Adult Presentation of Meckel's diverticulum – A Case Report
Abstract
Meckel’s diverticulum (MD) is a congenital outpouching or bulge in the lower part of the small intestine. It is the most common congenital defect of the gastrointestinal tract. MD is usually asymptomatic but when symptomatic, typically presents in childhood. A case is presented of a 33-year-old Caucasian man who presented with multiple episodes of bright red blood per rectum prior to hospital admission, with associated weakness and nausea. The patient denied abdominal discomfort, fevers, or vomiting. Eventually, it was found that the patient had a Meckel’s diverticulum with an associated focus of active extravasation from a dilated mesenteric vein. The feeding artery was successfully embolized with cessation of flow to the draining vein. Colonoscopy and computed tomography (CT) scan were inconclusive, and the patient ultimately underwent diagnostic laparoscopy and small bowel resection of the Meckel’s diverticulum to prevent further bleeding by removing aberrant tissue
[1]Martin JP, Connor PD, Charles K. Meckel’s diverticulum. Am Fam Physician. 2000;61(4):1037-1044.
[2]Dumper J, Mackenzie S, Mitchell P, Sutherland F, Quan ML, Mew D. Complications of Meckel’s diverticula in adults. Can J Surg. 2006;49(5):353-357. https://pubmed.ncbi.nlm.nih. gov/17152574
[3]Hong SN, Jang HJ, Ye BD, et al. Diagnosis of Bleeding Meckel’s Diverticulum in Adults. PLoS One. 2016;11(9):e0162615. https://doi.org/10.1371/journal.pone.0162615
[4] Leijonmarck CE, Bonman-Sandelin K, Frisell J, Räf L. Meckel’s diverticulum in the adult. Br J Surg. 1986;73(2):146-149. https://doi.org/10.1002/bjs.1800730225
[5]Sagar J, Kumar V, Shah DK. Meckel’s diverticulum: a systematic review. J R Soc Med. 2006;99(10):501-505. https://doi. org/10.1177/014107680609901011
[6]Sumer A, Kemik O, Olmez A, et al. Small Bowel Obstruction due to Mesodiverticular Band of Meckel’s Diverticulum: A Case Report. Case Rep Med. 2010;2010:901456. https://doi. org/10.1155/2010/901456
[7]Elsayes KM, Menias CO, Harvin HJ, Francis IR. Imaging manifestations of Meckel’s diverticulum. AJR Am J Roentgenol. 2007;189(1):81-88. https://doi.org/10.2214/AJR.06.1257
[8]Skarpas A, Siaperas P, Zoikas A, et al. Meckel’s Diverticulitis. A rare cause of small bowel obstruction. J Surg Case Rep. 2020;2020(9):rjaa339. https://doi.org/10.1093/jscr/rjaa339
[9]Hansen CC, Søreide K. Systematic review of epidemiology, presentation, and management of Meckel’s diverticulum in the 21st century. Medicine (Baltimore). 2018;97(35):e12154. https://doi.org/10.1097/MD.0000000000012154
[10]Al-Khayat H, Hayati H, Al-Khayat H, Sadeq A, Groof A, Zarka ZA. Portal-mesenteric vein thrombosis as an unusual
presentation of Meckel’s diverticulum complication. Ann Saudi Med. 2007;27(1):45-48. https://doi.org/10.5144/0256-
4947.2007.45
[11] Platon A, Gervaz P, Becker CD, Morel P, Poletti PA. Computed tomography of complicated Meckel’s diverticulum in adults: a pictorial review. Insights Imaging. 2010;1(2):53-61. https://doi.org/10.1007/s13244-010-0017-8
[12] Kabir SA, Raza SA, Kabir SI. Malignant neoplasms of Meckel’s diverticulum; an evidence-based review. Ann Med Surg (Lond). 2019;43:75-81. https://doi.org/10.1016/j.amsu.2019.05.017
[13] Fu T, Xu X, Geng L, Huang Y, Ding G, Ji H. The Clinical Manifestation Variety and Management Choice of Meckel’s Diverticulum with Complication: A Single Center Experience. Gastroenterol Res Pract. 2021;2021:6640660. https://doi.org/10.1155/2021/6640660[14] Marconato R, Nezi G, Capovilla G, et al. Primary mesenteric vein thrombosis: a case series. J Surg Case Rep. 2020;2020(3):rjaa016. https://doi.org/10.1093/jscr/rjaa016
[15] Groebli Y, Bertin D, Morel P. Meckel’s diverticulum in adults: retrospective analysis of 119 cases and historical review. Eur J Surg. 2001;167(7):518-24. https://doi. org/10.1080/110241501316914894
[16] An J, Zabbo CP. Meckel Diverticulum. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.
