Meckel's Scan Research Articles

Meckel’s scan in children: a review of 183 cases referred to two paediatric surgery specialist centres over 18 years

To review our practice of Meckel's Tc-99m pertechnetate scans over 18 years with regard to indications for the test, sensitivity and specificity in our particular referral patients' population. This is a retrospective review of Meckel's scans performed in two paediatric tertiary care teaching hospitals from April 1993 to March 2011 and followed up till October 2011. The scan was performed according to published international guidelines. 183 patients were included in this study. We classified the patients into two groups: group 1, which included 77 patients (42 %) presenting with painless per rectum bleeding, and group 2, which included 106 patients (58 %) presenting with other non-specific symptoms (e.g. abdominal pain, possibly associated with nausea and/or vomiting, failure to thrive). Data were analysed using Chi square test, considering P value less than 0.05 as significant. The age of the patients ranged from 4 days to 16.5 years (median 3 years). 161 of the total 183 children on the study (88 %) had a negative Meckel's scan, and 22 children (12 %) had a positive scan. In the group with a positive Meckel's scan (22 children), all patients underwent surgical exploration and ectopic gastric mucosa was found in 17 cases (77 %, true positives). In the remaining 5 cases (23 %), there was no evidence of ectopic gastric mucosa (false positives). Within the group with a negative scan, 8 children (5 %) underwent surgery; only 1 child had a ectopic gastric mucosa detected following surgery (false negative). In other 52 children (32 %) of the group with a negative Meckel's scan, an endoscopy was done, which showed a normal result in 21 children and was abnormal in 31 children. Of the remaining 101 (63 %) children with a negative Meckel's scan, 74 children (46 %) improved without any further intervention. In 13 cases (8 %), other pathologies were identified. The sensitivity and specificity of the Meckel's scan for ectopic gastric mucosa were 94 and 97 %, respectively. The Meckel's scan was positive in 26 % of the patients of group 1 and in only 2 % patients of group 2. The difference between the two groups was highly significant [P < 0.0001 (Yates-corrected Chi square); odds ratio 18 (Woolf-logit method 95 % CI)]. The Meckel's scan retains a high diagnostic accuracy in children for detecting a Meckel's diverticulum with ectopic gastric mucosa within it, when performed according to the recommended guidelines. The test yields its highest positive result in children presenting with significant per rectum bleeding.

Pediatric Nuclear Medicine in Acute Care

Various radiopharmaceuticals are available for imaging pediatric patients in an acute care setting. This article focuses on the common applications used on a pediatric patient in acute care. To confirm the clinical diagnosis of brain death, brain scintigraphy is considered accurate and has been favorably compared with other methods of detecting the presence or absence of cerebral blood flow. Ventilation-perfusion lung scans are easy and safe to perform with less radiation exposure than computed tomography pulmonary angiography and remain an appropriate procedure to perform on children with suspected pulmonary embolism as a first imaging test in a hemodynamically stable patient with no history of lung disease and normal chest radiograph. (99m)Tc pertechnetate scintigraphy (Meckel's scan) is the best noninvasive procedure to establish the diagnosis of ectopic gastric mucosa in Meckel's diverticulum. Hepatobiliary scintigraphy is the most accurate diagnostic imaging modality for acute cholecystitis. (99m)Tc-dimercaptosuccinic acid scintigraphy is the simplest, and the most reliable and sensitive method for the early diagnosis of focal or diffuse functional cortical damage. Bone scintigraphy is a sensitive and noninvasive technique for the diagnosis of bone disorders such as osteomyelitis and fracture. Of recent, positron emission tomography imaging using (18)F-NaF has been introduced as an alternative to bone scintigraphy. (18)F-fluorodeoxyglucose-positron emission tomography has the potential to replace other imaging modalities, such as the evaluation of fever of unknown origin in pediatric patients, with better sensitivity and significantly less radiation exposure than gallium scan.

