Hemorrhage from a Meckel's diverticulum as a cause of melena in infancy; report of a case in which the diverticulum was demonstrated roentgenographically.

Abstract

In the differential diagnosis of melena in infancy one of the conditions to be considered is hemorrhage from a Meckel's diverticulum. In the case to be reported here, a Meckel's diverticulum was demonstrated by a preoperative roentgenogram. The diagnosis was made clinically by the pediatrician and the consulting surgeon, but roentgenograms afforded positive evidence. Surgical removal of the diverticulum resulted in a cessation of the melena. Case Report T. G., white male, age thirteen months, was admitted to the hospital Nov. 25, 1948, because of bloody bowel movements and intense pallor. He had been passing large amounts of fresh and clotted blood in the stools for about twelve hours prior to admission. The pertinent previous history was as follows: The parents had first noticed blood in the stools in June 1948. Bleeding occurred on one day, followed by normal stools the next day and a recurrence of bleeding on the third day. A physician was consulted. A stool specimen at that time showed no blood. The child was not acutely ill, and because no abnormal condition was found on clinical examination, he was allowed to return home without hospitalization. In September 1948, there was a recurrence of bleeding for one day. At that time the parents noticed an increasing pallor. On admission of the infant to the hospital, Nov. 25, 1948, the examining pediatrician (C. F. F.) noted gross blood in the stools. The child appeared acutely ill and was very pale. Examinations of the eyes, ears, nose and throat, the thorax, the genitals, and the back and extremities were normal. Abdominal examination revealed no palpable masses or areas of rigidity. Rectal examination disclosed no abnormalities, but there was blood on the examining finger. Urinary findings were negative. The blood count showed a marked secondary anemia (6.6 gm. hemoglobin, 2,760,000 erythrocytes). Repeated studies on the same day and the following morning showed elevation of the white count, ranging between 12,000 and 17,000, but the differential count was normal. The blood was type 2, and was Rh positive. The child continued to pass bright red and dark blood in the stools, and the pediatrician considered a diagnosis of a bleeding Meckel's diverticulum most likely. Surgical consultation was obtained (W. R. L. II). It was the opinion of the surgeon, also, that a bleeding Meckel's diverticulum was the most likely diagnosis, but it was deemed advisable to examine the colon by x-ray prior to undertaking exploratory operation. Roentgen Examination: Before beginning the roentgen examination, the radiologist was aware of the clinical diagnosis of probable bleeding Meckel's diverticulum. The examination was undertaken primarily to rule out two other lesions: (1) a solitary polyp or polyposis of the colon (rectal examination had failed to reveal any polyps); (2) an intussusception (clinical examination had failed to reveal any definite evidence of this lesion).