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Thorndal C, Selnes O, Lei II, Schostek S, Koulaouzidis A. Retention of endoscopic capsules in diverticula: Literature review of a capsule endoscopy rarity. Endosc Int Open 2024; 12:E788-E796. [PMID: 38904054 PMCID: PMC11188752 DOI: 10.1055/a-2320-7104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 04/05/2024] [Indexed: 06/22/2024] Open
Abstract
Background and study aims This review aimed to provide an updated and comprehensive review of capsule retention within diverticula, shedding light on the characteristics and management of this rare event in capsule endoscopy. Methods A systematic literature search was conducted across multiple databases. All observational studies that reported capsule retention in a diverticulum among complication and outcomes, as well as case reports and series, were included. Manual cross-checking of references was also performed. Two extractors performed abstract and full-text reviews, as well as data-extraction. Results We found 167 references from Pubmed, Embase, and Web Of Science. Sixty-five duplicates were removed and another 71 references were excluded. Crosschecking of references found additional two articles. In total, 32 articles were included, resulting in a total of 34 cases of retained capsules in diverticula. The median age was 69 and the majority of the patients were male (76.5%). The most common retention occurred in Meckel's diverticulum (32.4%) followed by Zenker's diverticulum (20.6%). Investigation of capsule retention was done with x-ray (50%) and computed tomography (CT) scan (44.1%). Seventeen cases (50%) were asymptomatic. Resolution of the retention happened with endoscopy (35.3%) and surgical management (32.4%), as well as self-resolution (20.6%). Conclusions Due to the small number of cases, diverticula are not a risk factor for incomplete capsule endoscopy examination. It affects mainly elderly, male, asymptomatic patients, and typically is diagnosed with x-rays and CT scans. The most common type is Meckel's diverticulum, and endoscopy is the primary management. Capsule endoscopy retentions are extremely rare, with only 34 cases reported since the technology's introduction.
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Affiliation(s)
- Camilla Thorndal
- Surgical Research Unit, Odense University Hospital, Odense, Denmark
| | - Ola Selnes
- Surgical Research Unit, Odense University Hospital, Odense, Denmark
| | - Ian Io Lei
- University Hospital of Coventry and Warwickshire, Coventry, United Kingdom of Great Britain and Northern Ireland
| | | | - Anastasios Koulaouzidis
- Surgical Research Unit, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Odense University Hospital, Svendborg, Denmark
- Department of Social Medicine and Public Health, Pomeranian Medical University, Szczecin, Poland
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2
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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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3
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Ajagbe O, Okor M, Ojediran O, Dada O, Ayandipo O, Ajani M. INTESTINAL OBSTRUCTION FROM MECKEL'S DIVERTICULUM IN AN ADULT; UNSUSPECTED BUT FOUND- A CASE REPORT. Ann Ib Postgrad Med 2023; 21:84-88. [PMID: 38298334 PMCID: PMC10811716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/30/2023] [Indexed: 02/02/2024] Open
Abstract
Introduction Most cases of Meckel's Diverticulum (MD) are asymptomatic and when symptomatic, preoperative diagnosis of MD maybe a dilemma. Intestinal obstruction is a major complication in the adult population. Case presentation We report a case of a 24-year-old female presenting with intestinal obstruction from Meckels Diverticulum. Conclusion MD is largely asymptomatic in adults, however may be present and should be included in our array of differential diagnoses.
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Affiliation(s)
- O.A Ajagbe
- Department of Surgery, University College Hospital, Ibadan, Nigeria
| | - M.C Okor
- Department of Surgery, University College Hospital, Ibadan, Nigeria
| | - O.T Ojediran
- Department of Surgery, University College Hospital, Ibadan, Nigeria
| | - O.E Dada
- Department of Surgery, University College Hospital, Ibadan, Nigeria
| | - O.O Ayandipo
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - M.A Ajani
- Department of Pathology, College of Medicine, University of Ibadan, Ibadan, Nigeria
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4
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Hariharan A, Amin S, Munankami S, Shrestha M, Altomare J. Symptomatic Meckel's Diverticulum Presenting As Recurrent Gastrointestinal Bleeding in an Adult. Cureus 2023; 15:e41723. [PMID: 37575711 PMCID: PMC10414796 DOI: 10.7759/cureus.41723] [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: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
A 51-year-old male presented to the hospital with recurrent gastrointestinal bleeding. Prior work up with an esophagogastroduodenoscopy (EGD), colonoscopy, and video capsule endoscopy failed to reveal a bleeding source. Given a history of a terminal ileum diverticulum noted on previous colonoscopy and persistence of hematochezia, a Meckel's scan was performed, which revealed abnormal uptake suspicious for a Meckel's diverticulum containing ectopic gastric mucosa. After surgical resection, pathology confirmed a Meckel's diverticulum with gastric heterotopia. This case highlights the importance of considering Meckel's diverticulum for instances of recurrent gastrointestinal bleeding, especially in patients who are still symptomatic despite an extensive workup. Moreover, it is important to note that a Meckel's diverticulum can be missed on video capsule endoscopy.
