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Khan MMM, Arham A, Farooq R, Irfan S, Alvi R. Presentation of Perforated Meckel's Diverticulum and Phlegmon: A Case Report. Cureus 2024; 16:e53460. [PMID: 38435162 PMCID: PMC10908415 DOI: 10.7759/cureus.53460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 03/05/2024] Open
Abstract
One of the most frequently encountered congenital anomalies of the gastrointestinal tract is the Meckel's diverticulum. Perforation of the diverticulum, a rare complication, can significantly hinder accurate diagnosis of the condition. Other common complications associated with Meckel's diverticulum include intestinal obstruction, intussusception, volvulus, inflammation, and hemorrhage. The presentation is similar to the presentation of appendicitis at times. Formation of a phlegmon around a perforated Meckel's diverticulum can mask clinical signs and symptoms. We present a case of a 59-year-old man who presented with pain in the right upper and lower quadrants. After imaging, the patient underwent exploratory laparotomy, which revealed a perforated Meckel's diverticulum. This case highlights the importance of considering Meckel's diverticulum as a possible diagnosis in patients presenting with acute abdominal pain. A thorough approach to history and physical exam combined with imaging can help in the early diagnosis of a perforated Meckel's diverticulum.
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Affiliation(s)
| | - Asfia Arham
- General Surgery, Aga Khan University Hospital, Karachi, PAK
| | - Rimsha Farooq
- General Surgery, Aga Khan University Hospital, Karachi, PAK
| | - Simra Irfan
- General Surgery, Aga Khan University Hospital, Karachi, PAK
| | - Rehman Alvi
- General Surgery, Aga Khan University Hospital, Karachi, PAK
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Konstantakis C, Mantzios P, Sotiropoulos C, Anesidis S, Thomopoulos KC. Intussuscepted Polypoid Meckel's Diverticulum Presenting With Gastrointestinal Bleeding in a Young Adult. Cureus 2024; 16:e51744. [PMID: 38318558 PMCID: PMC10840443 DOI: 10.7759/cureus.51744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2024] [Indexed: 02/07/2024] Open
Abstract
A 22-year-old female patient with a recent hospitalization for gastrointestinal bleeding presented with recurrent hematochezia and a positive shock index. Previous investigations, including endoscopy and wireless small bowel capsule, were non-diagnostic. CT angiography revealed extravasation in the ileum. Initial tests like technetium-99m scintigraphy and ileocolonoscopy were negative. Repeat wireless small bowel capsule identified a partially ulcerated polypoid mass in the distal ileum. At surgical exploration, an intussuscepted Meckel's diverticulum was identified and resected. A histopathologic examination confirmed the diagnosis. Meckel's diverticulum is a rare cause of gastrointestinal bleeding in adults. Preoperative diagnosis can be challenging. Reports of a polypoid morphology are very scarce in indexed literature and mostly derive from investigation with device-assisted enteroscopy. We report this extremely rare finding at capsule endoscopy to raise clinician awareness and to discuss diagnostic difficulties associated with similar cases, such as the negative scintigraphy result and the optimal timing of repeat capsule endoscopy.
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Affiliation(s)
| | - Petros Mantzios
- Gastroenterology Department, University General Hospital of Patras, Patras, GRC
| | | | - Stathis Anesidis
- General Surgery Department, University General Hospital of Patras, Patras, GRC
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Yang J, Chen Z, Fan Y, Zhou L, Tian Q, Yin X, Jin X, Zhang H, Ning S. Endoscopic characteristics of Meckel's diverticulum in adults: a retrospective case-series from two tertiary general hospitals in China. Scand J Gastroenterol 2023:1-8. [PMID: 36651020 DOI: 10.1080/00365521.2022.2164211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND To analyze the diversity in endoscopic manifestations of Meckel's diverticulum (MD) in adults by using balloon-assisted enteroscopy (BAE) and supply more information on the application of BAE. METHODS A retrospective study was carried out on adult patients diagnosed with MD by BAE in two tertiary general hospitals in China, from May 2007 to September 2021. The patients were divided into a small bowel bleeding (SBB) group and a control group according to their main symptoms. Clinical charts and endoscopic images were reviewed, analyzed, and summarized. RESULTS Single diverticulum in the ileum and double-lumen sign were observed in all patients. The SBB group consisted of 51 patients, among which 35 cases of ulcerative lesions, 9 cases of erosive lesions, 9 cases of active bleeding/blood clots, and 4 cases of lumps inside the diverticulum were observed respectively. Majority of ulcerative lesions were inside the diverticulum (23/35). A circumferential stricture inside the diverticulum was discovered in 11 cases, and ulcerative lesions tended to occur at this structure (10/11). In the control group consisting of 15 patients, 1 case of erosive lesions at the orifice edge was observed. The percentage of patients with MD-associated ulcerative lesions was significantly higher in the SBB group than that in the control group (p < 0.001). CONCLUSIONS The endoscopic manifestations of MD in adults are extraordinarily complex and connected with the patients' primary symptoms. The internal features of MD should be regarded as crucial observational objectives in adult patients.
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Affiliation(s)
- Jing Yang
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhitao Chen
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Fan
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Zhou
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qingqing Tian
- Department of Pathology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xin Yin
- Department of Gastroenterology, Air Force Medical Center, Beijing, China
| | - Xiaowei Jin
- Department of Gastroenterology, Air Force Medical Center, Beijing, China
| | - Heng Zhang
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shoubin Ning
- Department of Gastroenterology, Air Force Medical Center, Beijing, China
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Morris G, Kennedy A. Small Bowel Congenital Anomalies. Surg Clin North Am 2022; 102:821-835. [DOI: 10.1016/j.suc.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Nakatani S, Inoki K, Tashiro T, Yamaguchi S, Gocho T, Yanagisawa F, Konda K, Tojo M, Kubota Y, Katagiri A, Yamamura F, Takeuchi Y, Tate G, Komoto M, Yamazaki K, Murakami M, Yoshida H. Small intestinal bleeding and stricture caused by Meckel's diverticulum. Clin Case Rep 2022; 10:e6144. [PMID: 35979381 PMCID: PMC9366935 DOI: 10.1002/ccr3.6144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 05/29/2021] [Accepted: 12/24/2021] [Indexed: 11/29/2022] Open
Abstract
A 44‐year‐old man presented to our hospital with lower gastrointestinal bleeding. We performed balloon‐assisted enteroscopy, which revealed diverticulum and stricture at the ileum. The patient underwent segmental small bowel resection and diagnosed with Meckel's diverticulum. We should keep in mind the possibility of intestinal stricture due to Meckel's diverticulum.