[17] Martin JP, Connor PD, Charles K. Meckel’s diverticulum. Am Fam Physician. 2000;61(4):1037-1044.
[18] Ellis BG, Thompson MR. Factors identifying higher risk rectal bleeding in general practice. Br J Gen Pract. 2005;55(521):949-955.[19] Lee JM, Lee KM. Endoscopic Diagnosis and Differentiation of Inflammatory Bowel Disease. Clin Endosc. 2016;49(4):370-375. https://doi.org/10.5946/ce.2016.090
[19] Lee JM, Lee KM. Endoscopic Diagnosis and Differentiation of Inflammatory Bowel Disease. Clin Endosc. 2016;49(4):370-375. https://doi.org/10.5946/ce.2016.090
[20] Ng KS, Holzgang M, Young C. Still a Case of “No Pain, No Gain”? An Updated and Critical Review of the Pathogenesis, Diagnosis, and Management Options for Hemorrhoids in 2020. Ann Coloproctol. 2020;36(3):133-147. https://doi.org/10.3393/ac.2020.05.04
[21] Howlader N, Noone AM, Krapcho M, et al. SEER Cancer Statistics Review, 1975-2013. Bethesda, MD: National Cancer Institute, 2016.
[22] Wolpin BM, Mayer RJ. Systemic treatment of colorectal cancer. Gastroenterology. 2008;134(5):1296-310. https://doi.org/10.1053/j.gastro.2008.02.098
[23] Sabry AO, Sood T. Rectal Bleeding. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.
[24] Farrell MB, Zimmerman J. Meckel’s Diverticulum Imaging. J Nucl Med Technol. 2020;48(3):210-213. https://doi.org/10.2967/jnmt.120.251918
[25] Elsayes KM, Menias CO, Harvin HJ, Francis IR. Imaging manifestations of Meckel’s diverticulum. AJR Am J Roentgenol. 2007;189(1):81-88. https://doi.org/10.2214/AJR.06.1257
[26] Kovacs M, Botstein J, Braverman S. Angiographic diagnosis of Meckel’s diverticulum in an adult patient with negative scintigraphy. J Radiol Case Rep. 2017;11(3):22-29. https://doi.org/10.3941/jrcr.v11i3.2032
[27]Rivas H, Cacchione RN, Allen JW. Laparoscopic management of Meckel’s diverticulum in adults. Surg Endosc. 2003;17(4):620- 622. https://doi.org/10.1007/s00464-002-8613-4
[28] Blouhos K, Boulas KA, Tsalis K, et al. Meckel’s Diverticulum in Adults: Surgical Concerns. Front Surg. 2018;5:55. https://doi. org/10.3389/fsurg.2018.00055
[2]Dumper J, Mackenzie S, Mitchell P, Sutherland F, Quan ML, Mew D. Complications of Meckel’s diverticula in adults. Can J Surg. 2006;49(5):353-357. https://pubmed.ncbi.nlm.nih. gov/17152574
[3]Hong SN, Jang HJ, Ye BD, et al. Diagnosis of Bleeding Meckel’s Diverticulum in Adults. PLoS One. 2016;11(9):e0162615. https://doi.org/10.1371/journal.pone.0162615
[4] Leijonmarck CE, Bonman-Sandelin K, Frisell J, Räf L. Meckel’s diverticulum in the adult. Br J Surg. 1986;73(2):146-149. https://doi.org/10.1002/bjs.1800730225
[5]Sagar J, Kumar V, Shah DK. Meckel’s diverticulum: a systematic review. J R Soc Med. 2006;99(10):501-505. https://doi. org/10.1177/014107680609901011
[6]Sumer A, Kemik O, Olmez A, et al. Small Bowel Obstruction due to Mesodiverticular Band of Meckel’s Diverticulum: A Case Report. Case Rep Med. 2010;2010:901456. https://doi. org/10.1155/2010/901456
[7]Elsayes KM, Menias CO, Harvin HJ, Francis IR. Imaging manifestations of Meckel’s diverticulum. AJR Am J Roentgenol. 2007;189(1):81-88. https://doi.org/10.2214/AJR.06.1257
[8]Skarpas A, Siaperas P, Zoikas A, et al. Meckel’s Diverticulitis. A rare cause of small bowel obstruction. J Surg Case Rep. 2020;2020(9):rjaa339. https://doi.org/10.1093/jscr/rjaa339
[9]Hansen CC, Søreide K. Systematic review of epidemiology, presentation, and management of Meckel’s diverticulum in the 21st century. Medicine (Baltimore). 2018;97(35):e12154. https://doi.org/10.1097/MD.0000000000012154
[10]Al-Khayat H, Hayati H, Al-Khayat H, Sadeq A, Groof A, Zarka ZA. Portal-mesenteric vein thrombosis as an unusual
presentation of Meckel’s diverticulum complication. Ann Saudi Med. 2007;27(1):45-48. https://doi.org/10.5144/0256-
