Bleeding Meckelʼs Diverticulum: An Alternative Diagnostic Approach

Abstract

Gastrointestinal bleeding secondary to Meckel's diverticulum in adulthood can be diagnosed by multiple methods but advanced endoscopic techniques are not routinely used. We described a case of Meckel's diverticulum diagnosed after retrograde double ballon enteroscopy (DBE). A 33-year-old female with a history of peptic ulcer disease (PUD) presented with melena. Her PUD was diagnosed 13 years ago in another country by EGD, without recurrence. The melena started 1 day prior to admission with sharp epigastric abdominal pain. She denied additional risk factors for PUD and had completed recent urea breath testing that was negative for Helicobacter pylori. On admission her labs were significant for a hemoglobin of 11 g/dL, MCV 82.4. Physical exam demonstrated mild diffuse abdominal tenderness. She underwent an inpatient EGD which was normal. Outpatient colonoscopy was unremarkable with a normal terminal ileum, followed by a capsule endoscopy that was significant only for a focal proximal jejunal erosion. The following month she developed recurrent melena with a hemoglobin of 10.2 g/dL. She completed antegrade DBE to the mid jejunum that was normal. She subsequently underwent a retrograde DBE, revealing blood throughout the colon, and a Meckel's diverticulum in the mild ileum with short distal ulceration and a visible vessel. The area was tattooed, and general surgery performed a laparoscopic small bowel resection of the Meckel's diverticulum without complications. She has remained asymptomatic since her surgery. Meckel's diverticulum that presents with bleeding is typically diagnosed via mesenteric arteriography or Meckel's scan. The endoscopic and radiographic evaluation varies for adult patients. The role of DBE in Meckel's diverticulum has been reported in small cases series but can be a reliable means of diagnosis.