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Affiliation(s)
- Shinya Nakatani
- Division of GastroenterologyDepartment of MedicineShowa University School of MedicineTokyoJapan
| | - Kazuya Inoki
- Division of GastroenterologyDepartment of MedicineShowa University School of MedicineTokyoJapan
| | - Tomoe Tashiro
- Division of GastroenterologyDepartment of MedicineShowa University School of MedicineTokyoJapan
| | - Sayaka Yamaguchi
- Division of GastroenterologyDepartment of MedicineShowa University School of MedicineTokyoJapan
| | - Toshihiko Gocho
- Division of GastroenterologyDepartment of MedicineShowa University School of MedicineTokyoJapan
| | - Fumito Yanagisawa
- Division of GastroenterologyDepartment of MedicineShowa University School of MedicineTokyoJapan
| | - Kenichi Konda
- Division of GastroenterologyDepartment of MedicineShowa University School of MedicineTokyoJapan
| | - Masayuki Tojo
- Division of GastroenterologyDepartment of MedicineShowa University School of MedicineTokyoJapan
| | - Yutaro Kubota
- Division of GastroenterologyDepartment of MedicineShowa University School of MedicineTokyoJapan
| | - Atsushi Katagiri
- Division of GastroenterologyDepartment of MedicineShowa University School of MedicineTokyoJapan
| | | | - Yoshiaki Takeuchi
- Division of GastroenterologyDepartment of MedicineShowa University School of MedicineTokyoJapan
| | - Genshu Tate
- Department of PathologyShowa University School of MedicineTokyoJapan
| | - Masahiro Komoto
- Division of Gastroenterological and General SurgeryDepartment of SurgerySchool of Medicine, Showa UniversityTokyoJapan
| | - Kimiyasu Yamazaki
- Division of Gastroenterological and General SurgeryDepartment of SurgerySchool of Medicine, Showa UniversityTokyoJapan
| | - Masahiko Murakami
- Division of Gastroenterological and General SurgeryDepartment of SurgerySchool of Medicine, Showa UniversityTokyoJapan
| | - Hitoshi Yoshida
- Division of GastroenterologyDepartment of MedicineShowa University School of MedicineTokyoJapan
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6
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Zhang L, Li L, Yuan W, Zhuang X, Wang C, Qiu F. OUP accepted manuscript. Gastroenterol Rep (Oxf) 2022; 10:goac006. [PMID: 35186299 PMCID: PMC8853843 DOI: 10.1093/gastro/goac006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/29/2021] [Accepted: 01/14/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Li Zhang
- Department of Gastroenterology, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, P. R. China
| | - Lei Li
- Department of Gastroenterology, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, P. R. China
| | - Wenjie Yuan
- Department of Gastroenterology, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, P. R. China
| | - Xiaohui Zhuang
- Department of Gastroenterology, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, P. R. China
- Corresponding author. Department of Gastroenterology, Affiliated Hospital of Weifang Medical University, 2428 Yuhe Road, Kuiwen District, Weifang, Shandong 261000, P. R. China. Tel: +86-18853682957;
| | - Chunya Wang
- Department of Gastroenterology, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, P. R. China
| | - Fengjiao Qiu
- Department of Gastroenterology, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, P. R. China
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Chang K, Chang C, Chou J, Wu Y, Huang P, Cheng K. Meckel's diverticulum diagnosed by double‐balloon enteroscopy: A single‐center retrospective study in Taiwan. JGH Open 2021; 6:63-68. [PMID: 35071790 PMCID: PMC8762615 DOI: 10.1002/jgh3.12697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 11/27/2021] [Accepted: 12/05/2021] [Indexed: 12/02/2022]
Abstract
Background and Aim Meckel's diverticulum (MD) is a common congenital abnormality of the gastrointestinal (GI) tract. Although a few patients with MD present symptoms, preoperative diagnosis of MD is a clinical challenge because of its endoscopic inaccessibility. The aim of the present study was to investigate patients with MD diagnosed by double‐balloon enteroscopy (DBE) in Taiwan. Methods We conducted a retrospective study in a tertiary referral center in middle Taiwan. The clinical characteristics, endoscopic features, histopathological findings, treatment methods, and outcomes of patients with MD diagnosed by DBE were analyzed. Results A total of 14 male patients with MD diagnosed by DBE were enrolled. The mean age of all patients was 32.3 years. GI bleeding (78.6%) accounted for the major indication of DBE, followed by abdominal pain and Crohn's disease follow‐up. The mean distance between the ileocecal valve and MD was 68.9 cm. The average length of 12 patients with surgically resected MD was 5.2 cm. The diagnostic yields of the other modalities excepting DBE are as follows: capsule endoscopy, 50%; Meckel's scan, 11.1%; computed tomography, 16.7%; small bowel series, 0%; and angiography, 33.3%. MD presented as a large ostium in 13 patients (92.9%), a small ostium in 1 patient (7.1%), and bleeding signs in 10 patients (71.4%). Twelve patients (85.7%) underwent surgical treatment and 2 patients (14.3%) received conservative treatment. Heterotopic gastric tissue was identified in 4 patients (28.6%). Conclusion The present study showed that DBE is a more powerful modality in detecting MD than the other conventional modalities in Taiwan.
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Affiliation(s)
- Kai‐Chih Chang
- Center for Digestive Medicine, Department of Internal Medicine China Medical University Hospital Taichung Taiwan
| | - Chia‐Hsi Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine Asia University Hospital Taichung Taiwan
- Taiwan Association for the Study of Small Intestinal Diseases (TASSID) Taoyuan Taiwan
| | - Jen‐Wei Chou
- Center for Digestive Medicine, Department of Internal Medicine China Medical University Hospital Taichung Taiwan
- Taiwan Association for the Study of Small Intestinal Diseases (TASSID) Taoyuan Taiwan
- School of Medicine China Medical University Taichung Taiwan
| | - Yi‐Hua Wu
- Center for Digestive Medicine, Department of Internal Medicine China Medical University Hospital Taichung Taiwan
| | - Po‐Ju Huang
- Center for Digestive Medicine, Department of Internal Medicine China Medical University Hospital Taichung Taiwan
| | - Ken‐Sheng Cheng
- Center for Digestive Medicine, Department of Internal Medicine China Medical University Hospital Taichung Taiwan
- School of Medicine China Medical University Taichung Taiwan
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Meckel's Diverticulum Diagnosed by Balloon-Assisted Enteroscopy: A Multicenter Report from the Taiwan Association for the Study of Small Intestinal Diseases (TASSID). Gastroenterol Res Pract 2021; 2021:9574737. [PMID: 34840565 PMCID: PMC8616713 DOI: 10.1155/2021/9574737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/18/2021] [Accepted: 11/02/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Aims Patients with Meckel's diverticulum (MD) are difficult to preoperatively diagnose because of its endoscopic inaccessibility. Balloon-assisted enteroscopy (BAE) allows endoscopic access to the entire small intestine. The aim of the current study was to investigate patients with MD diagnosed by BAE in Taiwan. Methods We conducted a retrospective, multicenter study of patients with MD who were diagnosed by BAE in Taiwan. The clinical characteristics, endoscopic features, histopathological findings, treatment methods, and outcomes were analyzed. Results A total of 55 patients with MD were enrolled (46 males and 9 females). The mean age at diagnosis was 34.1 years. Overt gastrointestinal bleeding (87.3%) was the primary indication for BAE, followed by abdominal pain (9.1%), suspected small bowel tumor (1.8%), and Crohn's disease follow-up (1.8%). The mean distance between the ileocecal valve and MD was 71.6 cm (regarding diagnostic yields: BAE—100%, capsule endoscopy—40%, Meckel's scan—35.7%, computed tomography—14.6%, small bowel series—12.5%, and angiography—11.1%; regarding endoscopic features of MD: a large ostium—89.1%, a small ostium—7.3%, and a polypoid mass—3.6%). Surgical treatment was performed in 76.4% patients, and conservative treatment was performed in 23.6% patients. The mean length of MD in 42 patients who underwent surgical resection was 5.2 cm (in 43 patients of MD with available histopathology: heterotopic gastric tissue, 42.4%, heterotopic gastric and pancreatic tissues, 7%; heterotopic pancreatic tissue, 4.7%; heterotopic colonic tissue, 2.3%; and a neuroendocrine tumor, 2.3%). Conclusions The current study showed BAE is a very useful modality for detecting MD compared with other conventional modalities.
