3146 A Curious Case of Hematochezia in a Young Adult

Abstract

INTRODUCTION: Meckel's diverticulum is a common congenital abnormality of the small intestine secondary to the vitello-intestinal duct. It commonly presents as hematochezia and abdominal pain in young children particularly those less than 2 years old. CASE DESCRIPTION/METHODS: A 26 years old lady presented to Emergency Department with history of hematochezia and abdominal pain for 2 days. The abdominal pain was mainly paraumbilical and colicky in nature and it was present intermittently for the past 6 months. One day prior to this visit, she was treated for acute gastroenteritis by a General Practitioner in view of presence of vomiting and diarrhea. However, symptoms were not improving and she subsequently developed hematochezia. She denies any fever and family history of gastrointestinal disease such as inflammatory bowel disease or malignancy. She denies any recent travelling and there is no sick contact recently. Physical examination was unremarkable and per rectal examination reveals blood mixed with stool with no mass or hemorrhoids seen. She has leukocytosis on blood investigation and abdominal radiograph performed in emergency department was unremarkable. She was subsequently admitted for treatment of dysentery and was started on intravenous ceftriaxone and metronidazole. However, patient's abdominal pain became severe requiring opioid for analgesia and an inpatient Computer Topography scan of her abdomen was obtained. Figures 1 and 2 shows the appearance of bowel within bowel appearance in the right lower quadrant in keeping with ileocolic intussusception. An urgent surgical consult was done and patient was agreeable for operation for bowel resection. Intra-operatively, a Meckel's diverticulum was noted to be the cause of the intussusception. The segment of ileum in the intussusception was noted to be ischemia with gangrene but no perforation noted. The intussuscepted bowel was resected and an end to end ileocolic anastomosis was performed. Post operatively patient recovered well and tolerated orally without any complications. She was discharged subsequently. DISCUSSION: This case illustrated that Meckel's diverticulum could be a differential diagnosis for young adults presenting with hematochezia. It is commonly misdiagnosed preoperatively in view of the rarity of these cases in the adult population.