A (Not So) Rare Cause of Obscure Gastrointestinal Bleed in Elderly

Abstract

A 76-year-old woman presented with a 1-day history of bleeding per rectum and a syncopal episode. Her past medical history was notable for 2 episodes of melena in the previous 8 months, and evaluation by upper and lower endoscopy and computed tomography angiography had not identified a source of bleeding. The physical examination revealed pallor and there was maroon-colored stool on rectal examination. Her hemoglobin level was 6.3 g/dL at presentation. After resuscitation, urgent upper endoscopy and colonoscopy up to 10 cm of ileum followed by multidetector computed tomography angiography did not reveal any bleeding source. A videocapsule endoscopy showed blood in the ileum with no bleeding source. Novel motorized spiral enteroscopy revealed a solitary diverticulum in distal ileum, suggestive of Meckel diverticulum (Figure A). Meckel scan confirmed the presence of ectopic gastric mucosa. During laparoscopy a large wide-mouthed Meckel diverticulum was identified and excision with primary anastomosis was performed (Figures B and C). Gastrointestinal bleeding as a result of Meckel diverticulum should be considered as a differential diagnosis even in elderly patients. A high index of suspicion is necessary for diagnosis. Novel motorized spiral enteroscopy may be useful in the evaluation of patients with obscure overt gastrointestinal bleeding when a small bowel source is suspected. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJkY2M1OWYyYWVmMWZmZTU5ZjVmNGNlMWU1MTA5NzNlOCIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjcyNTg3NzM0fQ.lP1rEC6Iy8N8YO69yqraGvWInBM0vPA8-AejgJRSFCKXA-pTgvJie207Rdn0R-68N90NO51Ea1845F0kkixsLijMM51V4a2rdoN_FqbD4xdGHUoRNKT2XXWQqN7v4UJWrK79sC0BXjJjKT-cxbihMb9dqe1WbUI9DqsxSPemQZzWFKw8btIQGv67-48gUxAH41tAIRcE_uJSjZwmGMi3gbexcnkMS2X7xnWGBfFq-p9M5SoF8Yf1JOWjRUy1fwI5_6oyc64R56mIKUR9335XdHehtHutczoyor132WSSLX6WabJhPfxP19b2m0dHqf5eRIpA929sByObeiVPEBAAAA Download .mp4 (5.38 MB) Help with .mp4 files Supplementary Video