Erosive Meckel's diverticulum causing concurrent intraluminal and intraperitoneal hemorrhage: first case report in infancy and review of literature.

Abstract

Background: Meckel's diverticulum (MD) is a congenital anomaly which is often asymptomatic. However, complications, including gastrointestinal hemorrhage and obstruction, can arise and primarily in young children. While gastrointestinal bleeding is relatively common, intraperitoneal bleeding from MD is exceedingly rare, particularly in infancy.

Case presentation: We report a rare case of a 9-month-old male who presented with symptoms of bronchiolitis but subsequently developed acute per rectum (PR) bleeding; initially passing dark blood-stained stools followed by fresh blood. Hemodynamic instability and severe anemia necessitated urgent fluid resuscitation and blood transfusion. Imaging revealed a dilated, inflamed segment of small bowel with adjacent fluid, raising the possibility of a complicated MD. Laparoscopic exploration confirmed intra-abdominal bleeding from a perforated MD eroding into an adjacent mesenteric vessel. Surgical intervention included resection of the MD and end-to-end anastomosis. Histological analysis revealed a perforated MD which contained ectopic gastric mucosa and eroded adjacent vascular mesentery.

Conclusion: This is the first reported case of concurrent gastrointestinal and intraperitoneal bleeding from MD in an infant. The unique presentation underscores the importance of considering MD in cases of unexplained GI bleeding in infants, even when intraperitoneal hemorrhage is present. This case adds to the limited pediatric literature on MD-associated intraperitoneal bleeding and emphasizes prompt surgical management in achieving favorable outcomes.