Pre-operative Angiographic Demonstration of Meckel’s Diverticulum with Massive Bleeding

A 12-year-old child presented to our emergency department with hypovolemic shock due to gastrointestinal bleeding. Gastroduodenoscopy, colonoscopy, and red blood cell nuclear scans were performed, but no definite focal lesions were identified. Emergency visceral angiography was performed. Contrast medium injection after selective catheterization of the superior mesenteric artery (SMA) showed an abnormal artery branching from the ileal artery and extravasation of the contrast material from that artery. The abnormal artery was thought to be the vitellointestinal artery, which is the feeding artery of Meckel’s diverticulum (Figure 1). After super-selective catheterization of this vessel, therapeutic embolization was performed (Figure 2). Despite this, control angiography at the end of the procedure showed extravasation of the contrast material, so the patient underwent surgery. Exploration revealed Meckel’s diverticulum on the anti-mesenteric side of the ileum (Figure 3a). Diverticulectomy with ileal resection followed by reconstruction with an ileal end-to-end anastomosis was performed. Microscopic examination demonstrated ectopic gastric mucosa accompanying intestinal mucosa in the Meckel’s diverticulum (Figure 3b).