Uncommon Cause of Severe Obscure GI Bleeding in the Young Patient with Alcohol-Induced Chronic Pancreatitis

Purpose: Hemosuccus pancreaticus (HP) is an uncommon cause of obscure GI bleeding, commonly found in chronic pancreatitis, resulting from a ruptured splenic artery aneurysm or bleeding from pseudocyst wall. Ruptured splenic artery aneurysm in HP is likely from pseudoaneurysm (which can be found in 10% of chronic pancreatitis) rather than true aneurysm (which is more likely associated with trauma, infection or weakening of the splenic artery wall). The bleeding is usually obscure but could become life-threatening which requires radiologic intervention or surgical management. A 27-year-old alcoholic man presented with fatigue from iron deficiency anemia. Physical examination was unremarkable except pale conjunctiva. On the first admission, upper endoscopy, colonoscopy, and small bowel follow-through were unremarkable. He was readmitted 4 months later with hematochezia and intermittent epigastric pain. CT scan of abdomen with contrast was obtained showing diffused calcified pancreas; therefore, alcohol-induced chronic pancreatitis was diagnosed. Meckel's scan and video-capsule endoscopy were also unremarkable. Repeated upper endoscopy revealed intermittent bleeding from major duodenal papilla and retained blood in second part of duodenum. With history of chronic pancreatitis, HP was suspected so visceral angiography was performed but no significant finding was detected. Three months later, he was readmitted with fatigue and epigastric pain. The third upper endoscopy found no pathology but the concern of HP remained unresolved. CT scan of abdomen with contrast was repeated and demonstrated an interval development of 1.9 × 1.2 cm dense enhancing lesion in the tail of pancreas. Repeated non-provocative visceral angiography showed a saccular pseudoaneurysm in the distal part of pancreas. He underwent a successful transcatheter embolization with coils. The patient recovered well with no recurrent rehospitalization during the next 3 years. In this case, we underscore the diagnostic significance of chronic pancreatitis leading to the development of HP resulting from ruptured splenic artery pseudoaneurysm connected to the pancreatic duct or to a larger side-branch. The distinct feature of HP is an episodic bleeding which delays the definite treatment due to difficulty locating site of bleeding. Surgery might also be an option if the bleeding site cannot be located or the interventional therapy is unsuccessful. Even if the first visceral angiography reveals no aneurysm, repeat visceral angiography might be warranted if HP remains a probable answer to the recurrent obscure GI bleeding. Also, the provocative visceral angiography might be useful in early diagnosis of this case.

Obscure gastrointestinal bleeding and Turner syndrome

Gastrointestinal bleeding in individuals with Turner syndrome is relatively rare and there have been only a handful of reported cases in the literature. Here, we present two patients with Turner syndrome who were evaluated for obscure gastrointestinal bleeding. Our first patient presented with iron deficiency anemia and the work-up for a possible gastrointestinal bleed was pertinent only for polyps and a non-bleeding vein in the colon seen on colonoscopy. Our second patient had a history of unexplained recurrent melena and iron deficiency anemia, with previously normal esophagogastroduodenoscopies, colonoscopies and a Meckel's diverticulum scan. Both patients were subsequently diagnosed with gastrointestinal vascular malformations via capsule endoscopy.

Ileal dysgenesis coexisting with multiple enteric duplication cysts in a child—MR enterography, CT, and Meckel scan appearances

There are numerous causes of iron deficiency anemia due to gastrointestinal tract bleeding in children. While a very thorough history may elucidate common etiologies, such as cow's milk protein-induced colitis and nonsteroidal anti-inflammatory drug-related gastritis or peptic ulcer disease, other less frequent causes often present a diagnostic challenge. We present the MR enterography (MRE), CT and Meckel scan findings of ileal dysgenesis coexisting with multiple enteric duplication cysts in a young child who presented with chronic iron deficiency anemia, recurrent gastrointestinal tract bleeding and unexplained bowel perforation. In this case, MRE was able to identify and characterize each individual lesion and directly guide appropriate surgical management.

Identification of Meckel Diverticulum by Capsule Endoscopy

A 5-year-old white boy with a medical history of constipation presented with a 1-day history of painless hematochezia. He had 2 episodes of bright-red blood in his stool with clots. Initial laboratory evaluation was positive for hemoglobin of 7.9, hemoccult-positive stool, and 2 negative Meckel scans after 5-day pretreatment with ranitidine (1). An upper endoscopy and colonoscopy were visually and histologically normal. Capsule endoscopy showing 2 lumens within the ileum was consistent with Meckel diverticulum (MD) (Fig. 1). The patient underwent an exploratory laparoscopy; an MD was found and removed (2). The presence of the enteric wall biopsy showing a layering architecture composed of villiform small intestinal mucosa and gastric oxyntic mucosa with focal ulceration on histological evaluation confirmed an MD. Capsule endoscopy, which is not the conventional method of detecting MD, can aid in identifying MD in patients whose previous evaluations are negative. Definitive treatment for MD is surgical removal in the symptomatic patient.FIGURE 1: Meckel diverticulum.

