P0794 - Masquerading Meckel’s in a Middle-Aged Male: Bleeding, Video Capsule Induced-Perforation, and Mystique

John Delaney, MD, Ren Bryant, DO, Brooks Richardson, MD, Courtney Perry, DO, MS
University of Kentucky, Lexington, KY

Introduction: Meckel’s diverticulum (MD) is a common congenital malformation of the GI tract, with an estimated 2% prevalence. Though most often clinically silent, MD can be a source of significant bleeding and abdominal pain. The majority of symptomatic MD present in children or young men under the age of 40. Here, we present an unusual case of persistent bleeding in a late middle-aged male who experienced a video-capsule endoscopy (VCE) induced perforation.

Case Description/Methods: A 55-year-old male presented to the emergency room with 4 days of melena, dyspnea, and fatigue. He reported regular NSAID use since a total knee replacement two weeks previously. On admission, he was tachycardic with a hemoglobin of 7.3 (baseline 14.0). EGD revealed a small Forrest III ulceration in the gastric lumen. Hemoglobin continued to downtrend during admission, prompting colonoscopy, which was non-diagnostic. VCE was deployed the following day given persistent bleeding. Four hours after swallowing the capsule, the patient experienced severe abdominal pain in the right lower quadrant. CT-angiography abdomen/pelvis showed a perforation in the terminal ileum requiring emergent ileocecectomy. Intraoperatively the surgeon noted a diverticulum and associated mucosal inflammation in the terminal ileum. The VCE images reviewed the following day revealed severe inflammation in the small bowel with active bleeding, appearance concerning for Crohn disease with stricture. However, surgical pathology later confirmed the presence of Meckel’s diverticulum and non-specific small bowel inflammation attributed to NSAID usage. The patient recovered well post-operatively without recurrence of bleeding, 6-month follow-up colonoscopy to assess anastomosis is pending.

Discussion: Meckel’s Diverticulum is a common phenomenon, though symptomatic presentation, particularly in late middle age, is exceedingly uncommon. Capsule impaction with small bowel perforation is also a rare occurrence. NSAID use has been associated with symptomatic MD bleeding and the development of small bowel enteritis and strictures. In this case, a perfect storm of heavy NSAID usage and previously silent MD contributed to VCE complication. Though rare, this case argues for inclusion of Meckel’s diverticulum in the clinician’s diagnostic differential, particularly in cases of persistent significant bleeding and non-diagnostic bidirectional endoscopy. Surgical resection is the definitive treatment for symptomatic Meckel’s diverticulum.


Disclosures:


John Delaney, MD, Ren Bryant, DO, Brooks Richardson, MD, Courtney Perry, DO, MS. P0794 - Masquerading Meckel’s in a Middle-Aged Male: Bleeding, Video Capsule Induced-Perforation, and Mystique, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.