Meckel's Diverticulum Diagnosed in a Child with Suspected Small Bowel Crohn's Disease

Abstract

We report a rare case of Meckel's diverticulum in a boy who initially presented with chronic iron deficiency anemia (IDA) without any history of gastrointestinal (GI) bleeding at 8 years-old. Isolated small bowel Crohn's disease was suspected based on findings of small bowel ulcers on capsule endoscopy. At four years from initial presentation, he developed massive GI bleeding. Abdominal computed tomographic angiography and small bowel series revealed findings suggestive of Meckel's diverticulum. Meckel's diverticulum should be suspected in children with unexplained chronic IDA even in the absence of prominent GI bleeding and negative findings on repetitive Meckel's scans. Moreover, Meckel's diverticulum should be included in the differential diagnosis of isolated small bowel Crohn's disease when the disease is limited to a short segment of the distal small bowel, as ulcers and inflammation may result as a consequence of acid secreted from adjacent heterotopic gastric mucosa constituting the Meckel's diverticulum.

Keywords: Crohn disease; Iron deficiency anemia; Meckel diverticulum.

Fig. 1. Technetium-99m pertechnetate (Meckel's) scan at initial presentation (A) and 4 years later (B). Meckel's scan results were both negative at initial presentation with pallor (A) and 4 years later when presenting with massive melena and syncope (B). ANT: anterior.

Fig. 2. Abdominal computed tomography image at initial presentation (A) and 4 years later (B). Initial findings reveal wall thickening of the terminal ileum (arrow) but no other remarkable findings (A), while a prominent enhancing tubular structure (arrowheads) connected to the distal ileum with a blind end (B) were noted 4 years later.

Fig. 3. Capsule endoscopy image at initial presnetation demonstrating diffuse erythematous mucosa and multiple aphthous ulcers in the distal ileum.

Fig. 4. Small bowel barium study performed 4 years later showing a contrast-filling structure (9.7 cm) outside and inferior to the terminal ileum, suspicious of Meckel's diverticulum (arrowheads).

Fig. 5. Diverticulectomy specimen (A) and histology (B). The specimen shows a segment of the ileum with a Meckel's diverticulum (arrowheads) of approximately 9-cm length (arrows) (A). Light microscopy image shows a low-power view with a mixture of gastric (yellow arrows) and intestinal epithelia (red arrows) within the Meckel's diverticulum (H&E, ×100) (B).