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Affiliation(s)
| | - Shefali Amin
- Internal Medicine, Tower Health Medical Group, West Reading, USA
| | | | - Manish Shrestha
- Internal Medicine, Tower Health Medical Group, West Reading, USA
| | - John Altomare
- Gastroenterology, Tower Health Medical Group, West Reading, USA
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5
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Baltes P, Dray X, Riccioni ME, Pérez-Cuadrado-Robles E, Fedorov E, Wiedbrauck F, Chetcuti Zammit S, Cadoni S, Bruno M, Rondonotti E, Johansson GW, Mussetto A, Beaumont H, Perrod G, McNamara D, Plevris J, Spada C, Pinho R, Rosa B, Hervas N, Leenhardt R, Marmo C, Esteban-Delgado P, Ivanova E, Keuchel M. Small-bowel capsule endoscopy in patients with Meckel's diverticulum: clinical features, diagnostic workup, and findings. A European multicenter I-CARE study. Gastrointest Endosc 2022; 97:917-926.e3. [PMID: 36572128 DOI: 10.1016/j.gie.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/29/2022] [Accepted: 12/14/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Meckel's diverticulum (MD) may remain silent or be associated with adverse events such as GI bleeding. The main aim of this study was to evaluate indicative small-bowel capsule endoscopy (SBCE) findings, and the secondary aim was to describe clinical presentation in patients with MD. METHODS This retrospective European multicenter study included patients with MD undergoing SBCE from 2001 until July 2021. RESULTS Sixty-nine patients with a confirmed MD were included. Median age was 32 years with a male-to-female ratio of approximately 3:1. GI bleeding or iron-deficiency anemia was present in nearly all patients. Mean hemoglobin was 7.63 ± 1.8 g/dL with a transfusion requirement of 52.2%. Typical capsule endoscopy (CE) findings were double lumen (n = 49 [71%]), visible entrance into the MD (n = 49 [71%]), mucosal webs (n = 30 [43.5%]), and bulges (n = 19 [27.5%]). Two or more of these findings were seen in 48 patients (69.6%). Ulcers were detected in 52.2% of patients (n = 36). In 63.8% of patients (n = 44), a combination of double lumen and visible entrance into the MD was evident, additionally revealing ulcers in 39.1% (n = 27). Mean percent SB transit time for the first indicative image of MD was 57% of the total SB transit time. CONCLUSIONS Diagnosis of MD is rare and sometimes challenging, and a preoperative criterion standard does not exist. In SBCE, the most frequent findings were double-lumen sign and visible diverticular entrance, sometimes together with ulcers.
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Affiliation(s)
- Peter Baltes
- Clinic for Internal Medicine, Agaplesion Bethesda Krankenhaus Bergedorf, Hamburg, Germany.
