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Revista Española de Enfermedades Digestivas

Print version ISSN 1130-0108

Rev. esp. enferm. dig. vol.110 n.1 Madrid Jan. 2018

http://dx.doi.org/10.17235/reed.2017.5219/2017 

LETTERS TO THE EDITOR

Hemorrhage and intestinal obstruction secondary to a Meckel's diverticulum: a case report

Bing-Yan Xue1  , Qi-Yun Tang1 

1Department of Gastroenterology. The First Affiliated Hospital of Nanjing Medical University. Nanjing, Jiangsu Province. China

Key words: Meckel's diverticulum; Hemorrhage; Intestinal obstruction

Dear Editor,

We present the case of a 17 year old male with a ten year history of anemia that presented with recurrent bloody stools, abdominal pain and fatigue of 3 month duration. When in the hospital, the lowest blood pressure reading was 91/44 mmHg. The physical examination was negative, laboratory tests revealed a decreased hemoglobin level of 60 g/L. The gastroscopy, colonoscopy, first-time double-balloon enteroscopy (DBE) via the anus at 120cm from the ileocecal valve and the capsule endoscopy up to the caecum were all negative. Therefore, a 99mTc-pertechnetate scan was performed in order to determine whether there was ectopic gastric mucosa. A rounded highly radioactive area was observed at the ileocecum. This positive result identified ectopic gastric mucosa, which led to a provisional diagnosis of a bleeding Meckel's diverticulum (MD). Subsequently, a double-balloon enteroscopy through the anus was performed by a more-experienced endoscopic physician. The diverticulum was found at a distance of 50 cm from the ileocecal valve with smooth mucosa (Fig. 1, Fig. 2).

Fig. 1 Diverticulum at a distance of 50 cm from the ileocecal valve with smooth mucosa. 

Fig. 2 99mTc scintigraphy which showed a round-like, high radioactive concentration in the ileocecum that lasted for 60 minutes. 

A laparoscopic exploration w<as performed and a closed loop obstruction and gangrene of MD at 60 cm from the ileocecal valve was found. A segmental bowel resection was performed and the histopathology confirmed a diverticulitis of Meckel's diverticulum. No complications were observed after six months of follow-up.

DISCUSSION

Meckel's diverticulum is a congenital gastrointestinal malformation and hemorrhage is the most common presentation. Severe bleeding implies MD with ectopic gastric mucosa which was found in this case. About 6% of cases are diagnosed before surgery 1. DBE and capsule endoscopy could assist the diagnosis of symptomatic MD. False-negative results may be related to the size and position of the MD.In addition, the experience of the endoscopic physician should not be over looked. The 99mTc-pertechnetate scan is the most well-established method for detecting Meckel's diverticulum, with a sensitivity and specificity of 85% and 95%, respectively 2. Surgery is the treatment of choice 3.

REFERENCES

1. Murruste M, Rajaste G, Kase K. Torsion of Meckel's diverticulum as a cause of small bowel obstruction: a case report. World J Gastrointest 2014;6:204-7. DOI: 10.4240/wjgs.v6.i10.204 [ Links ]

2. Mariani G, Pauwels EK, AlSharif A, et al. Radionuclide evaluation of the lower gastrointestinal tract. J Nucl Med 2008;49:776-87. DOI: 10.2967/jnumed.107.040113 [ Links ]

3. Juanmartiñena Fernández JF, Fernández-Urién Sainz I, Saldaña Dueñas C, et al. Meckel´s diverticulum bleeding detected by capsule endoscopy. Rev Esp Enferm Dig 2017;109:295-6 [ Links ]

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