Meckel’s diverticulum is the most common congenital small-bowel anomaly and is usually asymptomatic. However, torsion of Meckel’s diverticulum is an extremely rare complication that can mimic other acute abdominal conditions such as appendicitis or small-bowel obstruction, posing a clinical challenge to surgeons that may result in misdiagnosis, especially in the absence of advanced imaging.

Case presentation
A 16-year-old Syrian male patient presented to the emergency department with 24-hour duration of severe right lower quadrant pain, vomiting, nausea, and 2-day history of obstipation. Physical examination showed abdominal distention and tenderness in McBurney’s point, while plain abdominal X-ray showed air-fluid levels consist with small bowel obstruction. Computed tomography was not conducted since the device was out of service. Initial diagnosis of acute appendicitis was made on the basis of the clinical findings, and the patient underwent surgery, revealing a normal appendix, prompting exploratory laparotomy where a giant torsed Meckel’s diverticulum with necrosis was demonstrated 45 cm proximal to the ileocecal valve, measuring 7 × 4 × 3 cm. The torsed diverticulum was excised through enterectomy and an end-to-end anastomosis was performed without complications. Postoperative intravenous antibiotics were given (please refer to Graphical Abstract).

Conclusion
This case demonstrates that torsion of Meckel’s diverticulum can mimic appendicitis and present with small-bowel obstruction and may only be identified during surgery, particularly when advanced imaging is inaccessible. Clinicians should remain vigilant regarding Meckel’s diverticulum and its differential diagnoses in young patients with right lower‑quadrant pain and perform diagnostic exploration if deemed necessary.