PMC6333590_01
Technetium-99m pertechnetate (Meckel's) scan at initial presentation (A) and 4 years later (B). Meckel's scan results were both negative at initial presentation with pallor (A) and 4 years later when presenting with massive melena and syncope (B). ANT: anterior.
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F1
The findings of Meckel's scan were negative (Fig. 1A). Results of Meckel's scan were again negative (Fig. 1B).
Abdominal computed tomography image at initial presentation (A) and 4 years later (B). Initial findings reveal wall thickening of the terminal ileum (arrow) but no other remarkable findings (A), while a prominent enhancing tubular structure (arrowheads) connected to the distal ileum with a blind end (B) were noted 4 years later.
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F2
Abdominal computed tomography revealed focal wall thickening and enhancement in the ileocecal valve and terminal ileum (Fig. 2A). However, abdominal computed tomographic angiography revealed a prominent enhancing tubular structure connected to the distal ileum (Fig. 2B).
Capsule endoscopy image at initial presnetation demonstrating diffuse erythematous mucosa and multiple aphthous ulcers in the distal ileum.
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F3
Capsule endoscopy revealed localized multiple aphthous ulcers and diffuse erythematous mucosa in the distal ileum (Fig. 3).
Small bowel barium study performed 4 years later showing a contrast-filling structure (9.7 cm) outside and inferior to the terminal ileum, suspicious of Meckel's diverticulum (arrowheads).
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F4
Small bowel series also revealed a contrast filling structure suspected with a duplication cyst or Meckel's diverticulum in the distal ileum (Fig. 4).
Diverticulectomy specimen (A) and histology (B). The specimen shows a segment of the ileum with a Meckel's diverticulum (arrowheads) of approximately 9-cm length (arrows) (A). Light microscopy image shows a low-power view with a mixture of gastric (yellow arrows) and intestinal epithelia (red arrows) within the Meckel's diverticulum (H&E, x100) (B).
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F5
Laparoscopic resection of the lesion was performed (Fig. 5A), and histologic evaluation revealed pyloric glands within the diverticulum, thereby confirming the diagnosis of Meckel's diverticulum (Fig. 5B).