ADULT CASE OF MECKEL'S DIVERTICULUM CAUSING ANAL BLEEDING

A 49-year-old man admitted to hospital because of anal bleeding in 1994, when no bleeding point identified by gastrointestinal series. The patient was followed on an ambulant batis after conservative hemostasis. In December 1995, the patient was admitted again to the hospital because of anal bleeding. Angiography revealed no abnormalities and his clinical course was conservatively observed under blood transfusion. Angiography was performed again because tha anal bleeding became worse. When 1, 000 units of heparin was administered through the superior mesenteric artery, an extravasation was confirmed from an abnormal vessel branched from periphery of the iliac artery. Hemorrhage from the ileum was diagnosed and an emergency laparotomy was performed. During operation, a diverticulum in the ileum 60cm oral from the terminal ileum was found, and a partial excision of the ileum including the same portion was carried out. On the resected material, three ulcers were present in the diverticulum. Histopathologically, there was ectopic gastric mucosa at the tip of the diverticulum and Meckel's diverticulum was diagnosed. Complications of Meckel's diverticulum include hemorrhage, intestinal obstruction, and diverticulitis. Hemorrhage commonly occurs in children or younger, and rarely in adults. It may be necessary to entertain the possible diagnosis of adult Meckel's diverticulum for small bowel bleeding of unknown origin.