Gastrointestinal Bleeding due to Meckel's Diverticulum in an Elderly Patient

Abstract

Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract (1). It mostly occurs in children while it is also the most common cause of lower gastrointestinal bleeding in childhood. While the most common cause of gastrointestinal bleeding in adult patients is peptic ulcer, it is usually diverticulosis and angiodysplasia in older adults. In this report, we aim to present the case of an elderly adult patient who underwent operation due to acute lower gastrointestinal system (GIS) bleeding the etiology of which was determined to be Meckel's diverticulum. A sixty-five-year-old man was admitted to our emergency department with rectal bleeding. There was widespread abdominal tenderness with no defence or rebound on physical examination. We had fresh blood during the rectal examination. The hemoglobin level was 6 g/dl. In the colonoscopy, we observed that the entire colon was filled with blood but the source of bleeding could not be determined. We also failed to determine the source of bleeding in the upper gastrointestinal gastroscopy. Despite the blood transfusion the patient remained hemodynamically unstable and thus was taken to the operation room in emergency conditions. The exploration revealed a Meckel's diverticulum 80cm from the ileocecal valve. We observed fluid that could be related to the bleeding in the distal of the diverticula, in the ileum, and all over the colon lumen. The intraluminal section in the proximal of the diverticulum showed an externally usual picture. We opened the small intestine and Meckel's diverticulum with enterotomy and determined the active source of bleeding in the diverticulum. We then applied small bowel resection to include the diverticulosis followed by an end-to-end anastomosis. The patient returned to normal hemodynamically during the postoperative follow-up. The hematochezia stopped completely on the 4th postoperative day. The hemoglobin levels were stable as well. The patient was discharged in good health on postoperative day 6. Meckel's diverticulum is the most common cause of lower gastrointestinal bleeding in childhood. In adults, it usually causes mechanical intestinal obstruction. It should be kept in mind that Meckel's diverticulum may be the reason behind acute bleeding in adults and elderly patients while it may even cause acute lower gastrointestinal bleeding in the same patient groups (2). It will also be beneficial for surgeons and patients to remember that Meckel's diverticulum may result in GIS bleeding in older patients.