2578 Meckel's Diverticulum: A Diverticulum Like No Other

Abstract

INTRODUCTION: Meckel's diverticulum (MD) is a relatively uncommon cause of gastrointestinal (GI) bleeding in adults. “Often looked for and seldom found,” MD is challenging to diagnose despite the various imaging modalities available. Herein, we present the case of a young man who presented with lower GI hemorrhage and negative endoscopy, bleeding scan, and angiography. Meckel's diverticulum was later diagnosed via scintigraphy scan. We review the noninvasive diagnostic imaging for Meckel's diverticulum, mainly technetium-99m (Tc 99m) pertechnetate scan, and bleeding scan. CASE DESCRIPTION/METHODS: A 26-year-old man presented with multiple episodes of melena. He had acute onset anemia. Workup, including upper endoscopy, colonoscopy, and push enteroscopy were not able to identify the site of bleeding even after repeat procedures. A computed tomography scan with intravenous contrast and mesenteric angiography were also unrevealing. A Technetium 99m bleeding scan was read as negative. Persistent bleeding necessitated recurrent transfusions. Capsule endoscopy was deployed. A Meckel's scan (Tc 99m Pertechnetate scan) revealed an abnormal focus of uptake in the right lower abdomen suggesting the diagnosis of Meckel's diverticulum. The patient underwent laparoscopic resection of the diverticulum and was discharged home (Figures 1 and 2). A retrospective review of the bleeding scan revealed isolated uptake in the location of the Meckel's Diverticulum. Review of the capsule endoscopy revealed a diverticulum in the small bowel in the right lower quadrant without active bleeding (Figure 3). DISCUSSION: Bleeding Meckel's diverticulum is easier to diagnose than MD presenting with other symptoms, but still an outstanding challenge. High suspicion for MD should be sought in the evaluation of a young patient presenting with GI bleeding; the gold standard for diagnosis is the technetium-99m pertechnetate scan or so-called Meckel's scan. Bleeding scan is another noninvasive imaging modality that helps to detect a bleeding MD. Although both scans use Tc 99m, the mechanism is different. Meckel's scan uses Tc 99m, which is secreted by parietal cells in the mucus, thus detecting gastric cells within MD. On the other hand, the bleeding scan works via identifying Tc 99m that is bound to hemoglobin, therefore identifying a bleeding MD. Both scans are noninvasive and safe. The use of either one should be tailored according to the clinical presentation.