| | - Xavier Dray
- Sorbonne University, Centre for Digestive Endoscopy, Hospital Saint Antoine, APHP, Paris, France
| | - Maria Elena Riccioni
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Evgeny Fedorov
- Department of Surgical Gastroenterology and Endoscopy, Moscow University Hospital N31, Pirogov Russia National Research Medical University, Moscow, Russian Federation
| | - Felix Wiedbrauck
- Department of Gastroenterology, Allgemeines Krankenhaus Celle, Celle, Germany
| | | | - Sergio Cadoni
- Digestive Endoscopy Unit, CTO Hospital, Iglesias, Italy
| | - Mauro Bruno
- University Division of Gastroenterology, University Hospital City of Science and Health Turin, Turin, Italy
| | | | | | | | - Hanneke Beaumont
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Guillaume Perrod
- Department of Gastroenterology, Georges Pompidou European Hospital, Paris, France
| | - Deirdre McNamara
- Department of Gastroenterology, Tallaght University Hospital and School of Medicine Trinity College Dublin, Dublin, Ireland
| | - John Plevris
- Endoscopy Unit, The Royal Infirmary of Edinburgh, University of Edinburgh, Scotland
| | - Cristiano Spada
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy; Digestive Endoscopy Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Rolando Pinho
- Gastroenterology Department, Vila Nova de Gaia/Espinho-Hospital Centre, Vila Nova de Gaia, Portugal
| | - Bruno Rosa
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Nerea Hervas
- Department of Gastroenterology, Complejo Hospitalario Navarra, Pamplona, Spain
| | - Romain Leenhardt
- Sorbonne University, Centre for Digestive Endoscopy, Hospital Saint Antoine, APHP, Paris, France
| | - Clelia Marmo
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Ekaterina Ivanova
- Department of Surgical Gastroenterology and Endoscopy, Moscow University Hospital N31, Pirogov Russia National Research Medical University, Moscow, Russian Federation
| | - Martin Keuchel
- Clinic for Internal Medicine, Agaplesion Bethesda Krankenhaus Bergedorf, Hamburg, Germany; Clinic for Gastroenterology, Asklepios Klinik Altona, Hamburg, Germany
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Bhattarai HB, Bhattarai M, Shah S, Singh A, Yadav SK, Yadav BK, Uprety M, Subedi A, Singh PB, Priya A. Meckel's diverticulum causing acute intestinal obstruction: A case series. Clin Case Rep 2022; 10:e6518. [PMID: 36381041 PMCID: PMC9637932 DOI: 10.1002/ccr3.6518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/23/2022] [Accepted: 10/09/2022] [Indexed: 11/09/2022] Open
Abstract
Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. Most cases are asymptomatic and when symptomatic, preoperative diagnosis of MD is poor. Intestinal obstruction, Malena or hematochezia, and inflammation are major symptoms. We report three cases of 18-month, 2-year, and 9-year old male patients presenting with intestinal obstruction.
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Affiliation(s)
| | | | - Sangam Shah
- Institute of MedicineTribhuvan UniversityMaharajgunjNepal
| | | | | | | | - Manish Uprety
- Kathmandu University of Medical SciencesKathmanduNepal
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7
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Capsule Retention in Meckel's Diverticulum During Evaluation for Iron Deficiency Anemia. ACG Case Rep J 2022; 9:e00797. [PMID: 35784508 PMCID: PMC9246081 DOI: 10.14309/crj.0000000000000797] [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: 09/19/2021] [Accepted: 02/23/2022] [Indexed: 11/30/2022] Open
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Trucco I, Guido V, Alvite J, Duffau A, Reyes S, Olano C. Diagnosis of Meckel's diverticulum at the age of 54 by capsule endoscopy. Endoscopy 2022; 54:E372-E373. [PMID: 34374057 DOI: 10.1055/a-1540-6595] [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: 12/10/2022]
Affiliation(s)
- Ines Trucco
- Clínica de Gastroenterología, Universidad de la Republica, Montevideo, Uruguay
| | - Veronica Guido
- Clínica de Gastroenterología, Universidad de la Republica, Montevideo, Uruguay
| | - José Alvite
- Clínica de Gastroenterología, Universidad de la Republica, Montevideo, Uruguay
| | | | | | - Carolina Olano
- Clínica de Gastroenterología, Universidad de la Republica, Montevideo, Uruguay
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9
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Differentiation of Isolated Small Bowel Crohn’s Disease from Other Small Bowel Ulcerative Diseases: Clinical Features and Double-Balloon Enteroscopy Characteristics. Gastroenterol Res Pract 2022; 2022:5374780. [PMID: 35677723 PMCID: PMC9170512 DOI: 10.1155/2022/5374780] [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: 12/23/2021] [Accepted: 05/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background. The diagnosis of isolated small bowel Crohn’s disease (ISBCD) has always been challenging. Aims. This study is aimed at comparing the clinical features and double-balloon enteroscopy (DBE) characteristics of ISBCD with those of other small bowel ulcerative diseases (OSBUD). Methods. Patients with coexisting colonic and/or ileal valve lesions (
) or whose final diagnosis was not determined (
) were excluded. One hundred thirty-nine patients with ISBCD and 62 patients with OSBUD found by DBE were retrospectively analyzed. Results. The age of ISBCD onset was lower than that of OSBUD (OR 0.957, 95% CI 0.938-0.977,
). Abdominal pain was more common in ISBCD (OR 4.986, 95% CI 2.539-9.792,
). Elevated fibrinogen levels (OR 1.431, 95% CI 1.022-2.003,
) and lower levels of D-dimer (OR 0.999, 95% CI 0.999-1.000,
) were also more supportive of the diagnosis of ISBCD. Nonsteroidal anti-inflammatory drugs (NSAIDs) used for more than two weeks decreased the probability of a diagnosis of ISBCD (OR 0.173, 95% CI 0.043-0.695,
). Abdominal computed tomography revealed a higher proportion of skip lesions in ISBCD than in OSBUD (OR 9.728, 95% CI 3.676-25.742,
). The ulcers of ISBCD were more distributed in the ileum (111 (79.9%) vs. 29 (46.8%),
), and their main morphology differed in different intestinal segments. Longitudinal ulcers (OR 14.293, 95% CI 4.920-41.518,
) and large ulcer (OR 0.128, 95% CI 0.044-0.374,
) contributed to the differentiation of ISBCD from OSBUD. We constructed a diagnostic model, ISBCD index (
, 95% CI: 0.830-0.925), using multifactorial binary logistic regression to help distinguish between these two groups of diseases. Conclusion. Clinical features, laboratory tests, abdominal computed tomography, DBE characteristics, and pathology help to distinguish ISBCD from OSBUD.
