Massive Gastrointestinal Hemorrhage in an Adult Caused by Meckel's Diverticulum: A Case Report.

IF 0.7 Q3 MEDICINE, GENERAL & INTERNAL
International Medical Case Reports Journal Pub Date : 2025-09-26 eCollection Date: 2025-01-01 DOI:10.2147/IMCRJ.S541384
Ludan Zheng, Liangliang Li, Yubin Huo, Hui Su
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引用次数: 0

Abstract

Meckel's diverticulum is one of the most common congenital anomalies of the gastrointestinal tract in pediatric populations worldwide. Although Meckel's diverticulum itself is usually asymptomatic, patients often present with complications such as gastrointestinal bleeding, Meckel's diverticulitis, intestinal perforation, and other associated symptoms. Notably, Meckel's diverticulum is relatively uncommon in adults, with cases complicated by acute massive gastrointestinal bleeding being particularly rare. We report the case of a 41-year-old man presenting with hematochezia for one day. Upon admission, his hemoglobin level dropped significantly from 98 g/L to 62 g/L within 24 hours. Contrast-enhanced computed tomography strongly suggested contrast media extravasation, indicating active bleeding. Subsequent gastrointestinal endoscopy, including colonoscopy, failed to identify obvious pathological findings. Mesenteric angiography successfully localized the bleeding vessels, but multiple embolization attempts were unsuccessful. The initial imaging and endoscopic modalities may not pinpoint the source of bleeding in this rare condition. Ultimately, a combined laparoscopic and endoscopic approach was employed, which successfully identified and localized the bleeding site in the Meckel's diverticulum. Laparoscopic intestinal resection was then performed, and postoperative pathological examination confirmed Meckel's diverticulum with ectopic gastric tissue. Meckel's diverticulum-induced bleeding in adults is severe yet rare, with nonspecific diagnostic features that often complicate timely identification. In managing the case of massive gastrointestinal hemorrhage, we achieved a successful outcome through combined laparoscopic intestinal resection and endoscopic surgery, with timely diagnosis and targeted intervention leading to complete recovery. This case underscores the critical role of a multimodal diagnostic and therapeutic strategy, particularly the integration of laparoscopy and endoscopy, in overcoming the challenges of nonspecific presentations. It serves as a valuable reference for clinicians, emphasizing that persistent diagnostic uncertainty in severe lower gastrointestinal bleeding should prompt consideration of rare etiologies like Meckel's diverticulum, and that a combined surgical-endoscopic approach can be pivotal in achieving definitive diagnosis and curative treatment.

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成人梅克尔憩室致胃肠大出血1例。
梅克尔憩室是世界范围内儿童胃肠道最常见的先天性异常之一。虽然梅克尔憩室本身通常无症状,但患者常出现胃肠道出血、梅克尔憩室炎、肠道穿孔等并发症。值得注意的是,梅克尔憩室在成人中相对罕见,合并急性胃肠大出血的病例尤其罕见。我们报告的情况下,41岁的男子提出了一天的便血。入院时血红蛋白水平在24小时内由98 g/L显著下降至62 g/L。增强计算机断层扫描强烈提示造影剂外渗,提示活动性出血。随后的胃肠道内窥镜检查,包括结肠镜检查,未能发现明显的病理表现。肠系膜血管造影成功定位出血血管,但多次栓塞尝试均未成功。在这种罕见的情况下,最初的成像和内窥镜模式可能无法确定出血的来源。最终,采用腹腔镜和内镜联合入路,成功地确定并定位了Meckel憩室的出血部位。行腹腔镜肠切除术,术后病理检查证实Meckel憩室伴胃组织异位。成人梅克尔憩室引起的出血严重但罕见,其非特异性诊断特征往往使及时识别复杂化。在处理消化道大出血的病例中,我们通过腹腔镜肠道切除术和内镜手术相结合,及时诊断和有针对性的干预,使患者完全康复,取得了成功的结果。本病例强调了多模式诊断和治疗策略的关键作用,特别是腹腔镜和内窥镜检查的结合,在克服非特异性表现的挑战。它为临床医生提供了有价值的参考,强调严重下消化道出血的持续诊断不确定性应提示考虑罕见的病因,如梅克尔憩室,手术-内镜联合方法对于获得明确的诊断和治疗至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
International Medical Case Reports Journal
International Medical Case Reports Journal MEDICINE, GENERAL & INTERNAL-
CiteScore
1.40
自引率
0.00%
发文量
135
审稿时长
16 weeks
期刊介绍: International Medical Case Reports Journal is an international, peer-reviewed, open access, online journal publishing original case reports from all medical specialties. Submissions should not normally exceed 3,000 words or 4 published pages including figures, diagrams and references. As of 1st April 2019, the International Medical Case Reports Journal will no longer consider meta-analyses for publication.
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