Meckel's diverticulum with polypoid hyperplasia of ectopic gastric mucosa diagnosed by double-balloon enteroscopy and...

Area of Science:

• Gastroenterology
• Pediatric Surgery
• Diagnostic Imaging

Background:

• Meckel's diverticulum (MD) is a common congenital ileal anomaly.
• Bleeding from MD caused by ectopic gastric mucosa with polypoid hyperplasia is a rare complication.
• This case highlights a diagnostic challenge in a young patient with recurrent gastrointestinal bleeding.

Purpose of the Study:

• To report a rare case of Meckel's diverticulum presenting with significant gastrointestinal bleeding.
• To emphasize the diagnostic utility of advanced imaging techniques in identifying the source of obscure bleeding.
• To demonstrate the successful management of this rare condition.

Main Methods:

• A 14-year-old boy with intermittent melena and anemia underwent initial investigations including gastroscopy and exploratory laparotomy with intraoperative colonoscopy.
• Computed tomography (CT), angiography, and SPECT/CT with 99m-technetium pertechnetate were utilized for localization.
• Retrograde double-balloon enteroscopy (DBE) was performed for detailed visualization and diagnosis.

Main Results:

• Initial investigations were inconclusive, but recurrent bleeding prompted advanced imaging.
• SPECT/CT confirmed increased radiotracer uptake in the distal ileum.
• DBE revealed a Meckel's diverticulum with prominent mucosal polypoid hyperplasia, confirming the diagnosis.
• Surgical resection (diverticulectomy) resulted in an uneventful recovery.

Conclusions:

• Meckel's diverticulum with polypoid hyperplasia of ectopic gastric mucosa is an uncommon cause of gastrointestinal bleeding.
• The complementary use of double-balloon enteroscopy and SPECT/CT provides accurate anatomical and functional information for diagnosing such rare conditions.
• This multimodal diagnostic approach is crucial for effective management and improved patient outcomes.