PMC5342979_01
Abdominal CT on admission. Abdominal CT shows high-density bowel fluid in the distal side of the ileum. There is no ascites, and no other suspicious bleeding points are seen.
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Abdominal computed tomography (CT) showed a high density of bowel fluid in the distal side of the ileum (Fig. 1).
Double-balloon endoscopy. Double-balloon endoscopy shows the large diverticulum 80 cm oral to the ileocecal valve (Fig. 2a). There is a circular ulcer at the entrance of the diverticulum. Naked vessels are seen, and the vessels are clipped (Fig. 2b, c).
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There was also a circular ulcer at the entrance of the diverticulum (Fig. 2a). No bleeding could be seen, but naked vessels were seen and clipped (Fig. 2b).
Operative findings. A 3-cm incision was placed in the umbilicus. EZ access  was then inserted through the wound (Fig. 3a). Meckel's diverticulum is present 80 cm oral to the ileocecal valve (arrow) (Fig. 3b). From the first 3-cm wound, the lesion can be easily moved outside the body. Then, the Meckel's diverticulum including the ulcer lesion is resected by Endo GIA purple 60  (Fig. 3c).
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Tokyo, Japan) was inserted through the wound. Three ports were used, one for the scope and two for handling forceps (Fig. 3a). A Meckel's diverticulum was found 80 cm proximal to the ileocecal valve (Fig. 3b). The MD including the ulcer lesion was then resected by Endo GIA purple 60  (Covidien, MA, USA) (Fig. 3c).
Excised specimen and pathological findings. The resected specimen shows a circular ulcer in the Meckel's diverticulum that might have caused the bleeding (arrow) (Fig. 4a). On pathology, ulcer formation is seen in the MD (arrow) (Fig. 4b). There is ectopic gastric mucosa, but no atypical cells in the specimens (arrow head) 3c).
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The resected specimen showed a circular ulcer in the Meckel's diverticulum that might have caused the bleeding (arrow) (Fig. 4a).