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An 18-Year-Old Man with Bleeding From a Meckel's Diverticulum of the Terminal Ileum Diagnosed by 99mTc-Pertechnetate
Hasan M Alswiket1, Rakan S Alshahrani2, Ibrahim M Alzahrani3
1Department of Surgery, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia.
Insights
Meckel's diverticulum, a common cause of rectal bleeding in children, is rare in adults. A Meckel's scan is crucial for diagnosing this condition in adults when other tests are inconclusive.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Diagnostic Imaging
Background:
- Meckel's diverticulum is the most common congenital gastrointestinal anomaly in children.
- While typically presenting as painless rectal bleeding in pediatric patients, it is rarer in adults, where complications like obstruction and diverticulitis are more frequent.
- A Meckel's scan (99mTc-pertechnetate scintigraphy) is the most sensitive and specific diagnostic tool when Meckel's diverticulum is suspected.
Purpose of the Study:
- To report a case of Meckel's diverticulum presenting as lower gastrointestinal bleeding in an 18-year-old male.
- To highlight the diagnostic challenges of Meckel's diverticulum in adults.
- To emphasize the utility of Meckel's scan in diagnosing this condition in adults.
Main Methods:
- Case report of an 18-year-old male with acute rectal bleeding.
- Extensive diagnostic workup including CT scan, sigmoidoscopy, colonoscopy, EGD, and capsule endoscopy.
- Diagnosis confirmed by 99mTc-pertechnetate scintigraphy (Meckel's scan).
- Successful laparoscopic segmental resection.
Main Results:
- Initial investigations failed to identify the source of bleeding.
- Meckel's scan successfully diagnosed a Meckel's diverticulum of the terminal ileum.
- Laparoscopic resection was performed successfully.
Conclusions:
- Meckel's diverticulum can present as a diagnostic challenge in adults, despite being common in pediatric patients.
- A high index of suspicion is necessary for diagnosing Meckel's diverticulum in adults, especially with inconclusive initial investigations.
- Meckel's scan is a valuable tool for diagnosis in adults.
Abstract:
BACKGROUND Meckel's diverticulum represents the most common congenital anomaly of the gastrointestinal tract in the pediatric population. Although it is rarely symptomatic, painless rectal bleeding is the most common manifestation among pediatric patients. In contrast, Meckel's diverticulum is considerably rare in adults, in whom intestinal obstruction and diverticulitis are more frequent complications than bleeding. When it is suspected, a Meckel's scan is the most sensitive and specific diagnostic tool. Surgical excision remains the treatment of choice for Meckel's diverticulum. This report describes the case of an 18-year-old man with bleeding from a Meckel's diverticulum of the terminal ileum diagnosed by 99mTc-pertechnetate scintigraphy (Meckel's scan). CASE REPORT We report the case of an 18-year-old male patient who presented to the emergency department with a 24-hour history of 4 episodes of fresh rectal bleeding, associated with dizziness, nausea, palpitations, and a loss of consciousness. The patient underwent an extensive diagnostic workup, including computed tomography scan, sigmoidoscopy, colonoscopy, esophagogastroduodenoscopy, and capsule endoscopy, none of which revealed any abnormalities. A Meckel's scan eventually confirmed the presence of a Meckel's diverticulum on day 4 of admission, followed by a successful laparoscopic segmental resection on day 10 of admission. CONCLUSIONS Meckel's diverticulum, a common etiology of lower gastrointestinal bleeding in pediatric patients, presents a diagnostic challenge in adults, requiring a heightened index of suspicion. Clinical suspicion should be raised in cases with inconclusive initial investigations, particularly in younger adults.