GE Port J Gastroenterol. 2015;22(3):121---122

www.elsevier.pt/ge

IMAGES IN GASTROENTEROLOGY AND HEPATOLOGY

Meckel’s Diverticulum: A Rare Cause of Overt ObscureGastrointestinal Bleeding in an Adult Male

Divertículo de Meckel: Causa Rara de Hemorragia Digestiva ObscuraManifesta num Homem Adulto

Carlos Fernandes ∗, Rolando Pinho, João Carvalho

Gastroenterology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal

Received 21 November 2014; accepted 9 December 2014

anomaly in the GI tract. It results from a persistent remnantof the omphalomesenteric duct and it is usually located inthe antimesenteric side of the middle/distal ileum. It has

Available online 23 March 2015

A 64-year-old male, with history of arterial hypertensionand colonic polyps, recurred to the emergency departmentwith recurrent hematochezia in the last 6 h. He deniedabdominal pain, fever or other symptoms. No anemia orhemodynamic instability was present. Physical examinationconfirmed fresh blood and clots in the rectal ampulla. Anurgent colonoscopy revealed fresh blood and clots in the ter-minal ileum and through the colon. Subsequently an urgentupper gastrointestinal endoscopy was performed with norelevant findings. Hence, in the same day, an urgent cap-sule enteroscopy was performed. In the middle ileum, alarge diverticulum (Fig. 1) with erythematous mucosa in thefundus (Fig. 2) and a linear ulcer in the neck was found.Congestive mucosa and several deep ulcers with no activebleeding were apparent adjacent and downstream from thediverticulum (Fig. 3). These features highly suggested aMeckel’s diverticulum with ectopic gastric mucosa. Aftera multidisciplinary discussion, a laparoscopic diverticulec-tomy was performed. Histological evaluation confirmed aMeckel’s diverticulum with gastric and pancreatic tissues(Fig. 4). The patient was discharged 5 days later. No changesin the terminal ileum were apparent in a colonoscopy per-formed because of a post-polipectomy surveillance 4 monthslater.

∗ Corresponding author.E-mail address: carlosdpfernandes@gmail.com (C. Fernandes). F

a

http://dx.doi.org/10.1016/j.jpge.2014.12.0022341-4545/© 2014 Sociedade Portuguesa de Gastrenterologia. PublishedCC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4

Meckel’s diverticulum is the most common congenital

igure 1 Double lumen image in the middle ileum suggesting diverticulum.

by Elsevier España, S.L.U. This is an open access article under the.0/).

122 C. Fernandes et al.

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igure 2 Erythematous mucosa in the fundus of the divertic-lum.

n estimated prevalence of 2% in general population andt is twice more prevalent in males.1 Histological evalua-ion reveals ectopic tissue in 10---20% of the cases, mostlyastric mucosa.2 Nevertheless, the embryological origin ofhis later phenomenon is not well known. Meckel’s diver-iculum is often asymptomatic and only 2---4% will develop

related complication during the life course. Gastroin-estinal bleeding is the most common manifestation indults.3 Ectopic gastric tissue leads to acid secretion andonsequently to mucosal ulceration downstream from theiverticulum. Hence, an obscure or overt GI bleeding may

arely occur. A nuclear medicine study using 99m tech-etium pertechnetate --- Meckel’s scan --- has been usedor diagnosis. Nevertheless it is only able to diagnose

igure 3 Congestive and ulcerated mucosa in the terminalleum.

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igure 4 Histological evaluation revealing ectopic gastric andancreatic tissues in the diverticulum (HE; 100×).

eckel’s diverticulum with ectopic gastric mucosa, whichs only present in 20% of the cases. More recently, capsulenteroscopy and device-assisted enteroscopy have also beensed for diagnosis.4 A surgical approach is recommendedn symptomatic Meckel’s diverticulum.5 A simple divertic-lectomy or segmental bowel resection with a primarynastomosis are possible. The management of incidental andsymptomatic Meckel’s diverticulum is still controversial.

thical responsibilities

rotection of human and animal subjects. The authorseclare that no experiments were performed on humans ornimals for this study.

onfidentiality of data. The authors declare that no patientata appear in this article.

ight to privacy and informed consent. The authorseclare that no patient data appear in this article.

onflict of interest

othing to declare.

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