title: Meckel's diverticulum in an adult: an obscure presentation of gastrointestinal bleeding.
abstract: A 17-year-old boy, with a background of haemophilia A, presented to hospital with an episode of brisk and painless per rectal (PR) bleeding. Initial investigation with gastroscopy and colonoscopy revealed no source of bleeding. Examination of the small bowel including MRI, CT angiogram and capsule endoscopy revealed no abnormalities. Double balloon enteroscopy (DBE) from an antegrade position was attempted, with no abnormalities noted. The symptoms persisted and DBE was attempted again from a retrograde approach and a diverticulum was subsequently noted. Laparoscopic surgery was performed identifying a diverticulum as the source of bleeding, 110 cm from the ileocaecal valve, which is more proximal than is normally seen. Histological examination revealed a Meckel's diverticulum. The case described here, although more unusual in adults, demonstrates that complete visualisation of the small bowel remains challenging and that newer modalities of enteroscopy including DBE can help aid in the diagnosis of obscure gastrointestinal bleeding.
authors.affiliation: Department of Gastroenterology, Southmead Hospital, Bristol, UK.
authors.forename: Vijay
authors.initials: V
authors.lastname: Pattni
authors.affiliation: Department of Gastroenterology, Southmead Hospital, Bristol, UK.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Wright
authors.affiliation: Department of Gastroenterology, Southmead Hospital, Bristol, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Marden
authors.affiliation: Department of Gastroenterology, Southmead Hospital, Bristol, UK.
authors.forename: Ana
authors.initials: A
authors.lastname: Terlevich
mesh_terms: D000293:Adolescent; D058582:Double-Balloon Enteroscopy / Q000379:methods*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000601:surgery; D006467:Hemophilia A / Q000150:complications; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008467:Meckel Diverticulum / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome