Case Report

Massive gastrointestinal bleeding; never too old to be due to Meckel’s Diverticulum - A case report and literature review

Subhi Mansour, Kenan Halloun and Safi Khuri*

Published: 03 June, 2019 | Volume 3 - Issue 1 | Pages: 034-039

Gastrointestinal (GI) bleeding is a very common medical problem encountered in the acute care setting, and is a major cause of admission to hospitals with about 300,000 patients admitted annually. Obscure GI bleeding, defined as persistent or recurrent bleeding following initial negative upper and lower endoscopy, represents approximately 5% of all GI hemorrhages. The small bowel is the most common source for obscure GI bleeding. Variable lesions of the small bowel can cause obscure GI bleeding, with tumors, Crohn’s disease and Meckel’s diverticulum being more common in young age group. Meckel’s diverticulum, the most common GI congenital malformation, is usually asymptomatic and incidentally found. It can present with GI bleeding, seen more in pediatric patients, and rarely in adult patients. Herein, we present a 45 years old female patient, presenting with massive obscure GI bleeding due to Meckel’s diveticulum.

Read Full Article HTML DOI: 10.29328/journal.ascr.1001030 Cite this Article Read Full Article PDF


  1. Hilsden RJ, Shaffer EA. Management of gastrointestinal hemorrhage. Can Fam Physician. 1936; 41: 1939-1941. Ref.: https://bit.ly/2KnrPBn
  2. Blatchford O, Davidson LA, Murray WR, Blatchford M, Pell J. Acute upper gastrointestinal haemorrhage in west of Scotland: case ascertainment study. BMJ. 1997; 315: 510-514. Ref.: https://bit.ly/2Xsa7A0
  3. British Society of Gastroenterology Endoscopy Committee. Non-variceal upper gastrointestinal haemorrhage: guidelines. Gut. 2002; 4: 1-6. Ref.: https://bit.ly/2HS2cqJ
  4. Bull-Henry K, Al-Kawas FH. Evaluation of occult gastrointestinal bleeding. Am Fam Physician. 2013; 87: 430-436. Ref.: https://bit.ly/2EOL1UR
  5. Raju GS, Gerson L, Das A, Lewis B. American Gastroenterological Association (AGA) Institute medical position statement on obscure gastrointestinal bleeding. Gastroenterology. 2007; 133: 1694-1696. Ref.: https://bit.ly/30Yvqvn
  6. Szold A, Katz LB, Lewis BS. Surgical approach to occult gastrointestinal bleeding. Am J Surg. 1992; 163: 90-92. Ref.: https://bit.ly/2Wht4sF
  7. Gunjan D, Sharma V, Rana SS, Bhasin DK. Small bowel bleeding: a comprehensive review. Gastroenterology Report. 2014; 2: 262-275. Ref.: https://bit.ly/2EOt0pA
  8. Zhang BL, Chen CX, Li YM. Capsule endoscopy examination. Identifies different leading causes of obscure gastrointestinal. Bleeding in patients of different ages. Turk J Gastroenterol. 2012; 23: 220-225. Ref.: https://bit.ly/2JR0fN7
  9. Levy AD, Hobbs CM. From the archives of the AFIP. Meckel diverticulum: radiologic features with pathologic correlation. Radiographics. 2004; 24: 565–587. Ref.: https://bit.ly/2XjTczA
  10. Sagar J, Kumar V, Shah DK. Meckel's diverticulum: a systematic review. J R Soc Med. 2006; 99: 501-505. Ref.: https://bit.ly/2WfAixF
  11. Dumper J, Mackenzie S, Mitchell P, Sutherland F, Quan ML, et al. Complications of Meckel's diverticula in adults. Can J Surg. 2006; 49: 353-357. Ref.: https://bit.ly/2MlRNHM
  12. Satya R, O'Malley JP. Meckel diverticulum with massive bleeding. Radiology. 2005; 236: 836-840. Ref.: https://bit.ly/2WyR9uB
