Acute lower gastrointestinal bleeding from Meckel's diverticulum in a young adult: a case report on surgical management.

Introduction and importance: Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract, yet acute lower gastrointestinal bleeding as a presentation in adults remains uncommon and diagnostically challenging. This case highlights the importance of early surgical decision-making in this setting. Presentation of case: A 20-year-old male with no medical history presented with 2 days of hematochezia. Hemoglobin levels declined over 72 hours. The patient developed hemodynamic instability and episodes of syncope, which were managed on the surgical ward without vasopressor support. Upper and lower endoscopies were unremarkable. Contrast-enhanced computed tomography (CT) identified a blind-ending ileal structure consistent with MD. Laparoscopic exploration confirmed a 7 × 2 cm MD located 140 cm from the ileocecal valve. A 10-cm ileal segment was resected, and a hand-sewn anastomosis was performed. Histopathology confirmed ectopic gastric fundic-type mucosa without ulceration. The postoperative course was complicated by a transient paralytic ileus (Clavien-Dindo grade II), which was managed conservatively, with discharge on day 6. Clinical discussion: MD should be considered in young adults with unexplained hematochezia when standard endoscopy is negative. CT imaging is key in identifying MD. Segmental bowel resection is preferred when ectopic mucosa is suspected. While technetium-99 m pertechnetate scanning may be considered in stable patients with suspected MD, its sensitivity in adults is lower than in children. Conclusion: Surgical resection remains the definitive treatment for symptomatic cases. Prophylactic excision of incidentally discovered MD may be considered in selected patients with risk factors for complications, though this decision should be individualized and weighed against surgical risks.