Angiographic diagnosis of Meckel's diverticulum in an adult patient with negative scintigraphy

Abstract

A Meckel's diverticulum was diagnosed by mesenteric angiography in a 34 year-old patient who presented with hematochezia and dropping hemoglobin. The case demonstrates the challenges often encountered in workup of occult gastrointestinal (GI) bleeding, and shows that angiographic diagnosis of Meckel's diverticulum is possible, even in the absence of angiographic evidence of active extravasation. Our patient had a previous non-diagnostic workup including upper and lower endoscopy, videocapsulography, and Technetium-99m pertechnetate (Tc-99m) scintigraphy. Visceral angiogram demonstrated the presence of a persistent vitelline artery, diagnostic of Meckel's diverticulum. While no active extravasation was seen at the time of the angiogram, operative specimen demonstrated a Meckel's diverticulum with ectopic gastric mucosa and intraluminal hemorrhage.

Meckel’s Diverticulum with Dieulafoy’s Lesion: A Cause of Severe Hematochezia

“…Ectopic tissue was positive in 8 of the 10 cases in our series, which is consistent with the histological findings (Table 1). However, negative findings of Tc-99m scintigraphy, such as in cases 6 and 10 in our series cannot exclude MD because it sometimes fails to detect MD due to the absence or paucity of ectopic gastric mucosa [5].…”

“…Although not employed in this study, angiography can be a diagnostic tool for MD [5,8]. MD receives arterial blood supply from the vitelline artery, a remnant of the omphalomesenteric artery, which usually arises from a distal ileal branch of the superior mesenteric artery.…”

“…Indeed, if an infant or child presents with significant painless rectal bleeding, the presence of MD has to be suspected. It has been widely accepted that the bleeding results from a peptic ulcer caused by the acid-producing ectopic gastric mucosa in MD [1][2][3][4][5]. However, in the author's experience, a large and/or deep ulcer that can cause such severe hemorrhage is infrequently detected in resected MD, and furthermore MD without ectopic gastric mucosa also can develop serious bleeding.…”

COVID-19-Related Intestinal Ischemia in A 7-Year Old Boy

“…We hypothesize that the vasculitis affected first the vitello-intestinal artery, which is a thin and elongated vessel arising from the ileal branch of the superior mesenteric artery. 9 This led to the necrosis of Meckel's diverticulum with peritonitis and small bowel obstruction. The obstruction developed gradually and was not present on admission (normal bowel movements, no dilated bowel loops, and normal bowel sounds initially).…”

Clinical utility of double‐balloon enteroscopy in children: A single‐centre experience in South China

“…The diagnosis of small bowel disorders (SMD) is difficult using conventional modalities such as angiography and nuclear medicine . Single‐balloon enteroscopy, double‐balloon enteroscopy (DBE), capsule endoscopy and spiral enteroscopy are a few diagnostic techniques developed for the diagnosis of SMD .…”