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Reddy PM, Kulkarni S, Nabi Z, Kasle S, Chavan R, Pal P, Shrimal P, Choudhary H, Sayyed M, Reddy DN. Single balloon enteroscopy in children for evaluation of small bowel diseases in children: A large, tertiary center study. J Pediatr Surg 2021; 56:2005-2009. [PMID: 33189296 DOI: 10.1016/j.jpedsurg.2020.10.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/12/2020] [Accepted: 10/22/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIM Device assisted enteroscopy is the cornerstone for small bowel evaluation. However, the data are limited in pediatric patients. In this study, we aim to evaluate the safety and utility of single balloon enteroscopy (SBE) in children. METHODS The data of children (≤18-years) who underwent SBE from November 2010 to July 2020 was analyzed, retrospectively. The safety and diagnostic yield of SBE were assessed. RESULTS 189-SBE procedures (males 117, mean age 15.1 ± 2.76, range 3-18 years) were performed in 174-children. The indications for SBE were chronic abdominal pain in 119 (68.4%), gastrointestinal bleed 17 (9.8%), chronic diarrhea 17 (9.8%) and vomiting 13 (7.5%). Antegrade, retrograde and combined SBE were performed in 98 (51.8%), 77 (40.7%), 7 (3.7%) children, respectively. The mean length of small bowel intubation in antegrade and retrograde SBE groups were 168.9 ± 58.6 cm and 120.7 ± 52.1 cm, respectively. Overall, a positive finding was seen in 117 (67.2%) cases. The most common findings were ileal and jejunal ulcers with or without strictures in 76 (64.9%) children. A total of 18 therapeutic enteroscopic procedures were performed. There were no major adverse events. CONCLUSION SBE is a safe and effective procedure for the evaluation and management of small bowel diseases in children.
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Affiliation(s)
- Palle Manohar Reddy
- Consultant gastroenterologist, Asian institute of Gastroenterology, Hyderabad, India
| | - Sujay Kulkarni
- Consultant gastroenterologist, Asian institute of Gastroenterology, Hyderabad, India
| | - Zaheer Nabi
- Consultant gastroenterologist, Asian institute of Gastroenterology, Hyderabad, India.
| | - Sachin Kasle
- Consultant gastroenterologist, Asian institute of Gastroenterology, Hyderabad, India
| | - Radhika Chavan
- Consultant gastroenterologist, Asian institute of Gastroenterology, Hyderabad, India
| | - Partha Pal
- Consultant gastroenterologist, Asian institute of Gastroenterology, Hyderabad, India
| | - Pankaj Shrimal
- Consultant gastroenterologist, Asian institute of Gastroenterology, Hyderabad, India
| | - Hrushikesh Choudhary
- Consultant gastroenterologist, Asian institute of Gastroenterology, Hyderabad, India
| | - Mahiboob Sayyed
- Consultant gastroenterologist, Asian institute of Gastroenterology, Hyderabad, India
| | - D Nageshwar Reddy
- Chairman and Chief Gastroenterologist, Asian institute of Gastroenterology, Hyderabad, India.
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Bains L, Bhatia R, Kaushik R, Lal P, Rajpaul G, Veerpal. Inverted Meckel's diverticulum: a case report. J Med Case Rep 2021; 15:264. [PMID: 34020701 PMCID: PMC8140418 DOI: 10.1186/s13256-021-02736-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 02/14/2021] [Indexed: 12/28/2022] Open
Abstract
Background Inverted Meckel’s diverticulum refers to the condition in which the diverticulum inverts on itself. The reasons for such an inversion are poorly understood due to the rarity of the condition. We present a case of inverted Meckel’s diverticulum, an uncommon finding, as a cause of recurrent intussusception. Case presentation A 30-year old Indian woman presented with complaints of pain in the central abdomen for 3 days, accompanied with vomiting and loose stools. Computed tomography images were suggestive of intussusception with intestinal obstruction. Intra-operative findings were suggestive of an intussuscepted segment of ileum measuring 10 cm in length, proximal to ileocecal junction. Ileo–ileal anastomosis was performed after appropriate resection. Upon opening the specimen, we were surprised to find an inverted Meckel diverticulum with lipoma at one end causing the intussusception. The patient made an uneventful recovery and was discharged after 5 days. Conclusion The reasons for inversion include abnormal peristalsis around the diverticulum and non-fixity of the diverticulum itself. The inverted diverticulum itself can cause luminal compromise and acts as a lead point for intussusception leading to obstruction. Computed tomography remains the diagnostic tool of choice for identifying intestinal obstruction and intussusception. Although pathological signs, such as lipoma, can be identified, the identification of any inversion will require a proficient radiologist. Inverted Meckel’s diverticulum is a rare condition which is difficult to diagnose preoperatively. Treatment is surgical, whether diagnosed pre-operatively or intra-operatively, and includes segmental resection and anastomosis. This uncommon condition should be noted as one-off differential diagnosis for intussusception and intestinal obstruction.