Meckel's Diverticulum Preoperatively Diagnosed by Double-balloon Endoscopy

Symptomatic Meckel's diverticulum is an uncommon diagnosis in adults, and bleeding Meckel's diverticulum after childhood is even more infrequent. We present herein the case of a 22-year-old man with gastrointestinal hemorrhage secondary to Meckel's diverticulum containing ectopic gastric mucosa. As the source of bleeding could not be identified by upper and lower gastrointestinal endoscopy and visceral selective angiography, the new methods of capsule endoscopy and double-balloon endoscopy were used. Capsule endoscopy showed oozing hemorrhage in the ileum, and double-balloon endoscopy demonstrated a large diverticulum in the distal part of the ileum. Tc-99m pertechnetate Meckel's scan revealed an abnormal focus of uptake in the right lower abdomen. The diverticulum was resected laparoscopically. The postoperative course was uneventful, and the patient remains in complete remission as of this writing. Detecting Meckel's diverticulum endoscopically is difficult prior to surgery, but a combination of capsule endoscopy and double-balloon endoscopy facilitates examination of the entire small intestine, making precise diagnosis of Meckel's diverticulum possible.

Promising role of single photon emission computed tomography/computed tomography in Meckel′s scan

Meckel's scan is a common procedure performed in nuclear medicine. Single-photon emission computed tomography/computed tomography (SPECT/CT) in a suspected case of heterotopic location of gastric mucosa can increase the accuracy of its anatomic localization. We present two suspected cases of Meckel's diverticulum in, which SPECT/CT co-registration has helped in better localization of the pathology.

Inverted Meckel's diverticulum as a cause of occult lower gastrointestinal hemorrhage

Meckel's diverticulum is a common asymptomatic congenital gastrointestinal anomaly, but rarely it can present with hemorrhage. Over the last few years inverted Meckel's diverticulum has been reported in the literature with increasing frequency as an occult source of lower gastrointestinal hemorrhage. Here, we report a case of a 54-year-old male, who was referred for surgical evaluation with persistent anemia and occult blood per rectum after a work up which failed to localize the source over 12 mo, including upper and capsule endoscopy, colonoscopy, enteroclysis, Meckel scan, and tagged nuclear red blood cell scan. An abdominal computed tomography scan showed a possible mid-ileal intussusception and intraluminal mass. During the abdominal exploration, inverted Meckel's diverticulum was diagnosed and resected. We review the literature, discuss the forms in which the disease presents, the diagnostic modalities utilized, pathological findings, and treatment. Although less than 40 cases have been reported in the English literature from 1978 to 2005, 19 cases have been reported in the last 6 years alone (2006-2012) due to improved diagnostic modalities. Successful diagnosis and treatment of this disease requires a high index of clinical suspicion, which is becoming increasingly relevant to general gastroenterologists.

