Chen Shurong, Zhang Hong, Yu Xiongfei, Chen Yi
Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Department of Oncology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
AME Case Rep. 2023 Mar 20;7:19. doi: 10.21037/acr-22-105. eCollection 2023.
Meckel's diverticulum is a blind-end true diverticulum that contains all of the layers, which is normally found in the ileum. Prevalence of Meckel's diverticulum is around 2% in the general population, and even rare among adults. Gastrointestinal (GI) bleeding is a common complication of Meckel's diverticulum in children and in most cases, caused by peptic ulceration, due to ectopic gastric mucosa, while in minority cases, pancreatic tissue would also appear consisting around 6% of all Meckel's diverticulum patients.
Herein, we reported a 45-year-old man presented with recurrent hematochezia for over one-month without other remarkable symptoms or past medical history or signs on physical examination. Laboratory examinations showed hemoglobin of 114 g/L and ++++ in stool occult blood test without red blood cell. Contrasted abdominopelvic computerized tomography (CT) were normal and Meckel's electroconvulsive therapy (ECT) for identification was also negative. Considering gastroscopy and colonoscopy were both unremarkable in local hospital, double balloon enteroscopy was adopted and revealed double duct sign at about 100 cm proximal to the ileocecal valve and thus indicated existence of diverticulum. Further, ulceration was found at the far-end bottom of the blind-ending tube. The patient then underwent laparoscopic resection of Meckel's diverticulum and pathology study showed heterotopic pancreas in Meckel's diverticulum. The patient started feeding two days after surgery and was discharged on regular out-patient follow-up two weeks later. Till now, no reappear of hematochezia episode was observed.
Heterotopic pancreas in Meckel's diverticulum is relative rare clinical condition in adult which can cause recurrent lower GI bleeding. Thus, special attention should be paid in cases with unexplained lower GI bleeding in adult.
梅克尔憩室是一种包含所有肠壁层的盲端真性憩室，通常位于回肠。梅克尔憩室在普通人群中的患病率约为2%，在成年人中更为罕见。胃肠道出血是儿童梅克尔憩室的常见并发症，在大多数情况下，是由异位胃黏膜导致的消化性溃疡引起的，而在少数情况下，胰腺组织也会出现，约占所有梅克尔憩室患者的6%。
在此，我们报告一名45岁男性，反复便血一个多月，无其他明显症状，既往无病史，体格检查无体征。实验室检查显示血红蛋白为114g/L，大便潜血试验++++，无红细胞。腹部盆腔增强计算机断层扫描（CT）正常，用于识别的梅克尔电惊厥治疗（ECT）也为阴性。考虑到当地医院的胃镜和结肠镜检查均无异常，遂采用双气囊小肠镜检查，发现在回盲瓣近端约100cm处有双管征，提示存在憩室。此外，在盲端管的远端底部发现溃疡。患者随后接受了梅克尔憩室腹腔镜切除术，病理研究显示梅克尔憩室内有异位胰腺。患者术后两天开始进食，两周后定期门诊随访出院。迄今为止，未观察到便血再次发作。
梅克尔憩室内的异位胰腺在成人中是一种相对罕见的临床情况，可导致反复下消化道出血。因此，对于成人不明原因的下消化道出血病例应予以特别关注。