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Affiliation(s)
- Lovenish Bains
- Department of General Surgery, Maulana Azad Medical College, New Delhi, India.
| | - Rahul Bhatia
- Department of General Surgery, Maulana Azad Medical College, New Delhi, India
| | - Rohit Kaushik
- Department of General Surgery, Maulana Azad Medical College, New Delhi, India
| | - Pawan Lal
- Department of General Surgery, Maulana Azad Medical College, New Delhi, India
| | - Gayatri Rajpaul
- Department of General Surgery, Maulana Azad Medical College, New Delhi, India
| | - Veerpal
- Department of General Surgery, Maulana Azad Medical College, New Delhi, India
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Yang J, Tian D, Wu L, Dong M, Zhong J. Meckel's diverticulum with polypoid hyperplasia of ectopic gastric mucosa diagnosed by double-balloon enteroscopy and single-photon emission computed tomography/computed tomography. J Int Med Res 2021; 48:300060520955055. [PMID: 32954882 PMCID: PMC7509755 DOI: 10.1177/0300060520955055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Meckel’s diverticulum (MD) is a relatively common true congenital diverticulum on the ileum. Bleeding caused by polypoid hyperplasia of ectopic gastric mucosa in MD is rare. A 14-year-old Chinese boy presented with intermittent melena and haematochezia for 1 month. Laboratory data showed normocytic anaemia. Gastroscopic findings were normal. The patient underwent exploratory laparotomy without bowel preparation on day 2 because of sudden haematochezia and decreased haemoglobin. Intraoperative colonoscopy revealed inflammatory changes in the terminal ileal mucosa with diffuse haemorrhage. Melena with decreased haemoglobin recurred 20 days after the first operation. Computed tomography (CT) and angiography revealed a tubular lesion that was localised in the right lower abdominal quadrant. Single-photon emission computed tomography/computed tomography (SPECT/CT) fusion imaging with 99m-technetium pertechnetate confirmed moderately increased uptake in the distal ileum. Retrograde double-balloon enteroscopy (DBE) showed a diverticulum with prominent mucosal polypoid hyperplasia at an insertion depth of 100 cm from the anastomotic stoma. Diverticulectomy and end-to-end anastomosis were performed, and MD was confirmed by a histopathological examination. The patient’s postoperative recovery was uneventful during the 2-month follow-up. MD with polypoid hyperplasia of ectopic gastric mucosa is rare. Complementary use of DBE and SPECT/CT can accurately diagnose MD by providing anatomical and functional information.
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Affiliation(s)
- Jun Yang
- Department of Nuclear Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P.R. China
| | - Dan Tian
- Department of Nuclear Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P.R. China
| | - Lihua Wu
- Department of Nuclear Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P.R. China
| | - Mengjie Dong
- Department of Nuclear Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P.R. China
| | - Jijun Zhong
- Department of Nuclear Medicine, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, P.R. China
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Hideshima K, Watanabe T, Miyashima Y, Kumei S, Kume K, Yoshikawa I, Harada M. Meckel's Diverticulum Bleeding Missed by the First but Detected by the Second Capsule Endoscopy. J UOEH 2021; 43:75-80. [PMID: 33678788 DOI: 10.7888/juoeh.43.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A 13-year-old boy was admitted to our hospital because of bloody stools. Although a Meckel's diverticulum (MD) was suspected, capsule endoscopy (CE) revealed no remarkable findings. Seven months later, he was admitted again because of rebleeding. CE was performed again and revealed an elevated lesion and fresh blood in the ileum. A single balloon endoscopic examination revealed a diverticulum with an elevated lesion in it. Histologic findings showed ectopic gastric mucosa, thus we diagnosed this patient as having MD. Although CE is useful for the examination of obscure gastrointestinal bleeding, a single CE is not enough to diagnose MD bleeding. The timing in performing CE and the evaluation of other modalities would be valuable for patients suspected of having MD.
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Affiliation(s)
- Kousuke Hideshima
- The Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Tatsuyuki Watanabe
- The Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Yuichi Miyashima
- The Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Shinsuke Kumei
- The Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Keiichiro Kume
- The Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Ichiro Yoshikawa
- Department of Endoscopy, University Hospital of Occupational and Environmental Health, Japan
| | - Masaru Harada
- The Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan
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Abstract
BACKGROUND Ectopic pancreas in the ileum, including lesions within Meckel diverticulum, can cause severe manifestations and complications; yet, it was seldom reported in English literature. AIM This study aimed to raise awareness and provide information for better clinical management of this rare yet serious condition. METHODS A total of 1713 cases of small bowel resection were performed in our hospital between 2009 and 2018, among which 10 cases of ileac ectopic pancreas were identified. A comprehensive retrospective review of the 10 cases was taken. RESULTS Five lesions were located in the ileum wall and 5 were within Meckel diverticulum. Two lesions within Meckel diverticulum were incidental; the remaining 8 lesions were all associated with abdominal pain, gastrointestinal bleeding, and anemia. Of the 5 patients with lesions in the ileum wall, computed tomography uniformly revealed ileoileal intussusceptions with masses as lead points. Capsule endoscopies were performed in 6 cases, of which 3 showed positive findings. Double-balloon enteroscopy was conducted in one case and revealed an ileal diverticulum. Therapeutically, the offending bowel segments were removed, and intussusceptions were restored except for one case in which diverticulectomy was applied. No relapse or sequela was observed in the follow-up. CONCLUSIONS Ileac ectopic pancreas can be seen in the ileum wall or Meckel diverticulum. The majority of the lesions found in clinical practice present with abdominal pain, gastrointestinal bleeding, and anemia. Lesions in the ileum wall often cause ileoileal intussusception. Computed tomography, capsule endoscopy, and double-balloon enteroscopy are helpful preoperative examinations. Segmental small bowel resection is the treatment of choice.
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Abstract
OBJECTIVE We described a case series of patients diagnosed with Meckel's diverticulum using capsule endoscopy (CE), reviewed the literature, and aimed to reveal the common CE characteristics of Meckel's diverticulum. MATERIALS AND METHODS We reviewed a case series of Meckel's diverticulum in the Department of Gastroenterology, Beijing Shijitan Hospital Affliated to the Capital Medical University. In each case, primary upper endoscopy and colonoscopy failed to reveal a reason to explain the complaints (hematochezia in three cases and abdominal pain in one). CE (Pillcam SB2, Given Imaging, Yoqneam, Israel) was chosen as the next diagnostic test of choice and Meckel's diverticulum was detected by CE. Then, endoscopic characteristics and follow-up of Meckel's diverticulum were analyzed. RESULTS 4 patients were enrolled. CE revealed Meckel's diverticulum in patients with different features. In case 1, CE revealed a typically double lumen sign and diaphragm sign, with visible blood. In case 2 and case 3, CE revealed a protruding lesion with/without erosion. In case 4, CE revealed multiple caved lesions, double lumen sign and capsule retention in an abnormal blind end for over 2 hours. CONCLUSION Except double lumen sign, partial disappearance of normal mucosa and capsule retention, other CE findings could be used for the diagnosis of Meckel's diverticulum, such as protruding lesion, caved lesion, solitary polyp and stenosing lesion.
