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

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.