Meckel's Diverticulum: A Rare Cause of Overt Obscure Gastrointestinal Bleeding in an Adult Male Divertículo de Meckel: Causa Rara de Hemorragia Digestiva Obscura Manifesta num Homem Adulto

A 64-year-old male, with history of arterial hypertension and colonic polyps, recurred to the emergency department with recurrent hematochezia in the last 6 h. He denied abdominal pain, fever or other symptoms. No anemia or hemodynamic instability was present. Physical examination confirmed fresh blood and clots in the rectal ampulla. An urgent colonoscopy revealed fresh blood and clots in the terminal ileum and through the colon. Subsequently an urgent upper gastrointestinal endoscopy was performed with no relevant findings. Hence, in the same day, an urgent capsule enteroscopy was performed. In the middle ileum, a large diverticulum (Fig. 1) with erythematous mucosa in the fundus (Fig. 2) and a linear ulcer in the neck was found. Congestive mucosa and several deep ulcers with no active bleeding were apparent adjacent and downstream from the diverticulum (Fig. 3). These features highly suggested a Meckel’s diverticulum with ectopic gastric mucosa. After a multidisciplinary discussion, a laparoscopic diverticulectomy was performed. Histological evaluation confirmed a Meckel’s diverticulum with gastric and pancreatic tissues (Fig. 4). The patient was discharged 5 days later. No changes in the terminal ileum were apparent in a colonoscopy performed because of a post-polipectomy surveillance 4 months later.