Bleeding Meckel Diverticulum Associated with a Vitellointestinal Artery Aneurysm Found on Preoperative Angiography: Report of a Case

Abstract

An 18-year-old man was admitted to a local hospital with abdominal pain and bloody stool. Upper and lower gastrointestinal endoscopy failed to show any bleeding sites; however, an angiography of the superior mesenteric artery done on hospital day 4 showed an abnormal artery with an aneurysm, branching from the ileal artery. This artery was thought to be the vitellointestinal artery, a feeding artery of Meckel diverticulum. After embolization, he was transferred to our hospital, where we performed emergency laparotomy with partial resection of the ileum, including a bleeding Meckel diverticulum. Pathological examination revealed ectopic gastric mucosa and peptic ulceration, which we assumed was the origin of the bleeding. The patient had an uneventful postoperative course. Visceral artery aneurysms are rare but important vascular lesions because of their potential for fatal rupture. Although a minimally invasive procedure can be performed for a vitellointestinal artery aneurysm in patients with asymptomatic Meckel diverticulum, we treated our patient surgically because he presented with hemorrhagic shock and had been unresponsive to an H(2)-receptor antagonist.

Radiologist's perspective for the Meckel's diverticulum and its complications

“…The diverticulum has a separate fold of mesentery, which carries the supplying vessels. 10,11 CLINICAL MANIFESTATIONS The Meckel's diverticulum may be asymptomatic and often detected incidentally during surgery for some other indication. There is no known gender predisposition of asymptomatic Meckel's diverticula; however, symptomatic diverticula are more common in males than in females.…”

“…Digital subtraction angiography can help in detecting a persistent vitellointestinal artery in the case of bleeding from the Meckel's diverticulum 11 and in the planning of embolization of this artery.…”

Anatomical Variations of Vascular Anatomy in Meckel’s Diverticulum

“…Another case referred to a pregnant woman who had undergone surgery for resection of symptomatic MD, and the preoperative imaging revealed an artery, increased in length and width, with no branches, that is the embryonic artery ( 4 ). It is worth noting a case report referring to the case of an abnormal vitello-intestinal artery aneurysm in an asymptomatic case of MD ( 14 ). Last but not least, Watanabe et al described a clinical case of MD accompanied by a preduodenal portal vein (PDPV) ( 15 ).…”

“…For instance, Martre et al presented a case report of a gastrointestinal stromal tumor (GIST) on MD ( 3 ). Moreover, hemorrhage is the most frequent complication, especially in children, and in adults it can lead to chronic anemia due to the chronic blood loss from the gastrointestinal trunk ( 10 , 12 , 14 ).…”

“…Finally, it is equally important to highlight that aneurysms and vascular anomalies in general, even though they are not common in the general population, are of high clinical significance. A potential rupture of an aneurysm can be life-threatening, and the mortality rate is estimated to be 8.5% ( 14 ). The management of patients with a vitelline artery aneurysm and asymptomatic MD can be treated by a minimally invasive surgical procedure, if complications occur ( 14 ).…”