Mayo School of Graduate Medical Education Rochester, MN, United States
Matthew Heinrich, MD1, Xiao Jing Wang, MD2 1Mayo School of Graduate Medical Education, Rochester, MN; 2Mayo Clinic, Rochester, MN
Introduction: Meckel’s diverticulum is the most common congenital malformation of the gastrointestinal tract. Symptoms of Meckel’s diverticulum most commonly onset in childhood, but complications can develop throughout adulthood, presenting with nonspecific abdominal symptoms, gastrointestinal bleeding, diverticulitis, or intestinal obstruction. We present a case of adult-onset symptomatic Meckel’s diverticulum and highlight the limitations of diagnostic testing in adults.
Case Description/Methods: A 53-year-old male presented with worsening abdominal pain. CT scan found decreased duodenal folds concerning for celiac disease, but also noted two separate segments of mural hyperenhancement and wall thickening within the ileum. Celiac antibody testing was negative. Colonoscopy and upper endoscopy found mucosal ulceration in the terminal ileum and scalloped mucosa in the duodenum. Biopsies revealed erosion of the ileal mucosa but normal duodenal villous architecture with intraepithelial lymphocytes.
CT enterography at 6 months demonstrated persistent ileal ulcers and revealed an 8 cm Meckel’s diverticulum proximal to the ulcers. The patient underwent surgical resection of the diverticulum, and pathology was consistent with ectopic gastric mucosa. The patient experienced improvement in his abdominal symptoms.
Discussion: This case illustrates the radiologic illusiveness of Meckel’s diverticulum in the adult patient. Meckel’s diverticulum results from failed involution of the vitelline duct during development and classically contains ectopic gastric tissue. Meckel’s diverticulum can present with gastrointestinal hemorrhage related to mucosal ulceration, diverticulitis, or intestinal obstruction.
The incidence of symptomatic Meckel’s diverticulum in adults may be underappreciated due to the poor accuracy of commonly used diagnostic tests. In adults, Meckel’s diverticulum is often diagnosed via exploratory laparotomy, as less invasive investigations such as Technetium-99 pertechnetate scintigraphy (also known as Meckel’s scan), CT enterography, and capusule endoscopy, often fail to identify the diverticulum. One study found the mean accuracy of Meckel’s scan, capsule endoscopy, and CT enterography to be 21.4%, 35.7%, and 31.8%, respectively. By contrast, balloon-assisted enteroscopy has been shown to correctly identified Meckel’s diverticula in 85.0% of cases. Thus, pursuing balloon-assisted enteroscopy may prevent repeated testing and delays in surgical intervention.
Figure: Meckel's diverticulum
Disclosures: Matthew Heinrich indicated no relevant financial relationships. Xiao Jing Wang indicated no relevant financial relationships.
Matthew Heinrich, MD1, Xiao Jing Wang, MD2. P3047 - Adult Onset Complicated Meckel's Diverticulum, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.