A Case of Bleeding Meckel's Diverticulum in an 88-year-old Man

Abstract

An 88-year-old man visited a previous hospital because of frequent bouts of melena, when upper and lower gastrointestinal endoscopy did not reveal bleeding site in the colon but the presence of blood in the ileum. He was referred to our hospital with a suspected diagnosis of small bowel bleeding. Transanal double-balloon enteroscopy revealed a Meckel's diverticulum in the distal ileum, and at its origin an ulcer was identified, bleeding from the ulcer being diagnosed. Upon surgery, the Meckel's diverticulum was present 40 cm proximal to the ileocecal valve. Partial ileectomy was performed. Histopathology revealed that there were no ectopic gastric mucosa and pancreatic tissue within the diverticulum, but UI-II ulcer was present at the origin of the diverticulum. Bleeding from the Meckel's diverticulum rarely occurs in elderly people. To the best of our knowledge, all patients over 70 years reported in Japan had no ectopic gastric mucosa but ulcer at the origin of the diverticulum was observed in many of them. Accordingly we consider that causes of bleeding from the Meckel's diverticulum in elderly patients might differ from those in juvenile patients whose mechanism of the bleeding mainly lies in ectopic gastric mucosa ; and that ulcer formation caused by long-term mechanical stimulations or circulatory disturbance might induce the bleeding in the elderly.