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Affiliation(s)
- Lin Lin
- a Department of Gastroenterology , Beijing Shijitan Hospital Affliated to the Capital Medical University , Beijing , PR China
| | - Kuiliang Liu
- a Department of Gastroenterology , Beijing Shijitan Hospital Affliated to the Capital Medical University , Beijing , PR China
| | - Hong Liu
- a Department of Gastroenterology , Beijing Shijitan Hospital Affliated to the Capital Medical University , Beijing , PR China
| | - Jing Wu
- a Department of Gastroenterology , Beijing Shijitan Hospital Affliated to the Capital Medical University , Beijing , PR China
| | - Yaopeng Zhang
- b Department of Gastroenterology , Peking University Third Hospital , Beijing , PR China
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Wei MT, Tu CH, Chiu HM, Tseng PH, Lee YC, Chen CC, Wang HP, Wu MS. Diagnostic features of Meckel's diverticulum using single-balloon enteroscopy: A case series. ADVANCES IN DIGESTIVE MEDICINE 2018. [DOI: 10.1002/aid2.13083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Mike Tzuhen Wei
- Department of Internal Medicine; Weill Cornell Medical College; New York New York
| | - Chia-Hung Tu
- Graduate Institute of Clinical Medicine, College of Medicine; National Taiwan University; Taipei Taiwan
- Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Han-Mo Chiu
- Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Ping-Huei Tseng
- Graduate Institute of Clinical Medicine, College of Medicine; National Taiwan University; Taipei Taiwan
- Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Yi-Chia Lee
- Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Chien-Chuan Chen
- Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Hsiu-Po Wang
- Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Ming-Shiang Wu
- Graduate Institute of Clinical Medicine, College of Medicine; National Taiwan University; Taipei Taiwan
- Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
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16
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Huang TY. Balloon-assisted enteroscopy for symptomatic Meckel's diverticulum: High diagnostic accuracy and possible endoscopic intervention. ADVANCES IN DIGESTIVE MEDICINE 2018. [DOI: 10.1002/aid2.13089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tien-Yu Huang
- Division of Gastroenterology, Department of Internal Medicine; Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
- Taiwan Association for the Study of Small Intestinal Diseases; Taoyuan Taiwan
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17
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Abstract
PURPOSE OF REVIEW The objective is to provide an overview on the cause of small bowel bleeding. We discuss the role of small bowel endoscopy in the management of small bowel bleeding and provide an outline of pharmacotherapy that can be additionally beneficial. RECENT FINDINGS Small bowel capsule endoscopy (SBCE) is the initial diagnostic investigation of choice in small bowel bleeding. Computed tomography (CT) can be helpful in the context of small bowel tumours. Device-assisted enteroscopy (DAE) enables several therapeutic procedures such as argon plasma coagulation (APC) and haemoclip application. It can also guide further management with histology or by marking culprit lesions with India ink. A persistent rate of rebleeding despite APC is increasingly being reported. Pharmacotherapy has an emerging role in the management of small bowel bleeding. Somatostatin analogues are a well tolerated class of drugs that can play an additional role in the management of refractory bleeding secondary to small bowel angioectasias. SUMMARY SBCE is useful in determining the cause of small bowel bleeding. DAE offers an endoscopic therapeutic approach to small bowel bleeding replacing surgery and intraoperative enteroscopy. Pharmacotherapy, in addition to endotherapy, can play an important role in the management of multifocal, recurring bleeding small bowel lesions.
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18
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Piotuch B, Lubikowski J, Szymanik K, Wójcicki M. Mesenteric location of a perforated Meckel's diverticulum in an elderly patient with acute appendicitis: a case report. ANZ J Surg 2018; 89:E347-E349. [PMID: 29687560 DOI: 10.1111/ans.14477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 01/31/2018] [Accepted: 02/09/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Bernard Piotuch
- Department of SurgeryMinistry of the Interior and Administration Hospital Szczecin Poland
| | - Jerzy Lubikowski
- Department of General and Gastroenterological SurgeryPomeranian Medical University Szczecin Poland
| | - Krzysztof Szymanik
- Department of RadiologyMinistry of the Interior and Administration Hospital Szczecin Poland
| | - Maciej Wójcicki
- Department of SurgeryMinistry of the Interior and Administration Hospital Szczecin Poland
- Department of HepatologyWarsaw Medical University Warsaw Poland
- Department of General, Transplantation and Liver SurgeryWarsaw Medical University Warsaw Poland
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19
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Zhao L, Lu W, Sun Y, Liang J, Feng S, Shi Y, Wu Q, Wang J, Wu K. Small intestinal diverticulum with bleeding: Case report and literature review. Medicine (Baltimore) 2018; 97:e9871. [PMID: 29489685 PMCID: PMC5851745 DOI: 10.1097/md.0000000000009871] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Small intestinal diverticulum with bleeding is an important reason for obscure gastrointestinal bleeding (OGB) , in addition to tumor and vascular diseases. Small intestinal diverticulum with bleeding is difficult to detect by barium meal and angiographic methods and has been regarded as an important cause of obscure gastrointestinal tract bleeding in adolescents. Because of its complicated etiology and non-specific clinical manifestations, it is relatively difficult to detect small intestinal diverticulum with bleeding, especially in patients with a large amount of bleeding and hemodynamic instability. PATIENT CONCERNS This retrospective study collects clinical statistics of 19 patients admitted to our hospital from January 2010 to December 2016. Patients who had small intestinal diverticulum patients with bleeding were included in this study. Patients who were taking anticoagulants were excluded DIAGNOSES:: Small intestinal diverticulum patients with bleeding. INTERVENTIONS This retrospective study describes the clinical features of patients with small intestinal diverticulum whose main symptom was gastrointestinal bleeding and analyze the literature on this topic, with particular reference to the clinical characteristics, pathological features, and choice of examination methods. LESSONS Small intestinal diverticulum with bleeding is a common cause of obscure gastrointestinal bleeding, but it is difficult to detect using normal examination methods. For patients with repeated gastrointestinal bleeding and no positive results found on gastroscopy and colonoscopy, endoscopy of the small intestine and CTE with contrast can be considered as a diagnostic modality.
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Affiliation(s)
- Lifang Zhao
- Emergency Room of Digestive Diseases, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an
| | - Wei Lu
- Emergency Room of Digestive Diseases, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an
| | - Yinping Sun
- The Outpatient Internal Medicine Department of Beijing Veteran Cadre Service Administration, Central Military Commission Logistics Support Department, Beijing, China
| | - Junrong Liang
- Emergency Room of Digestive Diseases, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an
| | - Shanshan Feng
- Emergency Room of Digestive Diseases, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an
| | - Yongquan Shi
- Emergency Room of Digestive Diseases, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an
| | - Qiong Wu
- Emergency Room of Digestive Diseases, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an
| | - Jianhong Wang
- Emergency Room of Digestive Diseases, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an
| | - Kaichun Wu
- Emergency Room of Digestive Diseases, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an
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20
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Reminiscing on Remnants: Imaging of Meckel Diverticulum and Its Complications in Adults. AJR Am J Roentgenol 2017; 209:W287-W296. [PMID: 28834452 DOI: 10.2214/ajr.17.18088] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Meckel diverticulum may become symptomatic if it is complicated by hemorrhage, intestinal obstruction, diverticulitis, or tumor. Although classically described in children, it is often missed in adults because of lack of suspicion and difficulty in detection. The purpose of this article is to review the imaging findings and management of Meckel diverticulum and its complications. CONCLUSION Although it is infrequently encountered incidentally, Meckel diverticulum should be considered especially when interpreting examinations for abdominal pain, small-bowel obstruction, and gastrointestinal bleeding.
