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Preoperative diagnosis of Meckel's diverticulum by pertechnetate scan and laparoscopic resection
M Heinzelmann1, O Schöb, R Schlumpf
1Department of Surgery, University of Zürich, Switzerland.
Abstract:
Acute lower gastrointestinal hemorrhage in a 17-year-old boy was caused by a Meckel's diverticulum 1 day after ingestion of 500 mg acetylsalicylic acid. After conservative treatment of the bleeding, the diverticulum was diagnosed in the free interval by technetium pertechnetate scintigraphy, which showed an accumulation in the right lower quadrant simultaneously with the accumulation in the gastric mucosa. Elective explorative laparoscopy confirmed the diverticulum, and the resection was performed by laparoscopic means. Histology showed gastric-type mucosa in the diverticulum. The treatment of choice for Meckel's diverticulum, when it is diagnosed preoperatively or during laparoscopy, is laparoscopic resection.
Insights
A Meckel's diverticulum caused acute lower gastrointestinal bleeding in a teenager after aspirin use. Laparoscopic resection is the recommended treatment for diagnosed Meckel's diverticulum.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Diagnostic Imaging
Background:
- Meckel's diverticulum is a common congenital anomaly of the small intestine.
- It can lead to various complications, including gastrointestinal bleeding.
- Acetylsalicylic acid ingestion can precipitate or exacerbate bleeding from a Meckel's diverticulum.
Observation:
- A 17-year-old boy presented with acute lower gastrointestinal hemorrhage.
- The bleeding was temporally related to the ingestion of acetylsalicylic acid.
- Technetium pertechnetate scintigraphy revealed ectopic gastric mucosa within the diverticulum.
Findings:
- Meckel's diverticulum containing gastric-type mucosa was identified as the source of bleeding.
- Laparoscopic resection was successfully performed.
- Histological examination confirmed the presence of gastric mucosa.
Implications:
- Early diagnosis and prompt surgical intervention are crucial for managing Meckel's diverticulum complications.
- Laparoscopic resection is a safe and effective treatment option.
- This case highlights the importance of considering Meckel's diverticulum in pediatric patients with obscure gastrointestinal bleeding, especially after NSAID use.