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Laparoscopic Resection of bleeding Meckel’s Diverticulum in a young adult, with negative Nuclear Scan and angiographic diagnosis of Persistent aberrant Omphalomesenteric artery

Indraneil Mukherjee, MD, Aleksandr Demin, DO, Aleksandra Ogrodnik, MD, Andrey Mironenko, MD, Ian Provancha, Karen E Gibbs, MD. Staten Island University Hospital

Introduction: Meckel's diverticula are the most common congenital anomaly of the GI tract which is seen in 2-3% of the population. The most common presentation of such diverticulum in the pediatric population is hemorrhage, however small bowel obstruction, intussusceptions, diverticulitis, and ulceration have been reported. They usually present in the adult population. Technetium 99m pertechnate scan has been the gold standard diagnostic modality to detect ectopic gastric mucosa.  However, in adults, the diagnostic accuracy of the Meckel's scan is diminished. Although classically know to contain gastric tissue Meckel’s diverticula can present with duodenal, colonic, biliary or pancreatic ectopic tissue. When the diagnosis is ambiguous other modalities such as diagnostic laparoscopy and mesenteric angiography have been utilized.

Case Presentation: We present a case of 23-year-old female who presented with hematochezia and a lower GI bleed of unknown origin. She underwent an EGD and Colonoscopy which were negative. She had undergone a CT Angiogram which did not reveal any active bleeding. A Meckel’s scan did not discern any ectopic gastric mucosa. A mesenteric angiography was obtained which revealed the evidence of aberrant vessels in the right lower quadrant which was identified as persistent Persistent Omphalomesenteric (Vitelline) artery.  As she continued to bleed requiring blood transfusion, the patient was then taken for exploratory laparoscopy that revealed a Meckel’s diverticulum. A segmental small bowel resection and anastomosis was undertaken. The final pathology revealed ectopic gastric mucosa within the diverticulum as well as submucosal hemorrhage. The patient recovered well and did not require any further interventions.

Discussion: The approach to obscure Gastro-Intestinal bleeding has been changing with the advent of new technology. Technetium 99m pertechnate scan has been the gold standard diagnostic modality. But it can have more than 10% False Negative rate even with bleeding ectopic gastric mucosa.  We do suggest a CTA or a Mesentric Angiographic evidence of a  Persistent Omphalomesenteric (Vitelline) artery is suggestive of a Meckel’s Diverticulum and would warrant an exploration when the patient is symptomatic. 


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 93768

Program Number: V126

Presentation Session: Acute Care

Presentation Type: Video

62

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