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A 29-year-old man presented with acute rectal bleeding causing hemorrhagic shock. The patient had presented with a similar episode of digestive bleeding 4 years previously, with no diagnosis being found. His physical examination did not reveal any clinical abnormalities. Gastroscopy, colonoscopy, and abdominal computed tomography angiography (CTA) were normal. Small-bowel video capsule endoscopy revealed an ileal diverticular orifice, with the double-lumen sign. After passage of the capsule into the diverticulum, an ulcer with a visible vessel (Forrest IIa) was observed at the bottom of the diverticulum, located next to a patch of heterotopic gastric mucosa. During this examination, active bleeding was seen from this area of ulceration (▶Fig. 1; ▶Video1). A Meckel’s diverticulum was suspected. A 99mTc pertechnetate scintigraphy scan was performed, which confirmed the presence of ectopic gastric mucosa, corresponding to a probable Meckel’s diverticulum (▶Fig. 2). Surgery allowed the excision of a diverticulum of 6×2×1 cm that was found 70 cm above the ileocecal valve. Histological examination confirmed the presence of ectopic fundal mucosa within the diverticulum (▶Fig. 3). The patient left hospital 3 days after the surgery and has not represented with any further recurrence of bleeding. Meckel’s diverticulum is a vestigial remnant of the omphalomesenteric duct, located on the antimesenteric border of the ileum, within 100 cm above the Bauhin’s valve. About 50% of symptomatic Meckel’s diverticula have been found to contain ectopic tissue, especially gastric mucosa (35%–45%), which can cause ulceration and hemorrhage; 75% of hemorrhagic Meckel’s diverticula contain gastric ectopic mucosa [1]. Abdominal CT is an insensitive test for detection, especially in adults. In patients with obscure gastrointestinal bleeding, smallbowel video capsule endoscopy is a poE-Videos

Meckel’s diverticulum on third-generation video capsule endoscopy: intradiverticular ulcer, ectopic gastric mucosa, and active bleeding