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21
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Bleeding Meckel's Diverticulum in Children: The Diagnostic Value of Double-Balloon Enteroscopy. Gastroenterol Res Pract 2017; 2017:7940851. [PMID: 28421109 PMCID: PMC5381199 DOI: 10.1155/2017/7940851] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 01/19/2017] [Indexed: 02/01/2023] Open
Abstract
Background. Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. The purpose of this study was to evaluate the diagnostic value and safety of double-balloon enteroscopy (DBE) for bleeding MD in children. Methods. We included consecutive children who were highly suspected of MD between 2012 and 2013. All patients underwent Meckel's scan. DBE was performed for patient with negative Meckel's scan. An exploratory laparoscopy was performed in children with positive Meckel's scan or DBE. Results. 42 patients met the inclusion criteria. 40 patients were confirmed to have MD by exploratory laparoscopy. Meckel's scan was positive in 36 and negative in 6, with 34 as true positives and 2 as false positives. Six patients with negative Meckel's scan were found to have MD by retrograde DBE and had immediate operation. The distance from the diverticulum to the ileocecal valve was 40 to 60 cm. Ectopic gastric mucosa was present in all 6 patients (100%). After operation, patients were followed in clinic for 20 to 42 months and no evidence of GI bleeding or recurrent anemia was observed. Conclusions. Double-balloon enteroscopy can be a reliable diagnostic tool for bleeding Meckel's diverticulum in children with negative Meckel's scan.
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22
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Inverted Meckel's Diverticulum with Intussusception and Ulceration Diagnosed after Rectal Double-Balloon Enteroscopy. ACG Case Rep J 2016; 3:e171. [PMID: 28008404 PMCID: PMC5171934 DOI: 10.14309/crj.2016.144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 05/25/2016] [Indexed: 11/17/2022] Open
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23
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Intestinal hemorrhage caused by Meckel's diverticulum with ectopic gastric mucosa on polypoid lesion: a case report. Surg Case Rep 2016; 2:124. [PMID: 27815920 PMCID: PMC5097056 DOI: 10.1186/s40792-016-0252-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 10/28/2016] [Indexed: 11/10/2022] Open
Abstract
Meckel’s diverticulum may sometimes present as an intraluminal polypoid mass causing small bowel obstruction; however, gastrointestinal bleeding due to Meckel’s diverticulum with a polypoid lesion is rare. A 14-year-old girl presented with tarry stool and syncope in our hospital. Laboratory examination showed iron-deficiency anemia with a low hemoglobin level of 5.8 g/dl. The bleeding site was detected by neither upper gastrointestinal endoscopy nor colonoscopy. Transanal double-balloon enteroscopy showed a diverticulum with an ulceration at a site approximately 50 cm from the ileocecal valve and a polypoid lesion inside of the diverticulum. Histopathological examination of a polypoid lesion revealed an ectopic gastric mucosa of the fundic type. Furthermore, technetium-99m pertechnetate scintigraphy showed a hot spot in her lower right abdomen. On the basis of these findings, she was diagnosed as having hemorrhagic Meckel’s diverticulum. Single-incision laparoscopy-assisted segmental bowel resection of the ileum was performed. The patient recovered well, and she was discharged from the hospital on postoperative day 7. She was doing well 6 months later without evidence of reoccurrence. In this report, we describe a case of Meckel’s diverticulum with a polypoid lesion; hemorrhage may have occurred owing to the ulceration of the ileal mucosa with which the polypoid lesion directly came in contact. We consider this case to be of interest to gain insight into the site and mechanism of ulceration associated with Meckel’s diverticulum.
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24
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Gomes GF, Bonin EA, Noda RW, Cavazzola LT, Bartholomei TF. Balloon-assisted enteroscopy for suspected Meckel’s diverticulum and indefinite diagnostic imaging workup. World J Gastrointest Endosc 2016; 8:679-683. [PMID: 27803776 PMCID: PMC5067476 DOI: 10.4253/wjge.v8.i18.679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/10/2016] [Accepted: 08/29/2016] [Indexed: 02/05/2023] Open
Abstract
Meckel’s diverticulum (MD) is estimated to affect 1%-2% of the general population, and it represents a clinically silent finding of a congenital anomaly in up to 85% of the cases. In adults, MD may cause symptoms, such as overt occult lower gastrointestinal bleeding. The diagnostic imaging workup includes computed tomography scan, magnetic resonance imaging enterography, technetium 99m scintigraphy (99mTc) using either labeled red blood cells or pertechnetate (known as the Meckel’s scan) and angiography. The preoperative detection rate of MD in adults is low, and many patients ultimately undergo exploratory laparoscopy. More recently, however, endoscopic identification of MD has been possible with the use of balloon-assisted enteroscopy via direct luminal access, which also provides visualization of the diverticular ostium. The aim of this study was to review the diagnosis by double-balloon enteroscopy of 4 adults with symptomatic MD but who had negative diagnostic imaging workups. These cases indicate that balloon-assisted enteroscopy is a valuable diagnostic method and should be considered in adult patients who have suspected MD and indefinite findings on diagnostic imaging workup, including negative Meckel’s scan.
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25
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Abstract
OBJECTIVE Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. Although a majority of patients remain asymptomatic, complications may occur in a subset of patients. MD is a rare cause of gastrointestinal bleeding (GIB) in adults. We aimed to clarify the possible role of capsule endoscopy (CE) in the identification of Meckel's diverticulum. PATIENTS AND METHODS From October 2004 to December 2010, 157 CEs were performed (83 male individuals, mean age 51±20 years; range 3-83 years) for obscure GIB. Before CE, all patients underwent nonconclusive upper and lower endoscopy at least two times and barium follow-through. RESULTS CE identified the source of bleeding in 70/157 patients (44.6%). MD was diagnosed in 13/70 (18.6%) patients (11 male individuals, mean age 35±20 years, range, 3-69 years) after CE. Nine patients presented with obscure overt and four with obscure occult bleeding. The mean duration of obscure GIB history was 13 months (range 1-72 months). The mean hemoglobin concentration at the time of the procedure was 115±12 g/l. The findings of MD on CE were double lumen sign (13/13), visible blood (7/13), and diaphragm sign (6/13). All patients were operated upon, and MD histologically verified in 11. In two patients CE was false-positive and in two patients, false-negative. Capsule endoscopy had a positive predictive value of 84.6% for the diagnosis of MD. CONCLUSION MD should be considered in the differential diagnosis of obscure GIB in adults. CE is an effective and promising modality for diagnosing MD in patients with obscure GIB.