4947.2007.45
[11] Platon A, Gervaz P, Becker CD, Morel P, Poletti PA. Computed tomography of complicated Meckel’s diverticulum in adults: a pictorial review. Insights Imaging. 2010;1(2):53-61. https://doi.org/10.1007/s13244-010-0017-8
[12] Kabir SA, Raza SA, Kabir SI. Malignant neoplasms of Meckel’s diverticulum; an evidence-based review. Ann Med Surg (Lond). 2019;43:75-81. https://doi.org/10.1016/j.amsu.2019.05.017
[13] Fu T, Xu X, Geng L, Huang Y, Ding G, Ji H. The Clinical Manifestation Variety and Management Choice of Meckel’s Diverticulum with Complication: A Single Center Experience. Gastroenterol Res Pract. 2021;2021:6640660. https://doi.org/10.1155/2021/6640660[14] Marconato R, Nezi G, Capovilla G, et al. Primary mesenteric vein thrombosis: a case series. J Surg Case Rep. 2020;2020(3):rjaa016. https://doi.org/10.1093/jscr/rjaa016
[15] Groebli Y, Bertin D, Morel P. Meckel’s diverticulum in adults: retrospective analysis of 119 cases and historical review. Eur J Surg. 2001;167(7):518-24. https://doi. org/10.1080/110241501316914894
[16] An J, Zabbo CP. Meckel Diverticulum. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.
[17] Martin JP, Connor PD, Charles K. Meckel’s diverticulum. Am Fam Physician. 2000;61(4):1037-1044.
[18] Ellis BG, Thompson MR. Factors identifying higher risk rectal bleeding in general practice. Br J Gen Pract. 2005;55(521):949-955.[19] Lee JM, Lee KM. Endoscopic Diagnosis and Differentiation of Inflammatory Bowel Disease. Clin Endosc. 2016;49(4):370-375. https://doi.org/10.5946/ce.2016.090
[19] Lee JM, Lee KM. Endoscopic Diagnosis and Differentiation of Inflammatory Bowel Disease. Clin Endosc. 2016;49(4):370-375. https://doi.org/10.5946/ce.2016.090
[20] Ng KS, Holzgang M, Young C. Still a Case of “No Pain, No Gain”? An Updated and Critical Review of the Pathogenesis, Diagnosis, and Management Options for Hemorrhoids in 2020. Ann Coloproctol. 2020;36(3):133-147. https://doi.org/10.3393/ac.2020.05.04
[21] Howlader N, Noone AM, Krapcho M, et al. SEER Cancer Statistics Review, 1975-2013. Bethesda, MD: National Cancer Institute, 2016.
[22] Wolpin BM, Mayer RJ. Systemic treatment of colorectal cancer. Gastroenterology. 2008;134(5):1296-310. https://doi.org/10.1053/j.gastro.2008.02.098
[23] Sabry AO, Sood T. Rectal Bleeding. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.
[24] Farrell MB, Zimmerman J. Meckel’s Diverticulum Imaging. J Nucl Med Technol. 2020;48(3):210-213. https://doi.org/10.2967/jnmt.120.251918
[25] Elsayes KM, Menias CO, Harvin HJ, Francis IR. Imaging manifestations of Meckel’s diverticulum. AJR Am J Roentgenol. 2007;189(1):81-88. https://doi.org/10.2214/AJR.06.1257
[26] Kovacs M, Botstein J, Braverman S. Angiographic diagnosis of Meckel’s diverticulum in an adult patient with negative scintigraphy. J Radiol Case Rep. 2017;11(3):22-29. https://doi.org/10.3941/jrcr.v11i3.2032
[27]Rivas H, Cacchione RN, Allen JW. Laparoscopic management of Meckel’s diverticulum in adults. Surg Endosc. 2003;17(4):620- 622. https://doi.org/10.1007/s00464-002-8613-4
[28] Blouhos K, Boulas KA, Tsalis K, et al. Meckel’s Diverticulum in Adults: Surgical Concerns. Front Surg. 2018;5:55. https://doi. org/10.3389/fsurg.2018.00055
| Files | ||
| Issue | Vol 8 No 4 (2023): July-August | |
| Section | Case Report(s) | |
| DOI | https://doi.org/10.18502/crcp.v8i4.14574 | |
| Keywords | ||
| Adult meckel’s diverticulum Congenital diverticulum Rectal bleeding Painless rectal bleeding Gastroenterology | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Uwandu Q, Akpoviroro O. Adult Presentation of Meckel’s diverticulum – A Case Report. CRCP. 2024;8(4):150-154.
