Inversion of Meckel's diverticulum causing gastrointestinal bleeding and small bowel obstruction

Abstract

A 35-year-old man presented with vomiting, mid-gut colic, intermittent passage of fresh blood per rectum and a haemoglobin level of 8.0 g/dl. Clinical examination was unremarkable and initial investigation with abdominal sonography revealed no abnormality. Computed tomography of the abdomen demonstrated a thick-walled loop of small bowel in the region of the terminal ileum (Figure 1). A differential diagnosis of ileo-ileal intussusception, Crohn's disease and Meckel's diverticulitis was considered. The patient proceeded to exploratory laparotomy, which revealed inversion of a Meckel's diverticulum causing incomplete small bowel obstruction. Segmental ileal resection and primary anastomosis was performed without incident. Recovery was uneventful. Histopathological examination showed a 15 mm submucosal nodule with associated ulceration of the overlying mucosa in the base of the diverticulum (Figure 2). Microscopy confirmed that the nodule contained heterotopic pancreas with lobules of ductal and acinar epithelium.