Massive Bleeding from a Stercoral Ulcer in a True Colonic Diverticulum

Purpose: 28 year-old male with history of small internal hemorrhoids presented with multiple episodes of painless bleeding and clots per rectum for one day. He denied nausea, vomiting, abdominal pain, diarrhea, weight loss or use of NSAIDs. He was orthostatic and abdominal exam was unremarkable. A rectal exam revealed frank blood without any palpable mass. Hemoglobin was 8.9 gm/dL and did not respond appropriately to blood transfusions. An upper endoscopy showed mild nonerosive gastritis and an incomplete colonoscopy showed old and new blood clots up to the splenic flexure. A Meckel's scan was negative and a CT scan showed a round, heterogeneous, calcified mass in the proximal colon without surrounding fatty infiltration or definite colonic wall thickening. A repeat colonoscopy showed blood clots throughout colon with scant fresh blood on the right side and terminal ileum, but no definite bleeding source. An exploratory laparotomy identified a round, firm mass in the proximal ascending colon and intra-operative ileoscopy showed dark bile without evidence of bleeding. Right hemicolectomy with primary anastomosis was performed. The specimen was dissected and a large, firm fecal mass was dislodged from a diverticulum in the proximal ascending colon. Pathology specimen showed a 0.7 cm true diverticulum containing a fecalith, measuring 2 cm in diameter. The mucosa of the diverticulum was ulcerated with acute inflammation and granulation tissue abutting a blood vessel on histology. Patient ceased to bleed post-operatively, and was discharged home uneventfully. Acute lower GI bleeding has an incidence of 20 to 27 episodes per 100,000 persons annually. Most common colonic bleeding sources are pseudodiverticulosis, angioectasias, colitis, neoplasms and hemorrhoids. Stercoral ulceration is rare and almost always develops within the rectosigmoid colon in elderly, chronically constipated patients. The pressure necrosis of the bowel wall due to overlying firm and usually large fecalith is thought to be the main mechanism of injury. Only rarely stercoral ulcers and complications such as bleeding and perforation have been reported in anatomic locations other than the rectosigmoid. The incidence of true colonic diverticulum is much lower than that of pseudodiverticulum. A true diverticulum contains all three layers of the colonic wall and is thought to be congenital. Clinical course can parallel that of pseudodiverticulosis with inflammation, bleeding and perforation. This is the first reported case of massive bleeding from a stercoral ulcer inside a true colonic diverticulum.

Virtual enteroscopic images of inverted Meckel's diverticulum

A 55-year-old man presented to our hospital with gastroinestinal bleeding. Standard oesophagogastroduodenoscopy and olonoscopy were performed, but the source of bleeding could ot be identified. Contrast enhanced CT was performed and an ntussusception was suspected in the small bowel. Meckel scan esult was negative. Virtual enteroscopy (VE) was then performed o check for the presence of a leading lesion. The depicted small owel is shown in 3D overview (Fig. 1a) and dissection view Fig. 1b). The small bowel was 543 cm long on VE. An 8 cm long edunculated polypoid lesion was found in the ileum 130 cm rom the ileocecal valve (asterisk in Fig. 1b). The stalk and the ead are indicated by arrow and arrowhead, respectively (Fig. 1c nd d). According to the results of VE, retrograde single balloon nteroscopy (SBE) was performed to obtain a histopathological iagnosis. A polypoid lesion with a long stalk was identified in the leum (Fig. 2a and b). Forceps biopsy of the head was taken and icroscopic examination revealed inflammatory exudates without pithelial component. Three possible diagnoses were considered: eiomyoma, gastrointestinal stromal tumour, and inverted Meckel’s iverticulum. Since the patient had suffered from small bowel leeding and there was a strong possibility of an intestinal obstrucion, a partial resection of the ileum was performed. The final iagnosis was an inverted Meckel’s diverticulum (Fig. 2c and d).

National guidelines for capsule endoscopy: cost implications of non-compliance

IntroductionCapsule endoscopy (CE) is the investigation of choice to visualise the small intestinal mucosa. The British Society of Gastroenterology (BSG) published guidelines in 2008 concerning the use of CE. It...

Virtual Enteroscopic Images of Meckel's Diverticulum

V enteroscopy (VE) is a newly developed method to explore the entire small intestine with a modified protocol f virtual colonoscopy by inflating the small intestine with air hrough a jejunum-intubated tube and depicting the wall of the mall intestine. A 66-year-old man presented to our hospital with progressive nemia and a positive fecal occult blood test. He had undergone emodialysis for 15 years for renal failure caused by chronic lomerulonephritis. Erythropoietin and nonsteroidal anti-inammatory drugs (NSAIDs) had been given regularly for renal nemia and chronic thoracic pain. Esophagogastroduodenosopy and colonoscopy were performed, but the source of bleedng could not be identified. Video capsule endoscopy (VCE) was erformed, and multiple small erosions in the small bowel were ound. VE was performed, revealing the total length of the small owel was 595 cm (Figure A, B). At 103 cm from the ileocecal alve (Figure B, white arrow), an 8-cm–long diverticulum was depicted (Figure C, luminal view; Figure D, 3-dimensional overview; Figure E, wall view; black arrow, lumen of the intestine; white arrow, opening of the diverticulum; Supplementary Video 1), which could not be identified in a second look of the results of VCE. Meckel scan results were negative. Erosions found by VCE were not depicted by VE. Considering the location, size, and shape, a diagnosis of Meckel’s diverticulum was made. The dose of NSAIDs was reduced, and the patient has been observed for 4 months, with gradual recovery from anemia.

