Introduction: Meckel’s diverticulum is a common congenital anomaly of the small intestine that occurs in approximately 2% of the population and is often discovered incidentally at the time of abdominal exploration using laparotomy or laparoscopy. A 75-year-old male underwent gastrectomy 4 weeks ago for newly diagnosed stage IIIB gastrointestinal stromal tumor, currently on gleevac, presented to the hospital with abdominal pain and multiple episodes of nausea and vomiting. On presentation, his vital signs were: blood pressure 208/82 mm Hg, respiratory rate 22/min, pulse 96/min, temperature 99.3° F, and pulse ox 93% on room air. Physical examination was remarkable for hypoactive and tinkling bowel sounds, and diffuse tenderness in all 4 quadrants. Initial lab work revealed a blood glucose of 238 mg/dL; complete blood count was unremarkable except for leukocytosis with a WBC count of 10.6 U/L. Abdominal x ray and small bowel follow-through was performed, which confirmed multiple dilated loops of small bowel. High-grade mid small bowel obstruction was confirmed by a computed tomography. Initial conservative management was performed with placement of a nasogastric tube, but the patient’s condition continued to worsen, so an emergent open exploratory laparotomy was performed for adhesion lysis causing the obstruction. Incidentally, Meckel’s diverticulum was found in the distal small bowel and was also excised. Pathologic analysis revealed 2 mm of carcinoid tumor in the distal part of diverticulum (Figure 1). The patient had an uneventful recovery post-operatively and had complete resolution of symptoms on the day of discharge. The majority of patients with Meckel’s diverticulum remain asymptomatic throughout their lives. The most common complications include bleeding, perforation, ileus, intussusception, and diverticulitis. The removal of asymptomatic Meckel’s diverticulum in adults is controversial, but resection is recommended in children. Incidental discovery of carcinoid tumors in a Meckel’s diverticulum have rarely been reported in the literature.Figure 1: Carcinoid tumor cells with finely granular chromatin.