Lower gastrointestinal bleeding secondary to sigmoid diverticulosis with incidental Crohn's disease and Meckel's diverticulum: a case report.

INTRODUCTION

Lower gastrointestinal bleeding (LGIB) in older adults is most commonly caused by diverticular disease. Concomitant pathology may be encountered during evaluation, particularly in patients with multiple comorbidities.

PRESENTATION OF CASE: A 78-year-old man presented with painless hematochezia and hypovolemic shock while receiving clopidogrel. After stabilization, colonoscopy identified a sigmoid diverticulum with an adherent clot, which was treated with injection and clipping. During the same examination, an ulcerated ileocecal valve was noted. Retrograde single-balloon enteroscopy was subsequently performed, demonstrating terminal ileal ulceration consistent with Crohn's disease and an incidental Meckel's diverticulum.

DISCUSSION: Hemorrhage control was achieved endoscopically and attributed to diverticular bleeding. Further evaluation was undertaken based on the ileocecal finding, allowing direct assessment of the terminal ileum.

CONCLUSION

In this case, targeted evaluation, prompted by a focal ileocecal abnormality, identified silent Crohn's disease and an incidental Meckel's diverticulum; while unrelated to the bleeding source, their recognition informed subsequent management and surveillance.