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

Abstract

Background: Meckel's diverticulum (MD) is a remnant of the omphalomesenteric duct. Although the majority of MD are asymptomatic, it can present with severe hematochezia. Hematochezia is generally considered to result from a peptic ulcer caused by ectopic gastric mucosa in MD. However, this hypothesis has not been proved. Methods: 10 cases of surgically resected MD initially presenting with severe hematochezia were histologically examined. Results: Ectopic gastric mucosa was present in 9 cases, two of which also contained ectopic pancreas. No ectopic tissue was found in one case, which shows that bleeding can occur in MD without ectopic gastric mucosa. In addition, a rupture of aberrant submucosal arterioles through the overlying mucosa, a vascular abnormality called Dieulafoy's lesion, was detected in all the 10 cases. Conclusion: This study suggests that the actual cause of massive bleeding in MD is not a peptic ulcer, but Dieulafoy's lesion.

Heterotopic pancreas in Meckel’s diverticulum in an adult man with lower gastrointestinal bleeding: a case report and literature review

“…According to a study, symptoms are present in about 2–4% of all cases of MD, while it can be up to 60% of cases of MD with ectopic tissue ( 18 ). However, Takeyama J pointed out that Dieulafoy’s lesion (DL), a vascular abnormality, is the actual cause of GI bleeding in MD, with 100% detection rate of DL in 10 cases, and no ectopic tissue was found in one of the cases ( 19 ). This finding suggests that ectopic tissue may not be the only reason of GI bleeding in MD.…”