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Meckel Diverticulum — RACP Adult Medicine MCQ

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ModerateGastroenterologyMeckel DiverticulumRACP Adult Medicine

A 25-year-old man presents with painless massive rectal bleeding (bright red blood per rectum). He is haemodynamically stable after resuscitation. OGD is normal. Colonoscopy shows blood throughout the colon but no source identified. Technetium-99m pertechnetate scan shows abnormal uptake in the right iliac fossa consistent with ectopic gastric mucosa. What is the most likely diagnosis?

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Correct answer: D — Meckel diverticulum

Painless massive lower GI bleeding in a young adult with negative endoscopy and positive Meckel scan (Tc-99m pertechnetate detects ectopic gastric mucosa) is Meckel diverticulum. It follows the rule of 2s: 2% of population, 2 feet from ileocaecal valve, 2 inches long, presents before age 2 (but can present in adults). Ectopic gastric mucosa causes peptic ulceration and bleeding. Treatment: surgical resection (laparoscopic Meckel diverticulectomy).

Reference: eTG Surgical – 2024 – Lower GI Bleeding