LOWER GASTROINTESTINAL BLEEDING DUE TO MECKEL'S DIVERTICULUM IN AN ADULT

Case Presentation A 38-year-old male patient was admitted to the emergency department with persistent gastrointestinal bleeding, presenting with enterorrhagia, causing symptoms of weakness and malaise. He had no previous similar episodes and no reported comorbidities. Initially, a protocol for upper gastrointestinal bleeding was started, and the patient was transfused with one unit of packed red blood cells due to a significant drop in hemoglobin (Hb 6.9). An upper gastrointestinal endoscopy (UGI) showed only mild erosive gastritis in the antrum. During his hospitalization, two colonoscopies were performed without success in identifying the source of bleeding, and the patient received multiple blood transfusions. Subsequently, an abdominal CT scan and a scintigraphy for occult bleeding were performed, but both were non-diagnostic. The patient’s condition worsened with hemodynamic instability, and he was transferred to the urgent care unit and indicated for surgical treatment. During laparoscopy, a Meckel's diverticulum was found approximately 110 cm from the ileocecal valve with signs of bleeding. After enlarging the supraumbilical median incision, a bowel loop was exteriorized, and enteroscopy was performed through the diverticulum, which revealed bleeding below the diverticulum, scattered clots, and a non-bleeding polyp at the hepatic flexure. A segmental enterectomy was performed, followed by a latero-lateral anastomosis with a linear stapler without complications. After the surgery, the patient remained hemodynamically stable, with no further drops in hemoglobin.

Discussion This case of lower gastrointestinal bleeding in an adult due to a Meckel’s diverticulum is atypical and highlights the difficulty of diagnosis in such cases where traditional endoscopic examinations rarely provide answers. In severe cases that are refractory to clinical measures and in the absence of less invasive diagnostic tests, or in cases of hemodynamic instability, surgery still plays a critical role in managing the condition.

Conclusion It is important to always consider less common differential diagnoses in cases of occult gastrointestinal bleeding. Surgical intervention remains relevant in diagnosing conditions like Meckel's diverticulum, which may not be identified through imaging or traditional endoscopic methods (endoscopy and colonoscopy), with the added benefit of being therapeutic in many of these cases.

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Artikel online veröffentlicht:
25. April 2025