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26
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Takagaki K, Osawa S, Ito T, Iwaizumi M, Hamaya Y, Tsukui H, Furuta T, Wada H, Baba S, Sugimoto K. Inverted Meckel's diverticulum preoperatively diagnosed using double-balloon enteroscopy. World J Gastroenterol 2016. [PMID: 27158212 DOI: pmid/27158212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
An inverted Meckel's diverticulum is a rare gastrointestinal congenital anomaly that is difficult to diagnose prior to surgery and presents with anemia, abdominal pain, or intussusception. Here, we report the case of 57-year-old men with an inverted Meckel's diverticulum, who was preoperatively diagnosed using double-balloon enteroscopy. He had repeatedly experienced epigastric pain for 2 mo. Ultrasonography and computed tomography showed intestinal wall thickening in the pelvis. Double-balloon enteroscopy via the anal route was performed for further examination, which demonstrated an approximately 8-cm, sausage-shaped, submucosal tumor located approximately 80 cm proximal to the ileocecal valve. A small depressed erosion was observed at the tip of this lesion. Forceps biopsy revealed heterotopic gastric mucosa. Thus, the patient was diagnosed with an inverted Meckel's diverticulum, and single-incision laparoscopic surgery was performed. This case suggests that an inverted Meckel's diverticulum should be considered as a differential diagnosis for a submucosal tumor in the ileum. Balloon-assisted enteroscopy with forceps biopsy facilitate a precise diagnosis of this condition.
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Affiliation(s)
- Kosuke Takagaki
- Kosuke Takagaki, Tatsuhiro Ito, Moriya Iwaizumi, Yasushi Hamaya, Ken Sugimoto, First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Satoshi Osawa
- Kosuke Takagaki, Tatsuhiro Ito, Moriya Iwaizumi, Yasushi Hamaya, Ken Sugimoto, First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Tatsuhiro Ito
- Kosuke Takagaki, Tatsuhiro Ito, Moriya Iwaizumi, Yasushi Hamaya, Ken Sugimoto, First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Moriya Iwaizumi
- Kosuke Takagaki, Tatsuhiro Ito, Moriya Iwaizumi, Yasushi Hamaya, Ken Sugimoto, First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Yasushi Hamaya
- Kosuke Takagaki, Tatsuhiro Ito, Moriya Iwaizumi, Yasushi Hamaya, Ken Sugimoto, First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Hiroe Tsukui
- Kosuke Takagaki, Tatsuhiro Ito, Moriya Iwaizumi, Yasushi Hamaya, Ken Sugimoto, First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Takahisa Furuta
- Kosuke Takagaki, Tatsuhiro Ito, Moriya Iwaizumi, Yasushi Hamaya, Ken Sugimoto, First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Hidetoshi Wada
- Kosuke Takagaki, Tatsuhiro Ito, Moriya Iwaizumi, Yasushi Hamaya, Ken Sugimoto, First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Satoshi Baba
- Kosuke Takagaki, Tatsuhiro Ito, Moriya Iwaizumi, Yasushi Hamaya, Ken Sugimoto, First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Ken Sugimoto
- Kosuke Takagaki, Tatsuhiro Ito, Moriya Iwaizumi, Yasushi Hamaya, Ken Sugimoto, First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
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Takagaki K, Osawa S, Ito T, Iwaizumi M, Hamaya Y, Tsukui H, Furuta T, Wada H, Baba S, Sugimoto K. Inverted Meckel’s diverticulum preoperatively diagnosed using double-balloon enteroscopy. World J Gastroenterol 2016; 22:4416-4420. [PMID: 27158212 PMCID: PMC4853701 DOI: 10.3748/wjg.v22.i17.4416] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 01/22/2016] [Accepted: 02/22/2016] [Indexed: 02/06/2023] Open
Abstract
An inverted Meckel’s diverticulum is a rare gastrointestinal congenital anomaly that is difficult to diagnose prior to surgery and presents with anemia, abdominal pain, or intussusception. Here, we report the case of 57-year-old men with an inverted Meckel’s diverticulum, who was preoperatively diagnosed using double-balloon enteroscopy. He had repeatedly experienced epigastric pain for 2 mo. Ultrasonography and computed tomography showed intestinal wall thickening in the pelvis. Double-balloon enteroscopy via the anal route was performed for further examination, which demonstrated an approximately 8-cm, sausage-shaped, submucosal tumor located approximately 80 cm proximal to the ileocecal valve. A small depressed erosion was observed at the tip of this lesion. Forceps biopsy revealed heterotopic gastric mucosa. Thus, the patient was diagnosed with an inverted Meckel’s diverticulum, and single-incision laparoscopic surgery was performed. This case suggests that an inverted Meckel’s diverticulum should be considered as a differential diagnosis for a submucosal tumor in the ileum. Balloon-assisted enteroscopy with forceps biopsy facilitate a precise diagnosis of this condition.
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28
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Ileal stricture following Meckel's diverticulitis: a rare cause of intestinal obstruction. Clin J Gastroenterol 2016; 9:118-23. [PMID: 27146826 DOI: 10.1007/s12328-016-0647-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/23/2016] [Indexed: 12/21/2022]
Abstract
We report a very rare case of Meckel's diverticulitis with ileal stricture at the base of the diverticulum in a young adult as a cause of recurrent small bowel obstruction lasting for 7 years. None of the pre-operative investigations were able to diagnose the cause of obstruction. The patient had undergone appendicectomy 3 years ago but without any relief. Thereafter he was given a therapeutic trial of anti-tubercular drugs, but his symptoms rather worsened with this treatment. Finally, the diagnosis of Meckel's diverticulitis with ileal stricture was made on exploratory laparotomy. The patient recovered well following segmental ileal resection including the stricture and inflamed Meckel's diverticulum. This unusual case highlights that such a rare clinical entity should be considered as a differential diagnosis while dealing with cases of recurrent distal ileal obstruction so as to avoid misdiagnosis and mismanagement as happened in the present case.
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Pattni V, Wright K, Marden P, Terlevich A. Meckel's diverticulum in an adult: an obscure presentation of gastrointestinal bleeding. BMJ Case Rep 2016; 2016:bcr-2015-213852. [PMID: 27126093 DOI: 10.1136/bcr-2015-213852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A 17-year-old boy, with a background of haemophilia A, presented to hospital with an episode of brisk and painless per rectal (PR) bleeding. Initial investigation with gastroscopy and colonoscopy revealed no source of bleeding. Examination of the small bowel including MRI, CT angiogram and capsule endoscopy revealed no abnormalities. Double balloon enteroscopy (DBE) from an antegrade position was attempted, with no abnormalities noted. The symptoms persisted and DBE was attempted again from a retrograde approach and a diverticulum was subsequently noted. Laparoscopic surgery was performed identifying a diverticulum as the source of bleeding, 110 cm from the ileocaecal valve, which is more proximal than is normally seen. Histological examination revealed a Meckel's diverticulum. The case described here, although more unusual in adults, demonstrates that complete visualisation of the small bowel remains challenging and that newer modalities of enteroscopy including DBE can help aid in the diagnosis of obscure gastrointestinal bleeding.
