Enterolith-containing Meckel's diverticulum causing strangulated small bowel obstruction in an older adult: diagnostic implications of transition-point calcification on computed tomography.

INTRODUCTION: Preoperative diagnosis of Meckel's diverticulum in adults remains challenging because clinical presentation and computed tomography findings are often nonspecific. Enterolith-containing Meckel's diverticulum may present as strangulated small bowel obstruction with calcified lesions near the transition point. CASE PRESENTATION: An 83-year-old woman without prior abdominal surgery presented with abdominal pain, vomiting, and progressive malaise. Non-contrast computed tomography showed closed-loop small bowel obstruction with two adjacent high-density lesions near the pelvic transition point. Emergency surgery was performed because bowel ischemia was suspected. Laparoscopy was converted to open laparotomy because severe bowel dilatation prevented adequate visualization. A blind-ending diverticulum arising from the antimesenteric border of the distal ileum and containing two enteroliths was identified. The diverticulum twisted around the adjacent ileum, causing strangulation and segmental bowel necrosis. Based on its anatomical configuration, it was considered Meckel's diverticulum. Partial ileal resection was performed. Retrospective review indicated that the high-density lesions corresponded to enteroliths within the diverticulum. The patient was discharged on postoperative day 10 without complications. CONCLUSION: Meckel's diverticulum should be considered in older adults with strangulated small bowel obstruction without prior laparotomy. Enterolith-like calcifications adjacent to the distal ileal transition point may provide a diagnostic clue when the etiology is unclear preoperatively.