Heterotopic pancreas in Meckel's diverticulum in an adult man with lower gastrointestinal bleeding: a case report and literature review.

Background: Meckel's diverticulum is a blind-end true diverticulum that contains all of the layers, which is normally found in the ileum. Prevalence of Meckel's diverticulum is around 2% in the general population, and even rare among adults. Gastrointestinal (GI) bleeding is a common complication of Meckel's diverticulum in children and in most cases, caused by peptic ulceration, due to ectopic gastric mucosa, while in minority cases, pancreatic tissue would also appear consisting around 6% of all Meckel's diverticulum patients. Case Description: Herein, we reported a 45-year-old man presented with recurrent hematochezia for over one-month without other remarkable symptoms or past medical history or signs on physical examination. Laboratory examinations showed hemoglobin of 114 g/L and ++++ in stool occult blood test without red blood cell. Contrasted abdominopelvic computerized tomography (CT) were normal and Meckel's electroconvulsive therapy (ECT) for identification was also negative. Considering gastroscopy and colonoscopy were both unremarkable in local hospital, double balloon enteroscopy was adopted and revealed double duct sign at about 100 cm proximal to the ileocecal valve and thus indicated existence of diverticulum. Further, ulceration was found at the far-end bottom of the blind-ending tube. The patient then underwent laparoscopic resection of Meckel's diverticulum and pathology study showed heterotopic pancreas in Meckel's diverticulum. The patient started feeding two days after surgery and was discharged on regular out-patient follow-up two weeks later. Till now, no reappear of hematochezia episode was observed. Conclusions: Heterotopic pancreas in Meckel's diverticulum is relative rare clinical condition in adult which can cause recurrent lower GI bleeding. Thus, special attention should be paid in cases with unexplained lower GI bleeding in adult.