Meckel`s diverticulum: a rare case of rectal bleeding in a teenager

Introduction: Rectal bleeding is a common problem in pediatrics and in the majority of cases the causes are transient, benign and simplytreated.

The age of onset relates to certain diagnoses: anal fissures and intussusception in infant, and lymphoid hyperplasia and inflammatory bowel disease in the older child. In children younger than 2 years of age we also have to think in Meckel`s diverticulum (MD). In these cases the majority of patients don’t have symptoms, but the ones who are symptomatic, often present rectal bleeding, which is usually painless.

Case Report:

A 12 year-old-boy was admitted to the paediatric emergency room with a 3-day history of abdominal pain with rectal bleeding. No relevant personal or family history.

On examination, he presented a BMI > 95^thpercentile, he was pale, but was hemodynamically stable, with no pain on abdominal palpation. The hemogram showed an hemoglobin of 7 g/dL, so he received a blood transfusion and was admitted to the ward.

Throughout his stay he did an upper and lower endoscopy and an MR enterography, which didn’t reveal any alteration.

We were suspicious of an MD and after having done a technetium-99m pertechnetate scan, the diagnosis was confirmed.

He underwent surgical resection of the MD (segmental intestinal enterectomy), which ran without intercurrences.

The postoperative period was uneventful and he was discharged on day 6, clinically well.

Conclusion: Meckel`s diverticulum is a common congenital gastrointestinal malformation in children but is rare in teenagers. It has various clinical presentations and it is necessary to maintain a high suspicion in the paediatric age group.

Serious complications rarely happen but when they do, they can cause consequences, such as mechanical obstruction, intestinal perforation and shock.

Thus, prompt diagnosis and proper treatment are essential in warranting a better outcome.