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• W2921034556 abstract "Meckel's diverticulum (MD) is the most common congenital malformation of the gastrointestinal tract, occurring in 2% of the general population. Most diagnosis of MD are made in childhood. However, some patients may remain asymptomatic through adulthood or present later in life with complications such as anemia due to ileal ulceration. Strictures occur in MD due to secretion of hydrochloric acid and pepsin by heterotopic gastric tissue. We describe a case of an adult male presenting with abdominal pain and anemia who was diagnosed initially with small bowel ulceration consistent with Crohn's disease. However, he was eventually diagnosed with MD after surgical exploration. This case illustrates the difficulty in diagnosing MD in adults by standard imaging or endoscopy. A 45 year-old South Asian man without significant PMH presented to clinic with a one-year history of progressive anemia associated with fatigue and abdominal pain. Initial evaluation included an upper endoscopy and colonoscopy. A video capsule endoscopy (VCE) study revealed an inflammatory stricture in the distal ileum concerning for IBD. Retrograde DBE defined two ulcerated stenotic strictures located in the mid-ileum immediately adjacent to a diverticulum. Biopsies of the two strictures and diverticulum were suggestive of Crohn's disease. A Meckel's scan was performed and negative. Surgical resection of the diseased segment of bowel was consistent with a MD which was confirmed by histology. Meckel's diverticulum (MD) is primary diagnosed in childhood by 99mTc nuclear imaging or Meckel's scan (MS). The sensitivity and specificity of this scan in children is 85% and 95%, respectively, but falls to 62.5% and 9% in adults. This discrepancy may be related to a decline in heterotopic gastric mucosa with age in symptomatic MD. A case series evaluating an incidental MD in 311 patients found no presence of heterotrophic (ie. gastric and pancreatic) mucosa. One retrospective case-series found that DBE had a significantly higher diagnostic accuracy 85.0% (61.1%-96.0%) for MD than MS 21.4% (5.7%-51.2%) in the adult population with a (P = 0.001). However, DBE is not available in all centers. This same study also reported the diagnostic accuracy of other modalities for MD including small-bowel follow through (63%),VCE (36%),CT (32%), and angiography (0%). In cases in which a MD is suspected but evaluation by imaging and VCE are inconclusive, referral for DBE should be considered.1986_A Figure 1. Mid-ileum Stricture1986_B Figure 2. Stricture adjacent to Large Diverticulum1986_C Figure 3. Histopathology adapted from Fujita, Naoyuki" @default.
• W2921034556 created "2019-03-22" @default.
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• W2921034556 date "2018-10-01" @default.
• W2921034556 modified "2023-09-24" @default.
• W2921034556 title "Diagnosis of a Bleeding Meckelʼs in an Adult with a Negative Meckelʼs Scan" @default.
• W2921034556 doi "https://doi.org/10.14309/00000434-201810001-01986" @default.
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