Meckel’s Diverticulum with Dieulafoy’s Lesion: A Cause of Severe Hematochezia

ABSTRACT

Background

Meckel’s diverticulum (MD) is a remnant of the omphalomesenteric duct. Although the majority of MD are asymptomatic, it can present with severe hematochezia. Hematochezia is generally considered to result from a peptic ulcer caused by ectopic gastric mucosa in MD. However, this hypothesis has not been proved.

Methods

10 cases of surgically resected MD initially presenting with severe hematochezia were histologically examined.

Results

Ectopic gastric mucosa was present in 9 cases, two of which also contained ectopic pancreas. No ectopic tissue was found in one case, which shows that bleeding can occur in MD without ectopic gastric mucosa. In addition, a rupture of aberrant submucosal arterioles through the overlying mucosa, a vascular abnormality called Dieulafoy’s lesion, was detected in all the 10 cases.

Conclusion

This study suggests that the actual cause of massive bleeding in MD is not a peptic ulcer, but Dieulafoy’s lesion.

KEYWORDS:

• Meckel’s diverticulum
• Dieulafoy’s lesion
• hematochezia
• bloody stool
• intestinal bleeding

Acknowledgment

The author would like to thank Mr. Kenji Takasaki and Ms. Masumi Kurumada for their technical assistance in the histological examination for this paper, and Enago (www.enago.jp) for the English language review.

Disclosure statement

No potential conflict of interest was reported by the authors.

Funding

The author(s) reported there is no funding associated with the work featured in this article.