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BLEEDING MECKEL'S DIVERTICULUM
Authored By: Asif Moinuddin and Henry Royal.
Patient: 48 year old male
History: HISTORY:
48-year-old man with prior episodes of gastointestinal bleeding.
Image Size:[small][as-submitted]

Multimedia: 85283_1_submitted.avi

Fig. 2

Fig. 3
Image Size:[small][as-submitted]

Findings: RADIOPHARMACEUTICAL: 26.1 mCi Tc-99m in vitro labeled red cells i.v.
FINDINGS:
Following intravenous administration of Tc-99m labeled red cells, sequential abdominal images were obtained through 90 minutes. At 3 minutes post-injection, there is a focus of activity in the right lower quadrant, which subsequently refluxes into the small bowel on the early images. The focus of activity in the right lower quadrant persists throughout the 90 minutes of imaging.
Diagnosis: FINAL DIAGNOSIS:
Active gastrointestinal bleeding in the cecum or possibly in the distal ileum
General Discussion: COMPLETE HISTORY:
48-year-old man with prior episodes of gastointestinal bleeding. Previously, he underwent successfull embolization of  a branch of ileocolic artery that was supplying the terminal ileum. He now presents with new onset of bright red bleeding per rectum.

FOLLOW-UP:
Approximately after 16 months, the patient presented with nausea, vomiting and abdominal pain. CT examination was performed as part of acute abdomen protocol, which was concerning for Meckel's diverticulum in the region of prior bleeding. The patient underwent surgery and the pathological examination came back as Meckel's diverticulum with severe acute inflammation and mucosal necrosis 
Specific Discussion:

Meckel's diverticulum was initially described by Fabricius Hildanus in 1598. Later on during 1808 and 1820, Johann Friedrich Meckel demonstrated its origin as a failure of vitelline duct to obliterate during fetal development. It is the most common congenital anomaly of small intestine. Usually presents at an earlier age, commonly younger than 2 years of age and effects 2% of population. It is more common in males. It is usually 2 cm in length and width. Complications include, bleeding, bowel obstruction, volvulus, intussusception, inflammation, perforation, benign tumor such as leiomyomas, angiomas, neuromas, lipomas and malignant tumors namely, sarcoma, carcinoid and adenomcaricnomas.


TEACHING POINT:
This case represents an example of bleeding Meckel's diverticulum


ACKNOWLEDGEMENT:
Jonathan Sehy
Comments:
No comments posted.
Additional Details:

Case Number: 85283Owner(s): Asif Moinuddin and Henry RoyalLast Updated: 02-07-2013
Anatomy: Gastrointestinal (GI)   Pathology: Congenital
Modality: Nuc MedAccess Level: Readable by all users, writable by NucMed Certifiers
Keywords: meckel's, congenital, diverticulumACR: 70000.27900

Case has been viewed 44 times.
Certified by Henry Royal on 02-09-2009

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