A 25-year-old man was admitted in May 2007 due to non-specific abdominal discomfort of 48 hours' duration accompanied by rectorrhagia on the morning he came to the emergency department. His personal history included a slight decrease in coagulation factor VII, two episodes of self-limited lower gastrointestinal bleeding in 1999 (gastroscopy, colonoscopy, scintigraphy with Tc99, enteroscopy, intestinal transit and arteriography without lesions) and another episode in 2004 (gastroscopy, colonoscopy and ileoscopy and scintigraphy with marked red blood cells without abnormalities) manifested as haematochezia. Physical examination revealed nothing remarkable and the patient's haemodynamics remained stable. Emergency tests showed normal haemogram, biochemistry and coagulation. Given the patient's history, it was decided to begin the study with a scintigraphy with labelled red blood cells. Five hours after administering the tracer, a pathological deposit was observed in the right flank, compatible with activity in the small intestine at the level of the ileum, cecum or ascending colon. In order to rule out possible bleeding in these locations, it was decided to perform a colonoscopy that same afternoon, in which haematic remains were observed along the entire path explored up to 15 cm of the ileum, without finding a clear bleeding point. In view of the persistent lower gastrointestinal bleeding, the patient remained stable, and it was decided to transfuse 2 red blood cell concentrates and perform an arteriography in which no abnormalities were observed.

In view of these findings, it was decided to perform an endoscopic capsule enteroscopy (ECE) to assess the rest of the small intestine. The same afternoon of the day of the procedure, the patient presented with frank rectorrhagia with clinical and analytical repercussions (haemoglobin 4.7g/dl, and haematocrit 13.7%). In this situation, 3 red blood cell concentrates were transfused and the on-call surgeon was contacted, deciding to perform a new urgent arteriography without evidence of a bleeding point. In this new clinical scenario, an urgent laparotomy was performed in which Meckel's diverticulum was observed 50 cm from the ileocaecal valve with active haemorrhage from it, with no evidence of proximal bleeding. Ileal resection was performed including the diverticulum with termino-terminal anastomosis with a satisfactory subsequent evolution. The capsule examination visualised the following day showed the presence of abundant fresh haematic debris in the distal sections of the ileum.

