P4197 - Rare Case of Symptomatic Meckel’s Diverticulum in an Adult Male

Kesany Boupapanh, MD¹, Eleanor Belilos, MD¹, Ali Khan, MD^2
1Rush University Medical Center, Chicago, IL; ²Rush University Medical Center, Bannockburn, IL

Introduction: Meckel’s diverticulum (MD), the most common congenital gastrointestinal malformation, occurs in only 2% of the population. In children, technetium-99m pertechnate scans are the gold standard, but this is less sensitive in adults. We present a rare case of an adult male with a negative technetium-99m pertechnate scan who was found to have symptomatic MD on diagnostic laparoscopy.

Case Description/Methods: A 19-year-old male presented with hematochezia and orthostatic hypotension, and his hemoglobin was 7.9 g/dL. Initial tests, including an enteric pathogen panel, fecal lactoferrin, and stool culture, were negative. Esophagogastroduodenoscopy (EGD) showed a Mallory-Weiss tear and gastritis, with pathology negative for H. pylori. Colonoscopy revealed normal mucosa, non-bleeding hemorrhoids, and a presumed small bowel source of bleeding. CT abdomen/pelvis, CT angiogram and Technetium-99m pertechnate scan were unremarkable.

Patient was transferred for advanced endoscopy and started on octreotide. Despite hemodynamic stability, he required transfusions for continued hematochezia. Push enteroscopy showed a Forrest Class III gastric ulcer but no culprit lesion. Video capsule endoscopy identified an ileal lesion. Diagnostic laparoscopy revealed a broad-based MD near the proximal ileum, which was resected. Pathology confirmed heterotopic gastric mucosa consistent with MD.

Discussion: Meckel’s diverticulum (MD) is a true diverticulum formed due to incomplete obliteration of the vitelline duct. In children, they typically present with GI bleed however they are mostly asymptomatic in adults. Technetium-99m pertechnate scan is the gold standard for pediatric diagnostics, with 80-90% sensitivity and 95-98% specificity. In adults, sensitivity drops to 62.5% with a 60% positive predictive value. In adults, balloon-assisted enteroscopy (BAE) has a 95% diagnostic yield, higher than technetium-99m pertechnate scan's 21.4%, making BAE the preferred preoperative diagnostic modality. A predictive risk score for MD in children exists which can predict utility of explorative surgery without endoscopy. However, no predictive risk score exists for adults as most cases are easymptomatic and found incidentally. Currently, explorative laparoscopy is the gold standard for diagnosis and treatment in adults as it provides diagnosis and definitive treatment with resection.


Disclosures:


Kesany Boupapanh, MD¹, Eleanor Belilos, MD¹, Ali Khan, MD². P4197 - Rare Case of Symptomatic Meckel’s Diverticulum in an Adult Male, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.