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Peptic Ulcer in Meckel’s Diverticulum

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Abstract

Intestinal hemorrhage constitutes the essential symptom of peptic ulcer in Meckel’s diverticulum. The blood is usually passed as fresh blood or clots from the rectum, but at times the stools may be tarry. Hemorrhage may occur suddenly and be the only symptom, or it may be preceded or followed by abdominal pain. Pain is the only other symptom in this condition. However, unless the inflammatory changes about a chronic ulcer have reached the visceral peritoneum, there is no pain, rigidity, or tenderness, but there may be a colic-like distress variously described as vague, cramp-like, or gnawing. It usually bears no relation to meals but often may be referred to the umbilicus.

Nine cases of bleeding from the bowel proved at operation to be due to a Meckel’s diverticulum have been seen at Cleveland Clinic in the past fifteen years (table). All but 1 patient had bleeding from the rectum. This was a 4½-month-old baby boy who had bloody fecal drainage from a fistula at the umbilicus. Four patients complained of pain, varying from mild abdominal distress in the region of the umbilicus to cramps in the lower part of the abdomen with nausea and vomiting. Seven patients were male. Six patients were under 25 years of age, the average in this series being 21.3 years. Although peptic ulcer of Meckel’s diverticulum is said to be an affliction of childhood, no age group is immune.

The following is a detailed report of our most recent typical case.

Case Report

A boy,


 

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