Massive gastrointestinal bleeding; never too old to be due to Meckel’s Diverticulum - A case report and literature review
Main Article Content
Abstract
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.
Article Details
Copyright (c) 2019 Mansour S, et al.

This work is licensed under a Creative Commons Attribution 4.0 International License.
Hilsden RJ, Shaffer EA. Management of gastrointestinal hemorrhage. Can Fam Physician. 1936; 41: 1939-1941. Ref.: https://bit.ly/2KnrPBn
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
British Society of Gastroenterology Endoscopy Committee. Non-variceal upper gastrointestinal haemorrhage: guidelines. Gut. 2002; 4: 1-6. Ref.: https://bit.ly/2HS2cqJ
Bull-Henry K, Al-Kawas FH. Evaluation of occult gastrointestinal bleeding. Am Fam Physician. 2013; 87: 430-436. Ref.: https://bit.ly/2EOL1UR
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
Szold A, Katz LB, Lewis BS. Surgical approach to occult gastrointestinal bleeding. Am J Surg. 1992; 163: 90-92. Ref.: https://bit.ly/2Wht4sF
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
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
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
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
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
Satya R, O'Malley JP. Meckel diverticulum with massive bleeding. Radiology. 2005; 236: 836-840. Ref.: https://bit.ly/2WyR9uB
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
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
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
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
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
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
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
Carlioz P. Le diverticule de Meckel. De l’embryologie à la chirurgie. Montpellier: Sauramps. 2007. Ref.: https://bit.ly/2QBZ84F
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
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
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
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
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
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
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
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
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
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