Clinical and pathological analysis of hemorrhage from Meckel's diverticulum

Objective To analyze the clinical and pathological characters of patients with hemorrhage from Meckel’s diverticulum,so as to obtain a deeper understanding and to improve the treatment of this condition.Methods From Apr.1993 to Mar.2010,55 inpatients were diagnosed as hemorrhage from Meckel’s diverticulum by enteroscopy or/and surgery in General Hospital of PLA.The clinical and pathological data were then collected and retrospectively analyzed.Results All the patients,with median age of 25 years,presented repetitive or persistent gastrointestinal bleeding.Sudden massive bleeding occurred one or more times in 19 of 55 patients(34.5%) in whom chronic small hemorrhage had been found.The median distance from the diverticulum to ileocecal valve was 67cm.The median length of the diverticulum was 3.5cm.Forty-eight patients(87.3%) had only one diverticulum.Ulceration was found in the diverticulum in 18 patients(32.7%),ectopic gastric mucosa was found in 17 of 38 patients(44.7%),ectopic pancreatic tissue was found in 2 of 38 patients(5.3%),and a stromal tumor was found in the diverticulum in 2 of 38 patients(5.3%).Those patients with obscure intestinal bleeding were examined with oral barium meal,small bowel barium enema,coloscopy,capsule endoscopy,double-balloon enteroscopy,technetium99 scintigraphy,superior mesenteric artery angiography,or intraoperative colonoscopy,respectively,and 22.2%(2/9),90.9%(20/22),33.3%(6/18),25.0%(2/8),82.2%(16/19),88.9%(8/9),9.1%(1/11) and 100.0%(2/2) of patients were finally diagnosed as hemorrhagic Meckel’s diverticulum.The positive detection rate was significantly lower by oral barium meal than by small bowel barium enema(P < 0.001),and by capsule endoscopy than by double-balloon enteroscopy(P < 0.01).Among 39 patients,34(87.2%) received open surgery,and 5(12.8%) received laparoscopic surgery,and all of them recovered well after surgery without revisit.Conclusions Hemorrhagic Meckel’s diverticulum is commonly found in young Chinese people,who are always diagnosed as obscure gastrointestinal bleeding before a definite diagnosis of hemorrhagic Meckel’s diverticulum.Ectopic gastric mucosa is the main etiological factor of ulceration and hemorrhage of Meckel’s diverticulum.For preoperative examinations,small bowel barium enema,99Technetium scintigraphy and enteroscopy may give higher diagnostic rate of hemorrhagic Meckel’s diverticulum,and satisfactory result may be expected by extirpation of the lesion.