Idiopathic pulmonary hemosiderosis

Idiopathic pulmonary hemosiderosis (IPH) is a rare disorder (triad of iron-deficiency anemia, hemoptysis, and alveolar infiltrates). A 3-year-old male presented with mild fever, breathlessness, dry cough, and bluish nail discoloration for 8 days. He had required five blood transfusions in the past 1 year (last transfusion was given 4 months ago). He had a respiratory rate of 58/min with respiratory distress, cyanosis, and grade III clubbing. Respiratory system examination was normal. Several previous reports of hemoglobin were as low as 3.6 g/dl with hypochromic and microcytic anemia. There were transient increases in the hemoglobin and normalization of red cell morphology with blood transfusions. Serum iron, G6PD enzyme assay, hemoglobin electrophoresis, the sickling test, Coomb's test, stool and urine analysis, and a Meckel's scan were normal. HIV antibody and dsDNA were negative. The chest radiograph revealed symmetrical patchy infiltrates sparing lung apices (confirmed on high-resolution computed tomography). Lung biopsy diagnosed pulmonary hemosiderosis (interstitial lung disease with hemosiderin-laden macrophages scattered in the alveoli and areas of fibrosis in the alveolar septa). The patient showed marked clinical improvement in 10 days of therapy with prednisolone. IPH should be listed in the differential diagnosis of a child presenting with unexplained hypochromic, microcytic anemia and respiratory symptoms.

Meckel′s diverticulum in paediatric practice on Crete (Greece): A 10-year review

Although Meckel's diverticulum (MD) is the most prevalent congenital abnormality of the gastrointestinal tract, it has varied presentations and often becomes a diagnostic challenge. The purpose of this study was to review the diverse presentations of MD, record the epidemiologic features for Crete and review the detection techniques and the treatment options. This was a review of the records of all children who underwent surgery for MD in the department of Paediatric Surgery of the University Hospital of Crete (Greece) between January 1999 and January 2009. A total of 45 patients (32 male and 13 female) aged 1 to 13 years (median 10 years) with a diagnosis of MD were retrospectively reviewed. The collected data were analysed, looking at age, gender, clinical features, investigations, histopathological findings and surgical interventions. In 25 patients, MD was an incidental finding at laparotomy because of appendicitis. The remaining 20 patients were symptomatic and presented with various clinical features. Nine patients (19.9%) had clinical features of peritonitis; of these, three had perforated MD and six had Meckel's diverticulitis at laparotomy. Four patients were diagnosed with intestinal obstruction. Seven patients (15.5%) presented with lower gastrointestinal bleeding. Ultrasound scans revealed intussusception in three patients, requiring open reduction. The remaining four patients with bleeding per rectum underwent a Meckel's Tc99 scan that showed a positive tracer. All patients with MD underwent Meckel's diverticulectomy with appendicectomy. MD has an incidence of approximately 1 to 2% in our population. It is necessary to maintain a high index of suspicion in the diagnosis of MD paediatric age group because it can be easily misdiagnosed.

SPECT-CT image fusion could enhance Meckel scan

SPECT-CT image fusion could enhance Meckel scan

Images in haematology: Iron deficiency anaemia: an unusual presentation of lymphangioma

A 15-year-old Chinese male with underlying glucose-6-phosphate dehydrogenase deficiency presented with exertional dyspnoea and giddiness. He was not vegetarian and there was no history of bleeding. Physical examination was unremarkable. Full blood count showed microcytic hypochromic anaemia with marked reticulocytosis. A peripheral blood count 2 years previously had been unremarkable. He was found to have iron deficiency anaemia and started on oral iron supplements. Oesophagogastroduodenoscopy and colonoscopy were negative. Despite compliance with iron supplements and administration of intravenous iron, he remained persistently anaemic, requiring regular packed red cell transfusions. Further investigations, including a small bowel follow through, Meckel scan, evaluation for haemolysis and flow cytometric screening for paroxysmal nocturnal haemoglobinuria were all negative. Bone marrow studies showed erythroid hyperplasia with absent iron. A tagged red blood cell scan suggested active intermittent bleeding in the jejunum and proximal ileum. Magnetic resonance imaging of the abdomen showed a sheet-like mass in the mid-retroperitoneum surrounding the coeliac axis, proximal common hepatic and splenic arteries, superior and inferior mesenteric veins and superior mesenteric artery, and abutting the duodenum and proximal jejenum. The patient underwent a laparotomy and was found to have an extensive retroperitoneal lymphangioma extending from the second part of the duodenum to the duodenojejunal flexure. An on-table duodenoscopy showed bleeding lesions in the third part of the duodenum. Because of the high risk involved with a complete resection, only the third part of the duodenum, which had mucosal involvement, was resected. Histology was consistent with a lymphangioma. The patient has been well since, with a normal haemoglobin concentration, red cell indices and iron studies. Lymphangioma is a rare benign cystic tumour occurring mainly in children. It has a variable presentation depending on the site of the tumour, but chronic gastrointestinal blood loss presenting as iron deficiency anaemia is a rare occurrence.

