MASSIVE GASTROINTESTINAL HEMORRHAGE AS PRESENTATION OF MECKEL'S DIVERTICULUM

Abstract

Introduction: Meckel's diverticulum represents the incomplete involution of the omphalomesenteric duct, being the most frequent congenital malformation of the gastrointestinal tract. It can present as an intraoperative finding during abdominal surgery or as a complication, with bleeding, inflammation, or intestinal obstruction.

Bleeding is a relatively common complication in children, but not in adults, making its diagnosis more difficult.

Surgical treatment with resection of the diverticulum is mandatory in the presence of complications.

Clinical case: 17-year-old patient who consulted for melena stools of 48 to 72 hours of evolution. He was hospitalized with a diagnosis of gastrointestinal bleeding, with admission hematocrit of 19% and hemoglobin of 6.2g/dl. No bleeding site is observed in upper or lower gastrointestinal videoendoscopy.

Given the presumed diagnosis of Meckel's diverticulum, laparoscopy was performed, revealing a diverticular sac located 50 cm from the ileocecal valve. Diverticulectomy and closure with mechanical suture is performed.

Conclusion: A rare case of massive lower gastrointestinal bleeding in adults originating in the small intestine (Meckel's diverticulum) was presented. In the absence of imaging findings but with high clinical presumption, laparoscopy made it possible to reach the diagnosis, identify Meckel's Diverticulum and perform its resection in a single operative act.