Unveiling the hidden cause behind painless lower gastrointestinal bleeding in an adult - Meckel's Diverticulum: A case report.

INTRODUCTION

The prevalence of Meckel's Diverticulum ranges from 0.3 % to 2.9 %. Although lower gastrointestinal bleeding is the most common presentation of Meckel's Diverticulum in children, it is a rare presentation in adults, as ectopic gastric mucosa (the source of bleeding) is less prevalent in this age group.

CASE PRESENTATION: A 30-year-old male presented with painless per rectal bleeding for 2 weeks. No obvious positive finding was found on clinical examination. Routine baseline blood investigations, endoscopy, colonoscopy, and abdominal ultrasonography were normal. He had been experiencing similar episodes intermittently over the past three years, but the cause was not diagnosed earlier. Contrast Enhanced Computed Tomography (CECT) of the abdomen and pelvis confirmed the diagnosis of Meckel's Diverticulum, for which wedge resection was done.

DISCUSSION: Hydrochloric acid produced by the ectopic gastric mucosa can erode the adjacent ileal mucosa, leading to ulceration and bleeding. The risk of developing complications in untreated asymptomatic Meckel's is 5 % - 6 %, whereas the incidence of complication following prophylactic resection is 1 %. Considering the risk-benefit ratio, some literature recommends prophylactic resection in all asymptomatic cases, whereas others suggest it only when one or more of the following risk factors are present: age < 50 years, diverticulum length > 2 cm, male gender, or presence of fibrous band.

CONCLUSION

Meckel's Diverticulum can be thought of as one of the differentials in patients with painless rectal bleeding. Patient should be investigated for Meckel's if no other pathology is identified. Early diagnosis and treatment decrease the morbidity and mortality.