Kovacs Mark, Botstein Jonathan, Braverman Stuart
Department of Radiology, Medical University of South Carolina, Charleston, SC, USA.
Department of Radiology, Santa Barbara Cottage Hospital, Santa Barbara, CA, USA.
J Radiol Case Rep. 2017 Mar 31;11(3):22-29. doi: 10.3941/jrcr.v11i3.2032. eCollection 2017 Mar.
A Meckel's diverticulum was diagnosed by mesenteric angiography in a 34 year-old patient who presented with hematochezia and dropping hemoglobin. The case demonstrates the challenges often encountered in workup of occult gastrointestinal (GI) bleeding, and shows that angiographic diagnosis of Meckel's diverticulum is possible, even in the absence of angiographic evidence of active extravasation. Our patient had a previous non-diagnostic workup including upper and lower endoscopy, videocapsulography, and Technetium-99m pertechnetate (Tc-99m) scintigraphy. Visceral angiogram demonstrated the presence of a persistent vitelline artery, diagnostic of Meckel's diverticulum. While no active extravasation was seen at the time of the angiogram, operative specimen demonstrated a Meckel's diverticulum with ectopic gastric mucosa and intraluminal hemorrhage.
一名34岁出现便血和血红蛋白下降的患者通过肠系膜血管造影诊断为梅克尔憩室。该病例展示了隐匿性胃肠道出血检查中常遇到的挑战，并表明即使没有血管造影显示的活动性造影剂外渗，梅克尔憩室的血管造影诊断也是可能的。我们的患者之前接受过上消化道和下消化道内镜检查、视频胶囊内镜检查以及锝-99m高锝酸盐（Tc-99m）闪烁扫描等非诊断性检查。内脏血管造影显示存在持续的卵黄动脉，这是梅克尔憩室的诊断依据。虽然血管造影时未发现活动性造影剂外渗，但手术标本显示为伴有异位胃黏膜和腔内出血的梅克尔憩室。
