Lower gastrointestinal bleeding secondary to sigmoid diverticulosis with incidental Crohn’s disease and Meckel’s diverticulum: a case report

Introduction: Lower gastrointestinal bleeding (LGIB) in older adults is most commonly caused by diverticular disease. Concomitant pathology may be encountered during evaluation, particularly in patients with multiple comorbidities. Presentation of case: A 78-year-old man presented with painless hematochezia and hypovolemic shock while receiving clopidogrel. After stabilization, colonoscopy identified a sigmoid diverticulum with an adherent clot, which was treated with injection and clipping. During the same examination, an ulcerated ileocecal valve was noted. Retrograde single-balloon enteroscopy was subsequently performed, demonstrating terminal ileal ulceration consistent with Crohn’s disease and an incidental Meckel’s diverticulum. Discussion: Hemorrhage control was achieved endoscopically and attributed to diverticular bleeding. Further evaluation was undertaken based on the ileocecal finding, allowing direct assessment of the terminal ileum. Conclusion: In this case, targeted evaluation, prompted by a focal ileocecal abnormality, identified silent Crohn’s disease and an incidental Meckel’s diverticulum; while unrelated to the bleeding source, their recognition informed subsequent management and surveillance.