Diagnostic and Therapeutic Tricks in a Rare Case of Pediatric Ileal Congenital Arteriovenous Malformation

Diagnostic and Therapeutic Tricks in a Rare Case of Pediatric Ileal Congenital Arteriovenous Malformation

Appendiceal Carcinoid Mimicking a Meckel's Diverticulum on Tc-99m Pertechnetate Imaging

A 47-year-old man with chronic abdominal pain presented with bloody diarrhea, fatigue, nausea, and vomiting. A Tc-99m pertechnetate scan revealed focal increased radiotracer uptake in the midabdomen. Although not in the typical location, Meckel's diverticulum was the leading diagnosis. The patient underwent laparoscopic exploration which was negative for Meckel's diverticulum. The appendix was slightly prominent and, therefore, was removed. An unsuspected appendiceal carcinoid tumor was found at pathology–one of a handful of published cases of carcinoid tumor discovered by a false-positive Meckel's scan and the only reported case of appendiceal carcinoid mimicking Meckel's diverticulum on nuclear scintigraphy.

Bleeding Meckelʼs Diverticulum with a Negative Meckelʼs Scan - Uncommon Feature of an Uncommon Entity

Purpose: Case: A 30-year old male presented with a 13-month history of obscure GI bleeding. He initially presented elsewhere after a single episode of maroon colored stools. He had been previously healthy, and used NSAIDs rarely. He was adopted and of Korean descent; his family history was unknown. He denied easy bruising or epistaxis. Initial workup elsewhere revealed iron-deficiency anemia. EGD and colonoscopy were negative. He was advised to avoid NSAIDs, which he did. Two weeks later, he had recurrent bleeding. A capsule enteroscopy, single balloon enteroscopy (SBE), tagged red blood cell scan and Meckel's scan were negative. At our institution, a repeat antegrade SBE showed a single non-bleeding jejunal vascular ectasia that was cauterized. He was well for 9 months, then again developed maroon stools. He denied NSAID use. Workup included a SBE that was unremarkable, a triple-phase CT enterography (CTE) showing a Meckel's diverticulum, a Meckel's scan which was again negative, and a capsule enteroscopy revealing a mid-ileal ulcer. Due to ongoing bleeding, a retrograde double balloon enteroscopy (DBE) was done and revealed a large mid-ileal diverticulum with a 2 cm ulcer at its rim containing a flat pigmented spot, treated endoscopically. Persistent bleeding led to surgical resection of the diverticulum. Pathology confirmed a Meckel's diverticulum, with circumferential ulceration around its neck and a thrombosed artery in the ulcer base. Histologic sampling of the entire diverticulum failed to reveal ectopic gastric mucosa. Discussion: Meckel's diverticulum is the most common congenital anomaly of the GI tract. It affects 2% of the population, but only 2% develop complications, often before age 2. Complications include bleeding (most commonly), obstruction, diverticulitis, intussusception and perforation. Up to 90% of bleeding diverticula contain ectopic gastric mucosa. Our patient had a triple-phase CTE demonstrating a Meckel's diverticulum, and a DBE localizing it as the bleeding source, despite negative Meckel's scans. Histologic evaluation of the surgical specimen failed to reveal ectopic gastric mucosa, ruling out acid-mediated ulceration. The pattern of ulceration suggested the diverticulum had bled from repetitive inversion and eversion of the diverticulum into the ileal lumen, leading to ulceration in the neck. This putative mechanism has not been reported in the literature. This case highlights that a Meckel's diverticulum may be a source of GI bleeding despite absence of ectopic gastric mucosa.