P1319 - A Mysterious Case of Gastrointestinal Bleed: Duplication Cyst or Meckel’s Diverticulum?

Khandokar A. Talib, MD, Godson Senyondo, MD, Minhaz Ahmad, MD, Amanke Oranu, MD
United Health Services Hospital, Johnson City, NY

Introduction: Gastrointestinal bleeding from Meckel’s diverticulum (MD) or duplication cyst are not common differential diagnoses in the adult population. We are presenting a case of GI bleed with initial concern of bleeding from duplication cyst but later finding of Meckel’s diverticulum.

Case Description/Methods: 21-year-old male with no comorbidities presented to the emergency room with the complaint of multiple episodes of bloody bowel movement for 3 days without any abdominal pain, nausea, or vomiting. He was having 3 to 4 black tarry stools per day with occasional blood clots. He was hemodynamically stable. Abdomen was soft, non-tender, and non-distended. His hemoglobin was 6.3 g/dL from baseline hemoglobin of 14 g/dL. CT abdomen revealed a 27.3 mm x 40 mm right mid-abdominal intestinal duplication cyst (Figure A). EGD did not show any abnormality in the esophagus, stomach, or duodenum (Figure B). Colonoscopy showed blood in the entire colon and in the distal ileum (Figure C&D). CT angiogram of the abdomen did not reveal any active bleeding. A tagged RBC scan revealed diffuse radionucleotide activity within the proximal and mid-descending colon. The patient required a total of 10 units of PRBC transfusion for ongoing melena and anemia. The patient was then transferred to another facility for a double-balloon enteroscopy. He underwent another colonoscopy which was normal. Technetium - 99 pertechnetate scan was performed showing possible Meckel’s diverticulum. MRI enterography did not show any Meckel’s diverticulum. The patient underwent diagnostic laparoscopy which revealed Meckel’s diverticulum and diverticulectomy was performed. Biopsy revealed Meckel’s diverticulum with polypoid gastric-type mucosa. Patient was discharged home 2 days after the surgery in stable condition.

Discussion: Technetium-99m pertechnate scan is specific to ectopic gastric mucosa and not specifically to Meckel's diverticulum; therefore, it may be positive in gut duplication cysts with ectopic gastric mucosa. In an adult, a duodenal duplication cyst may cause upper gastrointestinal hemorrhage. MD is the most common congenital malformation of the GI tract in the pediatric age group. While MD or duplication cysts are not common diagnoses amongst adult patients for ongoing GI bleed, these should be considered for patients who have no identifiable source of GI bleed following repeated endoscopic evaluation and extensive workup.



Disclosures:


Khandokar A. Talib, MD, Godson Senyondo, MD, Minhaz Ahmad, MD, Amanke Oranu, MD. P1319 - A Mysterious Case of Gastrointestinal Bleed: Duplication Cyst or Meckel’s Diverticulum?, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.