Abstract
Meckel’s diverticulum may sometimes present as an intraluminal polypoid mass causing small bowel obstruction; however, gastrointestinal bleeding due to Meckel’s diverticulum with a polypoid lesion is rare. A 14-year-old girl presented with tarry stool and syncope in our hospital. Laboratory examination showed iron-deficiency anemia with a low hemoglobin level of 5.8 g/dl. The bleeding site was detected by neither upper gastrointestinal endoscopy nor colonoscopy. Transanal double-balloon enteroscopy showed a diverticulum with an ulceration at a site approximately 50 cm from the ileocecal valve and a polypoid lesion inside of the diverticulum. Histopathological examination of a polypoid lesion revealed an ectopic gastric mucosa of the fundic type. Furthermore, technetium-99m pertechnetate scintigraphy showed a hot spot in her lower right abdomen. On the basis of these findings, she was diagnosed as having hemorrhagic Meckel’s diverticulum. Single-incision laparoscopy-assisted segmental bowel resection of the ileum was performed. The patient recovered well, and she was discharged from the hospital on postoperative day 7. She was doing well 6 months later without evidence of reoccurrence. In this report, we describe a case of Meckel’s diverticulum with a polypoid lesion; hemorrhage may have occurred owing to the ulceration of the ileal mucosa with which the polypoid lesion directly came in contact. We consider this case to be of interest to gain insight into the site and mechanism of ulceration associated with Meckel’s diverticulum.
Highlights
BackgroundMeckel’s diverticulum is the most common congenital malformation of the gastrointestinal tract (present in 0.6–4 % of the population) due to the persistence of the congenital vitellointestinal duct [1]
Meckel’s diverticulum is the most common congenital malformation of the gastrointestinal tract due to the persistence of the congenital vitellointestinal duct [1]
Meckel’s diverticulum may at times present as an intraluminal polypoid mass causing small bowel obstruction, and this occurs when the diverticulum is inverted into the ileum and may serve as a lead point for intussusceptions [4]
Summary
Meckel’s diverticulum is the most common congenital malformation of the gastrointestinal tract (present in 0.6–4 % of the population) due to the persistence of the congenital vitellointestinal duct [1]. We describe a case of intestinal hemorrhage caused by Meckel’s diverticulum with ectopic gastric mucosa on the polypoid lesion. Physical examinations showed an anemic change in the palpebral conjunctiva On admission, her blood pressure was 98/58 mmHg, heart rate was 98 beats per minute, and respiratory rate was 18 breaths per minute. Laboratory tests (Table 1) showed the following blood and biochemical findings: hemoglobin, 6.2 g/dl (normal, 12–16 g/dl); Fig. 1 Contrast-enhanced CT images showing a tumor with a contrasting effect in the ileum (arrow) serum iron, 10 μg/dl (normal, 70–180 μg/dl); unsaturated iron-binding capacity, 386 μg/dl (normal, 137–325 μg/dl); and ferritin, 5.8 μg/dl (normal, 6.2–138.0 μg/dl). Transanal double-balloon enteroscopy revealed bifurcation of the intestinal tract (Fig. 2a), and in one lumen seen at the bottom of the screen, a polypoid lesion inside of the diverticulum (Fig. 2b, arrow) and ulceration (Fig. 2b, arrowhead) were observed. The patient did well postoperatively, and she was discharged from the hospital on day 7 without the need
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