Inverted Meckel's diverticulum presenting as chronic anemia: case report and literature review

Meckel's diverticulum is a remnant of the omphalomesenteric duct and is the most common congenital abnormality of the gastrointestinal tract. Complications resulting from a Meckel's diverticulum occur in up to 4% of patients with this anomaly and include obstruction, "diverticulitis," gastrointestinal hemorrhage, intussusception and perforation. This report describes the unusual presentation of a Meckel's diverticulum as a small-bowel polyp in a patient with chronic anemia. This case of an inverted Meckel's diverticulum presenting as a small-bowel mass is rare. Even more unusual is this patient's presentation with chronic anemia in the absence of any significant gastrointestinal symptoms. From our review of the literature, we could find only 2 other reports of an inverted Meckel's diverticulum presenting with chronic anemia.1,2 Pathological examination of the resected specimen revealed the presence of heterotopic gastric mucosa with resultant ulceration of the adjacent small-- bowel mucosa. Peptic ulceration of this small-bowel mucosa represents the likely etiology for the patient's chronic anemia. Heterotopic gastric mucosa has been reported to occur in up to 50% of Meckel's diverticula and in up to 80% of symptomatic patients.3 Although H. pylori-- induced "gastritis" has also been described with Meckel's diverticula,4 no H. pylori organisms were found in our operative specimen. Interestingly, this patient's anemia at initial presentation may have been exacerbated by the ingestion of nonsteroidal anti-inflammatory medication.5 This case highlights the importance of considering a complication of a Meckel's diverticulum in the clinical work-up of a patient presenting with obstruction, gastrointestinal bleeding or abdominal pain that is atypical or undiagnosed after standard investigations.