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Affiliation(s)
- Vijay Pattni
- Department of Gastroenterology, Southmead Hospital, Bristol, UK
| | - Kathryn Wright
- Department of Gastroenterology, Southmead Hospital, Bristol, UK
| | - Peter Marden
- Department of Gastroenterology, Southmead Hospital, Bristol, UK
| | - Ana Terlevich
- Department of Gastroenterology, Southmead Hospital, Bristol, UK
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Abstract
OPINION STATEMENT The small bowel is a challenging area for endoscopic evaluation and therapy due to its length and angulated configuration. A small lumen diameter and segmental peristalsis made it a perfect fit for examination by a novel ingestible wireless camera in a capsule. The development of capsule endoscopy changed the diagnosis and management of bleeding lesions, ulcers, and tumors deep in the small bowel, allowing earlier diagnosis with excellent patient acceptance. Device-assisted enteroscopy revolutionized small bowel therapy, particularly management of bleeding, Peutz-Jeghers polyposis, and tumor marking for minimally invasive surgery. Small bowel stricture dilation in select patients is safe and effective. Tools for a spectrum of small bowel therapies are available but remain suboptimal to tackle lesions on angulated folds deep in the small bowel. Universal terminology to describe the endoscopic appearance of vascular lesions will facilitate studies of endoscopic and medical therapy. The future holds improvements in imaging, easier advancement through the small bowel, and therapeutic capacity. This review focuses on methods of small bowel endoscopy, therapy, and outcomes.
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Affiliation(s)
- Dejan Micic
- Division of Gastroenterology, Hepatology and Nutrition, University of Chicago, 5841 South Maryland Avenue, S401 MC 4080, Chicago, IL, 60637, USA
| | - Carol E Semrad
- Division of Gastroenterology, Hepatology and Nutrition, University of Chicago, 5841 South Maryland Avenue, S401 MC 4080, Chicago, IL, 60637, USA.
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Abstract
The small intestine is a complex organ system that is vital to the life of the individual. There are a number of congenital anomalies that occur and present most commonly in infancy; however, some may not present until adulthood. Most congenital anomalies of the small intestine will present with obstructive symptoms while some may present with vomiting, abdominal pain, and/or gastrointestinal bleeding. Various radiologic procedures can aid in the diagnosis of these lesions that vary depending on the particular anomaly. Definitive therapy for these congenial anomalies is surgical, and in some cases, surgery needs to be performed urgently. The overall prognosis of congenital anomalies of the small intestine is very good and has improved with improved medical management and the advent of newer surgical modalities. The congenital anomalies of the small intestine reviewed in this article include malrotation, Meckel's diverticulum, duodenal web, duodenal atresia, jejunoileal atresia, and duplications.
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Affiliation(s)
- Grant Morris
- Department of Pediatrics, Geisinger Clinic, 100 N. Academy Avenue, Danville, PA, 17822, USA
| | - Alfred Kennedy
- Department of Pediatric Surgery, Geisinger Clinic, 100 N. Academy Avenue, Danville, PA, 17822, USA
| | - William Cochran
- Department of Pediatric Gastroenterology, Geisinger Clinic, 100 N. Academy Avenue, Danville, PA, 17822, USA.
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Qi S, Huang H, Wei D, Lv C, Yang Y. Diagnosis and minimally invasive surgical treatment of bleeding Meckel's diverticulum in children using double-balloon enteroscopy. J Pediatr Surg 2015; 50:1610-2. [PMID: 26059237 DOI: 10.1016/j.jpedsurg.2015.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 05/06/2015] [Accepted: 05/13/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND/PURPOSE To demonstrate the diagnosis of bleeding Meckel's diverticulum (MD) using double-balloon enteroscopy (DBE) and to highlight the utility of this technique for guidance in minimally invasive surgery. MATERIALS AND METHODS From August 2011 to September 2014, 21 pediatric patients with bloody diarrhea underwent transanal DBE examinations. When a lesion such as MD or a tumor was detected, the enteroscopic light source was brought as close to the umbilicus as possible. A small incision was made at the umbilicus, and the lesion indicated by the enteroscopic light source was pulled out of the umbilicus for lesion removal and intestinal anastomosis. If no lesion was detected, the DBE exam was ended after the scope had been advanced at least 200 cm into the ileum. All patients were followed closely after discharge. RESULTS Fourteen children were diagnosed with MD and underwent successful removal via an umbilical incision using enteroscopic light guidance; a standard resection was then performed. Two patients were diagnosed with lymphoma and successfully treated using the same method. Five patients had negative enteroscopic findings. Of these, a 4-year-old boy had recurrent bloody diarrhea and a negative laparoscopic evaluation after 7 months. In 4 patients, bloody diarrhea did not recur during follow-up. CONCLUSIONS DBE is an ideal tool for the diagnosis and minimally invasive treatment of bleeding MD in children.
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Affiliation(s)
- Shiqin Qi
- Department of Pediatric Surgery, Anhui Provincial Children's Hospital, Hefei 230053, China.
| | - He Huang
- Department of Pediatric Surgery, Anhui Provincial Children's Hospital, Hefei 230053, China
| | - Decheng Wei
- Department of Pediatric Surgery, Anhui Provincial Children's Hospital, Hefei 230053, China
| | - Chengchao Lv
- Department of Pediatric Surgery, Anhui Provincial Children's Hospital, Hefei 230053, China
| | - Yong Yang
- Department of Pediatric Surgery, Anhui Provincial Children's Hospital, Hefei 230053, China
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A Rare Cause of Acute Abdomen: Perforation of Double Meckel's Diverticulum. Case Rep Gastrointest Med 2015; 2015:648417. [PMID: 26266061 PMCID: PMC4525454 DOI: 10.1155/2015/648417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 06/01/2015] [Accepted: 06/09/2015] [Indexed: 12/29/2022] Open
Abstract
Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. In this report, we aimed to represent a case of intestinal perforation, caused by double Meckel's diverticulum, which is a very rare entity in surgical practice. The patient was a 20-year-old Caucasian man, admitted to hospital with complaints of abdominal pain, nausea, and vomitting during the last 3 days. Physical examination indicated tenderness, rebound, and guarding in the right lower quadrant of abdomen. Abdominal X-ray revealed a few air-liquid levels in the left upper quadrant. In the operation, 2 Meckel's diverticula were observed, one at the antimesenteric side, at 70 cm distance to the ileocecal valve, approximately in 3 cm size, and the other between the mesenteric and antimesenteric sides, approximately in 5 cm size. The first one had been perforated at the tip and wrapped with omentum. A 30 cm ileal resection, including both diverticula with end-to-end anastomosis, was performed. The diagnosis of symptomatic Meckel's diverticulum is considerably hard, especially when it is complicated. Diverticulectomy or segmentary resections are therapeutic options. In patients with acute abdomen clinic, Meckel's diverticulum and its complications should be kept in mind, and the intestines should be observed for an extra diverticulum for caution although it is a very rare condition.
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