Diagnosis and Rx of bleeding Meckel's by lap surgery.
With 600 + members, it is likely that every few weeks some member of our meets a case of bleeding Meckels.
This case was published. A 15 year old boy collapsed at home after 4 days of bright PR bleeding. Abdo was soft and non-tender, and there was dark blood PR. The family doctor made the correct ultimate diagnosis.
He was resuscitated in hospital, and then bled more, dropping his Hb from 10.4 to 8.2 g over a day. He was transfused. A Meckel's nuclear scan was negative, and so were endoscopy, colonoscopy, and barium enema.
Laparoscopy showed the diverticulum, which was removed after stapling the base, transecting, and oversewing a bleeding point with 3/0 silk.
Discussion in the paper referred to earlier similar reports, and the false positives and false negatives when looking for a bleeding Meckel's.
My own comment: I would have been tempted to use laparoscopy for the definitive diagnosis and then use surgeons's previously described technique to exteriorise the Meckel's through the extended telescope port after gripping it with a duckbill from an extra 5 mm port. [I have an old English paper by Prudhov, the father of a surgeon I met in Dubois's OR in Paris, describing a similar technique using a cystoscope]. This could have substituted a simple suture for stapling and an extra port. I am stingy and penny-pinching, and begrudge the use of staplers where feasible.
Bleeding Meckel's this month, anyone? How diagnosed, treated?