Obscure Gastrointestinal Bleeding in an Adolescent Masked by Gastric Erosions: Meckel’s Diverticulitis Complicated by Adhesive Obstruction and Small Bowel Perforation

TL;DR

A teenager with recurring gastrointestinal bleeding was initially misdiagnosed due to gastric erosions, but later found to have a rare Meckel’s diverticulum complication.

Contribution

This case emphasizes the importance of considering Meckel’s diverticulum in adolescents with persistent GI bleeding despite normal initial tests.

Findings

Initial tests showed gastric erosions, leading to a gastritis diagnosis and temporary symptom relief.

CT imaging and surgery later confirmed Meckel’s diverticulitis with ectopic gastric mucosa as the true cause.

The case underscores the need to evaluate the small bowel when GI bleeding persists despite initial findings.

Abstract

Meckel’s diverticulum is the most frequent congenital anomaly of the gastrointestinal tract, yet its identification can be challenging when symptoms mimic those of more common conditions. In adolescents, this often leads to misdirection during the diagnosis and delays in identifying the true source of bleeding. A 16-year-old male presented with recurrent melena and abdominal pain. Initial esophagogastroduodenoscopy (EGD) revealed mild gastric erosions, and colonoscopy was normal, prompting treatment for gastritis and temporary symptom resolution. Ten months later, he returned with massive gastrointestinal bleeding. CT imaging suggested Meckel's diverticulitis, which was confirmed intraoperatively, and the patient underwent segmental small bowel resection with appendectomy. Histopathology confirmed Meckel's diverticulitis, which contained ectopic gastric mucosa. This case highlights the diagnostic pitfalls of obscure gastrointestinal bleeding in young patients. Mild gastric erosions should not preclude the evaluation of the small bowel when bleeding persists. Early consideration of Meckel’s diverticulum can help prevent avoidable morbidity and ensure timely, effective management.

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