  13. Ymaguchi M, Takeuchi S, Awazu S. Meckel's diverticulum. Investigation of 600 patients in Japanese literature. Am J Surg. 1978; 136: 247-249. https://bit.ly/2JSHN71
  14. Elsayes KM, Menias CO, Harvin HJ, Francis IR. Imaging manifestations of Meckel's diverticulum. AJR Am J Roentgenol. 2007; 189: 81–88. Ref.: https://bit.ly/2Wf0W9C
  15. Fink AM, Alexopoulou E, Carty H. Bleeding Meckel's diverticulum in infancy: unusual scintigraphic and ultrasound appearances. Pediatr Radiol. 1995; 25: 155-156 Ref.: https://bit.ly/310Y4vO
  16. Stǎnescu GL, Pleșea IE, Diaconn R, Gheonea C, Sabetay C, et al. Meckel’s diverticulum in children, clinical and pathological aspects. Rom J Morphol Embryol. 2014; 55 (supp 3): 1167-1170. Ref.: https://bit.ly/2IoGNV9
  17. Kusumoto H, Yoshida M, Takahashi I, Anai H, Maehara Y, et al. Complications and diagnosis of Meckel's diverticulum in 776 patients. Am J Surg. 1992; 164: 382-383. Ref.: https://bit.ly/2XjtThh
  18. Stone PA, Hofeldt MJ, Campbell JE, Vedula G, DeLuca JA, et al. Meckel diverticulum: ten-year experience in adults. South Med J. 2004; 97: 1038-1041. https://bit.ly/2Igztea
  19. Mitchell AW, Spencer J, Allison DJ, Jackson JE. Meckel's diverticulum: angiographic findings in 16 patients. AJR. 1998; 170: 1329-1333. Ref.: https://bit.ly/2WG7NIy
  20. Carlioz P. Le diverticule de Meckel. De l’embryologie à la chirurgie. Montpellier: Sauramps. 2007. Ref.: https://bit.ly/2QBZ84F
  21. Leijonmarck CE, Bonman-Sandelin K, Frisell J, Räf L. Meckel's diverticulum in the adult. Br J Surg. 1986; 73: 146-149. Ref.: https://bit.ly/2Icifyn
  22. Chan KW, Lee KH, Mou JW, Cheung ST, Tam YH. Laparoscopic management of complicated Meckel’s diverticulum in children: a 10-year review. Surg Endosc. 2008; 22: 1509–1512. Ref.: https://bit.ly/2YX4IBB
  23. Yamaguchi M, Takeuchi S, Awazu S. Meckel's diverticulum. Investigation of 600 patients in Japanese literature. Am J Surg. 1978; 136: 247–249. Ref.: https://bit.ly/2JSHN71
  24. Clark JK, Paz DA, Ghahremani GG. Imaging of Meckel’s diverticulum in adults: pictorial essay. Clin Imaging. 2014; 38: 557–564. Ref.: https://bit.ly/2Wzqz4j
  25. Lin S, Suhocki PV, Ludwig KA, Shetzline MA. Gastrointestinal bleeding in adult patients with Meckel's diverticulum: the role of technetium 99m pertechnetate scan. South Med J. 2002; 95: 1338–1341. Ref.: https://bit.ly/2HOnTaM
  26. Sfakianakis GN, Conway JJ. Detection of ectopic gastric mucosa in Meckel's diverticulum and in other aberrations by scintigraphy: ii. Indications and methods—a 10-year experience. J Nucl Med. 1981; 22: 732–738. Ref.: https://bit.ly/2IdVxFX
  27. Schwartz MJ, Lewis JH. Meckel's diverticulum: pitfalls in scintigraphic detection in the adult. Am J Gastroenterol. 1984; 79: 611–618. Ref.: https://bit.ly/2JPw3lG
  28. Lee JS, Moon W, Park SJ, Park MI, Kim KJ, et al. Haemoorhagic Meckel’s diverticulum in an older woman diagnosed by repeated angiographies. Turk J Gastroenterol. 2009; 20: 282-286. Ref.: https://bit.ly/2Xr1xBX
  29. Lichtstein DM, Herskowitz B. Massive gastrointestinal bleeding from Meckel's diverticulum in a 91-year-old man. South Med J. 1998; 91: 753-754. Ref.: https://bit.ly/30S0jS6
  30. Lequet J, Menahem B, Alves A, Fohlen A, Mulliri A. Meckel's diverticulum in the adult. J Visc Surg. 2017; 154: 253–259. Ref.: https://bit.ly/2HOh0q3


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