Elifranji Mohammed, Ahmed Muhammed E A, Heffernan Sheena, O'Neill John, Gillick John
Department of Paediatric Surgery, Children's Health Ireland, Dublin, Ireland.
Department of Histopathology, Children's Health Ireland, Dublin, Ireland.
Clin J Gastroenterol. 2025 Jun;18(3):459-462. doi: 10.1007/s12328-025-02125-y. Epub 2025 Apr 8.
Meckel's diverticulum (MD) is a congenital anomaly which is often asymptomatic. However, complications, including gastrointestinal hemorrhage and obstruction, can arise and primarily in young children. While gastrointestinal bleeding is relatively common, intraperitoneal bleeding from MD is exceedingly rare, particularly in infancy.
We report a rare case of a 9-month-old male who presented with symptoms of bronchiolitis but subsequently developed acute per rectum (PR) bleeding; initially passing dark blood-stained stools followed by fresh blood. Hemodynamic instability and severe anemia necessitated urgent fluid resuscitation and blood transfusion. Imaging revealed a dilated, inflamed segment of small bowel with adjacent fluid, raising the possibility of a complicated MD. Laparoscopic exploration confirmed intra-abdominal bleeding from a perforated MD eroding into an adjacent mesenteric vessel. Surgical intervention included resection of the MD and end-to-end anastomosis. Histological analysis revealed a perforated MD which contained ectopic gastric mucosa and eroded adjacent vascular mesentery.
This is the first reported case of concurrent gastrointestinal and intraperitoneal bleeding from MD in an infant. The unique presentation underscores the importance of considering MD in cases of unexplained GI bleeding in infants, even when intraperitoneal hemorrhage is present. This case adds to the limited pediatric literature on MD-associated intraperitoneal bleeding and emphasizes prompt surgical management in achieving favorable outcomes.
梅克尔憩室（MD）是一种先天性异常，通常无症状。然而，包括胃肠道出血和梗阻在内的并发症可能会出现，且主要发生在幼儿身上。虽然胃肠道出血相对常见，但MD引起的腹腔内出血极为罕见，尤其是在婴儿期。
我们报告了一例罕见病例，一名9个月大的男性患儿最初表现为细支气管炎症状，但随后出现急性直肠（PR）出血；最初排出黑便，随后出现鲜血便。血流动力学不稳定和严重贫血需要紧急液体复苏和输血。影像学检查显示一段小肠扩张、发炎，伴有邻近液体，提示可能存在复杂的MD。腹腔镜探查证实腹腔内出血是由穿孔的MD侵蚀邻近肠系膜血管所致。手术干预包括切除MD并进行端端吻合。组织学分析显示穿孔的MD含有异位胃黏膜并侵蚀了邻近的血管系膜。
这是首例报道的婴儿MD并发胃肠道和腹腔内出血的病例。这种独特的表现强调了在婴儿不明原因胃肠道出血病例中考虑MD的重要性，即使存在腹腔内出血。该病例补充了关于MD相关腹腔内出血的有限儿科文献，并强调及时手术治疗以取得良好预后。
