Bleeding Intestinal Ulcer (Intussusception)

anus_14b_n.jpg: Resected diverticulum of the small intestine with a bright mucous membrane on the left in the picture, and adjacent to it a darkly discolored intestinal wall. Within the transitional zone there is a deep, round, and stamped out defect. The defect corresponds to an ulcer due to the presence of gastric mucosa (bright mucous membrane with thick folds) within a Meckel's diverticulum. The ulcer leads to melaena. anus_14a_n.jpg: Technetium scintigraphy. Technetium accumulates in the gastric mucosa of the stomach (large white spot below the left lower rib), and if gastric mucosa occurs somewhere else as in the presented case ( anus_14a_n.jpg), there, too (small white spot paramedially at the bottom). Because gastric mucosa occurs in half of the examined Meckel's diverticulum the technetium scinitgraphy may be used to identify Meckel's diverticulum as cause of melaena. anus_14c_n.jpg: On the right side in the picture there is a divided segment of the small intestine which connects to another structure; the mucous membrane of the latter structure is brighter and exhibits another structure. Between the two structures there is a hole in the intestinal wall with redness in the surroundings. The structure on the left side is a divided Meckel's diverticulum covered by gastric mucosa close to the small intestine. Due to gastric secretion a bleeding ulcer has developed in the small intestine near the transition to the diverticulum with an occult perforation. Because 50 % of the operated Meckel's diverticula contain gastric mucosa, blood in the stool or the melaena belongs to one of the most frequent complications of Meckel's diverticulum besides the symptomatic invagination and the acute inflammation of the diverticulum (analogously to an appendicitis). In contrast to the intussusception, Meckel's diverticulum with ulcer leads to painless and sometimes profuse bleeding often in toddlers which have very low hemoglobin.