Hematochezia caused by an ileal duplication in a 9-year-old male: A case report

Introduction

Enteric duplications are rare congenital anomalies of the gastrointestinal tract, often presenting with nonspecific symptoms, including abdominal pain and hematochezia. Symptoms that also exist with other more common etiologies, such as Meckel's diverticulum.

Case Presentation

A 9-year-old male pediatric patient with atopic dermatitis was brought into his pediatrician's office due to a five-month history of hematochezia, weight loss, abdominal pain, and fatigue. He was referred to the emergency department and was subsequently admitted to the Pediatric Hospitalist service. During his admission, he underwent an extensive evaluation. Results were largely unremarkable, with a normal hemoglobin level of 12.1. Positive findings included an elevated ESR of 15, IgE of 326, and IgM of 226. A Meckel's scan demonstrated focal radiotracer uptake in the anterior lower midline abdomen, prompting surgical intervention for a suspected Meckel's diverticulum. A transumbilical single incision was created, and a GelPoint ^Ⓡ Mini Advanced Access Platform (CNGL3) was inserted for laparoscopic assistance. Intraoperative findings revealed a 23cm segment of duplicated ileum which was subsequently resected. Pathology revealed tubular type small intestinal duplication with gastric heterotopia. The intraoperative findings of duplication of the ileum, with pathology confirming the presence of gastric mucosa within the duplication, explained the positive Meckel's scan. Following discharge from the hospital, the patient had follow-up appointments with gastroenterology and nutrition services.

Conclusion

Ileal duplications must be included in the differential diagnosis of children with chronic gastrointestinal bleeding. Meckel's scintigraphy may be positive if ectopic gastric mucosa is present in the duplication.