Divertículo de Meckel complicado: Reporte de un caso

Karina Fernanda Viteri Tigse; Henry Paúl Velasco Molina; Mercedes Isabel  Guamán Guamán; Edgar Gustavo  Mendieta Bermeo

doi:10.26871/killkana_salud.v9i3.1653

Authors

Karina Fernanda Viteri Tigse Hospital José Carrasco Arteaga https://orcid.org/0000-0002-4482-586X
Henry Paúl Velasco Molina Hospital José Carrasco Arteaga https://orcid.org/0009-0007-1225-8999
Mercedes Isabel Guamán Guamán Hospital José Carrasco Arteaga https://orcid.org/0000-0001-7405-8895
Edgar Gustavo Mendieta Bermeo Hospital José Carrasco Arteaga https://orcid.org/0000-0003-0953-8862

DOI:

https://doi.org/10.26871/killkana_salud.v9i3.1653

Keywords:

Meckel's diverticulum, Laparoscopy, Gastrointestinal Bleeding, Capsule Endoscopy, Computed Tomography Angiography

Abstract

Introduction: Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, caused by the persistence of the omphalomesenteric duct. Although frequently asymptomatic, it may lead to complications such as gastrointestinal bleeding, intestinal obstruction, and diverticulitis. Case presentation: We report the case of a 16-year-old male with no significant medical history who presented with intermittent episodes of moderate to severe hematochezia, along with fatigue and colicky abdominal pain. Multiple diagnostic tests, including upper gastrointestinal endoscopy, colonoscopy, video capsule endoscopy, and contrast-enhanced abdominal CT, failed to identify the bleeding source. Ultimately, an abdominal CT angiography revealed an image suggestive of Meckel's diverticulum. The patient underwent laparoscopic resection of the diverticulum and incidental appendectomy. The postoperative course was favorable, with complete resolution of bleeding. Histopathological analysis confirmed heterotopic gastric mucosa with focal ulceration. Conclusion: This case underscores the diagnostic challenge of obscure gastrointestinal bleeding in adolescents and emphasizes the importance of maintaining a high clinical suspicion for Meckel's diverticulum.

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References

Sandoval GE, Toro-Pérez J, Pohl VE, Hurtado JP, Zambra RM, Sanguineti MA. Divertículo de Meckel y sus complicaciones. Rev Cir. 2024;76(1):46–54. Disponible en: http://dx.doi.org/10.35687/s2452-454920240011786

Urrutia Soto H, Donoso Carrasco C, Carvajal Flores O. Divertículo de Meckel sintomático en pediatría. Andes Pediatr. 2021;92(1):104–109. Disponible en: https://andespediatrica.cl/index.php/rchped/article/view/2470

Blouhos K, Boulas KA, Tsalis K, Barettas N, Paraskeva A, Kariotis I, et al. Meckel's diverticulum in adults: surgical concerns. Front Surg. 2018;5:55. Available in: https://doi.org/10.3389/fsurg.2018.00055

Guzmán-Martínez S, Galván-Montaño A, Lara-Escalera S, Estrada Hernández M. del R, García-Peña A, Castañeda-Ángeles EG, et al. Divertículo de Meckel con tejido pancreático ectópico en un niño de 12 años con invaginación intestinal. Reporte de caso y revisión de la literatura. Rev Cirugía y Cirujanos. 2018;86(5):399–403. Disponible en: https://doi.org/10.24875/CIRU.18000193

Hansen CC, Søreide K. Systematic review of epidemiology, presentation, and management of Meckel’s diverticulum in the 21st century. Medicine. 2018;97(35): e12154. Available in: https://doi.org/10.1097/MD.0000000000012154

Sempértegui R, Campos S, Salazar JA, Reyes L, Santillán X. Divertículo de Meckel, reporte de tres casos en hospitales de tercer nivel de Quito, Ecuador. Metro Cienc. 2022;30(3):75–84. Disponible en: https://doi.org/10.47464/MetroCiencia/vol30/3/2022/75-84

García L, Rodríguez L, Díaz G. Divertículo de Meckel. A propósito de un caso. Rev.Med.Electrón. 2019; 41(1):173-179. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1684-18242019000100173&lng=es.

Aboughalia HA, Cheeney SHE, Elojeimy S, Blacklock LC, Parisi MT. Meckel diverticulum scintigraphy: technique, findings and diagnostic pitfalls. Pediatr Radiol. 2023;53(3):493–508. Available in: https://doi.org/10.1007/s00247-022-05527-z

Yan P, Jiang S. Tc-99m scan for pediatric bleeding Meckel diverticulum : a systematic review and meta-analysis. J Pediatr. 2023;99(5):425–431. Available in: https://doi.org/10.1016/j.jped.2023.03.009

Kumar M, Singh P, Kumari P, Kaushik R. Revisiting the forgotten remnant: Imaging spectrum of Meckel's diverticulum. SA J Radiol. 2022;26(1):a2431. Available in: https://doi.org/10.4102/sajr.v26i1.2431

Santamaría C, Oliveros J, Aguayo J, León D, Acosta D. Experiencia en el tratamiento del divertículo de Meckel con abordaje abierto versus laparoscópico-asistido supraumbilical en niños. Revista Ecuatoriana de Pediatría. 2022;23(2):101-109. Disponible en: https://doi.org/10.52011/162

Baeza P, Nicolás I. Experiencia en cirugía de urgencia de Divertículo de Meckel en adultos. Rev Cir. 2022;74(2):165-171. Disponible en: http://dx.doi.org/10.35687/s2452-454920220021355

An J, Zabbo CP. Meckel Diverticulum. StatPearls Publishing; 2023. Available in: https://www.ncbi.nlm.nih.gov/books/NBK499960/.

Piotrowicz G, Ossowska-Dorosz B, Dorosz Ł, Kaszubowski MF, Sylwia Małgorzewicz, Stępień B, et al. Managing diverticula: dietary changes for a more comfortable life. Gastroenterology Rev. 2025;20(1):92–101. Available in: https://doi.org/10.5114/pg.2024.144982

Gurudu S, Bruining D, Acosta R, Eloubeidi M, Faulx A, Khashab M, et al. The role of endoscopy in the management of suspected small-bowel bleeding. Gastrointest Endosc. 2017;85(1):22–31.DOI: http://dx.doi.org/10.1016/j.gie.2016.06.013