticula > 2 cm, and the presence of ectopic tissue. We present a case report of a 61-year-old male presenting with acute abdominal pain and signs of small bowel obstruction. CT imaging revealed intestinal obstruction. The patient underwent an exploratory laparotomy, and an internal hernia caused by an MD adherent to the retroperitoneum was found. A segmental small bowel resection with ileo-ileal anastomosis was performed. Histological examination confirmed MD with ectopic gastric tissue. Management of MD should be guided by patient age, diverticulum characteristics, and histological features. This case highlights MD as a potential etiology for acute small bowel obstruction in patients without prior abdominal surgeries. Clinicians must maintain a high index of suspicion for MD in atypical presentations and tailor management to individual risk factors and intraoperative findings.