Konishi Takako, Manabe Noriaki, Haruma Ken, Fujiwara Hideyo, Fujiwara Hiroyasu, Takaoka Munenori, Akiyama Takashi, Kato Katsuya, Hata Jiro, Yamatsuji Tomoki
Department of Surgery, Kawasaki Medical School, Okayama, Japan.
Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, 2-6-1 Nakasange, Kita-Ku, Okayama, 700-8505, Japan.
Clin J Gastroenterol. 2024 Oct;17(5):876-882. doi: 10.1007/s12328-024-02019-5. Epub 2024 Jul 24.
A 23-year-old man with a history of anemia of unknown cause was referred to our hospital. He had experienced melena three times: at 6 months, 10 years, and 20 years of age. He underwent upper and lower gastrointestinal endoscopy at 10 and 20 years of age, and small intestinal capsule endoscopy twice at 20 years of age, but the site of bleeding could not be identified. At first, a transabdominal ultrasound was performed for suspected Meckel's diverticulum. A cystic diverticulum was found in the ileum, with an apertural diameter of 5 mm and a total size of 4 cm. The cyst showed an area of loss of wall stratification, which appeared to be an ulcer scar. Based on these observations, we diagnosed anemia resulting from a hemorrhagic Meckel's diverticulum and performed laparoscopic resection. Postoperative histopathology revealed ectopic gastric mucosa and ulcer formation within the Meckel's diverticulum, which was thought to be the cause of the bleeding. Meckel's diverticulum should be considered in cases of hemorrhage in young patients. A transabdominal ultrasound as a screening test detected a diverticulum with an ulcer scar in the ileum, which led to the identification of the underlying disease.
一名有不明原因贫血病史的23岁男性被转诊至我院。他曾三次出现黑便：分别在6个月、10岁和20岁时。他在10岁和20岁时接受了上、下消化道内镜检查，并在20岁时接受了两次小肠胶囊内镜检查，但出血部位均未明确。起初，因怀疑梅克尔憩室而进行了经腹超声检查。在回肠发现一个囊性憩室，开口直径5毫米，总大小4厘米。囊肿显示壁层分层缺失区域，似乎是溃疡瘢痕。基于这些观察结果，我们诊断为出血性梅克尔憩室导致的贫血，并进行了腹腔镜切除术。术后组织病理学显示梅克尔憩室内有异位胃黏膜和溃疡形成，这被认为是出血原因。对于年轻患者出血病例应考虑梅克尔憩室。经腹超声作为筛查检查发现了回肠有溃疡瘢痕的憩室，从而明确了潜在疾病。
