A 25-year-old male was admitted in May 2007 for a 48-hour history of nonspecific abdominal discomfort accompanied by rectal bleeding in the morning that came to the emergency department.
His personal history included a slight decrease in coagulation factor VII, two cases of self-limiting lower gastrointestinal bleeding in 1999 (gastroscopy, manifesting as ileostomy, gammagraphy and other hematological abnormalities enteroscopy, intestinal transit).
There was nothing remarkable in the physical examination concerning the patient with stable hemodynamics.
The emergency blood count, biochemistry and coagulation were normal.
Given the patient's history, it was decided to start the study with a gammagraphy, marked ascending colon with a tracer, a pathological deposit at the level of the right flank being compatible with activity in the area.
In order to rule out possible bleeding in these locations, it was decided to perform the same evening, when remnants were observed, covering the entire explored tract up to 15 cm of ileum, without finding a clear bleeding point.
Established persistent lower gastrointestinal bleeding, establishing a stable patient, it was decided to transfuse 2 concentrates of iodine and perform an arteriography in which no abnormalities were observed.
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We decided to perform capsule endoscopy to assess the rest of the small intestine.
The same afternoon of the day of the procedure, the patient had a frank rectal bleeding with clinical and analytical repercussions (hemoglobin 4.7g/dl, and hematocrit 13.7%).
In this situation, three tapered units were transfused and a new arteriography was contacted by the guardian surgeon without evidence of bleeding.
In this new clinical scenario, an emergency laparotomy was performed, in which Meckel's diverticulum was observed 50 cm from the ileocecal valve with active bleeding from it, without appreciating proximal bleeding.
Ileal resection was performed including the diverticulum with termino-terminal anastomosis with a satisfactory later evolution.
The examination of the capsule revealed the presence of abundant fresh pigments in the distal ileum.
