Meckel's diverticulum causing massive lower intestinal bleeding in a teenager: A case report

Meckel's diverticulum (MD), the most common congenital gastrointestinal (GI) abnormality, results from incomplete obliteration of the vitelline duct and is often asymptomatic. Its diagnosis can be challenging in older patients due to nonspecific symptoms and reduced sensitivity of Technetium-99m pertechnetate scans. A 15-year-old male presented with a 4-day history of hematochezia, vomiting, and symptoms of anemia. Upon admission, he experienced a massive lower GI bleed (∼2 L), leading to hemodynamic instability, which improved after resuscitation. Laboratory tests revealed hemoglobin (Hb) of 7.7 g/dL, international normalized ratio (INR) of 1.5, and platelet (PLT) count of 131,000/μL. Initial imaging, including esophagogastroduodenoscopy (EGD), colonoscopy, and contrast-enhanced abdominal computed tomography (CT), failed to identify the bleeding source. A subsequent Meckel's scan was also negative. However, CT angiography revealed a diverticular structure with edematous, enhancing walls, consistent with MD. Laparoscopic resection of the diverticulum, located 50 cm from the ileocecal junction, was performed with a stapled side-to-side anastomosis. Histopathology confirmed MD with ectopic gastric mucosa. The patient recovered well, was discharged on postoperative day two, and remained asymptomatic at follow-up. MD must be suspected as a source of lower gastrointestinal bleeding in teenagers, even in cases with a negative Meckel's scan.