Angiographic Diagnosis of a Meckel’s Diverticulum in a 26-month-old Boy

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TL;DR

This case report describes a 26-month-old boy with recurrent hematochezia where standard diagnostic tests including multiple Meckel's scans were negative, but superior mesenteric angiography revealed abnormal vasculature in the terminal ileum. Exploratory laparotomy confirmed a Meckel's diverticulum (MD) with ectopic gastric mucosa, and diverticulectomy was performed. The case highlights that angiography can detect MD even in the absence of acute bleeding by visualizing the vitelline artery, and should be considered when Meckel's scan is falsely negative.

Full summary

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**Background:** Meckel's diverticulum (MD) is the most common congenital malformation of the gastrointestinal tract, occurring in approximately 2% of the population. The gold standard for diagnosis is the Meckel's scan, which detects accumulation of Technetium-99m. However, false negatives can occur, likely due to insufficient gastric mucosa within the diverticulum. Literature on angiographic findings for MD diagnosis is limited to a few individual cases. This case report presents a pediatric patient with recurrent hematochezia in whom standard diagnostic workup was negative, but angiography successfully identified the MD.

**Methods:** This is a single case report of a 26-month-old boy who presented with recurrent hematochezia. The patient underwent an extensive diagnostic workup including abdominal ultrasound for intussusception, three Meckel's scans, a tagged red blood cell scan, CT-angiography, upper endoscopy, colonoscopy, and video capsule endoscopy. All of these studies returned normal results. Subsequently, superior mesenteric angiography was performed. After angiographic findings, exploratory laparotomy and Meckel's diverticulectomy were carried out.

**Key Results:** Abdominal examination was normal. Laboratory findings showed hemoglobin of 7.5 g/dL. Abdominal ultrasound revealed a short (0.3 cm) segment of wall thickening in the distal ileum. All three Meckel's scans, tagged red blood cell scan, CT-angiography, upper endoscopy, colonoscopy, and video capsule endoscopy were normal. Superior mesenteric angiography revealed an area of abnormal vasculature in the terminal ileum, specifically demonstrating multiple abnormal corkscrew-like arteries of the ileocolic artery. Exploratory laparotomy subsequently showed an obvious Meckel's diverticulum. Meckel's diverticulectomy was performed, and histological examination confirmed the presence of ectopic gastric mucosa within the MD.

**Clinical Implications:** This case demonstrates that angiography can detect MD even in the absence of acute bleeding through visualization of the vitelline artery. When clinical suspicion for MD remains high despite negative Meckel's scans—which may be falsely negative due to insufficient ectopic gastric mucosa—angiography should be considered as a diagnostic option. The abnormal corkscrew-like arteries of the ileocolic artery observed in this patient represent a characteristic angiographic finding that may aid in diagnosis. This is particularly relevant in pediatric patients with recurrent hematochezia where standard diagnostic modalities have been exhausted. The case adds to the limited literature on angiographic diagnosis of MD and supports the role of angiography in challenging diagnostic scenarios.