S6073 Age Is Just a Number: A Case of Meckel’s Diverticular Bleed in an Elderly Man

Introduction: Meckel’s diverticulum (MD) is the most common congenital anomaly of the gastrointestinal (GI) tract, occurring in approximately 1-3% of the population. It results from the incomplete obliteration of the vitelline duct and represents a true diverticulum, typically located in the distal ileum. Most cases are asymptomatic; however, complications such as GI bleeding (GIB), small bowel obstruction, and diverticulitis can arise. While more commonly diagnosed in children it can also present incidentally or with complications in older adults. We report a case of an elderly patient who presented with significant GIB and was subsequently diagnosed with MD. Case Description/Methods: A 74-year-old man with a past medical history of hypothyroidism, hyperlipidemia, and prior prostate and laryngeal cancers presented with lower GIB. The patient reported a 2-week history of constipation and bloating and noted a few drops of blood during wiping prior to presentation. His symptoms initially improved but later progressed to large-volume, dark red, painless bloody bowel movements. On admission, his hemoglobin was 7 g/dl (down from a baseline of 12). He required transfusions and underwent esophagogastroduodenoscopy/colonoscopy, both of which were inconclusive. Capsule endoscopy revealed an ileal source of bleeding. Meckel's nuclear scan (technetium-99 m scintigraphy) was positive, and he subsequently underwent laparoscopic small bowel resection. Pathology confirmed a 4.7 × 2.2 × 2.0 cm Meckel’s diverticulum containing ectopic gastric mucosa. Patient had no further episodes of GIB, and his anemia resolved. There was no documented history of GIB during childhood. Discussion: Our case is notable due to the patient’s advanced age presenting with a Meckel’s diverticular bleed, which is an uncommon etiology of lower GIB in this age group. The diagnosis of MD in older patients is often delayed or missed due to its rarity, nonspecific clinical presentation and low sensitivity of traditional diagnostic modalities. While Meckel’s scan is highly sensitive in the pediatric population, it has limited diagnostic yield in adults, with sensitivities as low as 21%; however, in our case it was positive. Capsule endoscopy is another diagnostic test to identify the source of bleeding; however, it may also fail to localize it, leading to a diagnosis that is often established intraoperatively. This case underscores the importance of considering MD in the differential diagnosis of unexplained GIB, even in elderly patients.