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Wu J, Huang Z, Wu H, Ji M, Wang Y, Tang Z, Huang Y. The diagnostic value of video capsule endoscopy for Meckel's diverticulum in children. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 112:429-433. [PMID: 32450705 DOI: 10.17235/reed.2020.6708/2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract and is also an important cause of bloody stool and anemia in children. However, there are few data about video capsule endoscopy (VCE) for MD in children. This study aimed to evaluate the diagnostic value of VCE for MD in children. MATERIALS AND METHODS children who underwent VCE for obscure gastrointestinal bleeding from October 1st 2015 to August 31st 2019 at the Children's Hospital of Fudan University were included in this retrospective study. Medical data, VCE data and Meckel's scans, etc. were collected for each patient. RESULTS sixteen patients were diagnosed with MD by VCE, including 13 males and 3 females. The age of the patients ranged from 4 years to 13 years, with an average of 7.8 ± 2.7 years. Lower gastrointestinal tract bleeding was the main symptom for patients with MD, including hematochezia (75 %) and melena (25 %). Of the VCE findings, 14 patients had double lumen signs and 2 showed protruding lesions. Among the 16 patients diagnosed with MD by VCE, 14 patients were diagnosed with MD by Meckel's scan, 3 with MD by abdominal enhanced CT and 14 patients were diagnosed with MD by surgery. During the follow-up, bleeding occurred sporadically in patient 12 and the reason is still unknown. CONCLUSIONS VCE is useful for the diagnosis of MD and should be used as a valuable and less invasive examination to confirm or establish a diagnosis.
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Affiliation(s)
- Jie Wu
- Gastroenterology, Children's Hospital of Fudan University
| | - Zhiheng Huang
- Gastroenterology, Children's Hospital of Fudan University,
| | - Ha Wu
- Nuclear Medicine, Children's Hospital of Fudan University
| | - Min Ji
- Radiology, Children's Hospital of Fudan University
| | - Yuhuan Wang
- Gastroenterology, Children's Hospital of Fudan University
| | - Zifei Tang
- Gastroenterology, Children's Hospital of Fudan University
| | - Ying Huang
- Gastroenterology, Children's Hospital of Fudan University
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Abstract
PURPOSE OF REVIEW Increasing use of small bowel endoscopy unravels ulcers in a relevant number of patients. Although often attributed to inflammatory bowel disease (IBD), these ulcers may be unspecific or caused by a variety of other diseases. This review summarizes the recent literature related to differential diagnosis of small bowel ulcers. RECENT FINDINGS NSAID enteropathy is the major differential diagnosis to IBD in patients with small bowel ulcers. Intestinal tuberculosis must be considered in patients at risk. Rare causes for small bowel ulcers are autoinflammatory, neoplastic, vascular diseases, or nontuberculous infections. Morphology of small bowel ulcers cannot provide a reliable differentiation, and even histology is not specific in all cases. History with special focus on NSAID medication and clinical symptoms not typical for IBD, laboratory tests in the search of systemic disease, and microbiologic testing of biopsies can be helpful. Genetic testing allows identification of few rare entities like defects in prostaglandin metabolism. SUMMARY Due to a massive overlap in the endoscopic appearance of small bowel ulcers between possible causes, diagnosis should be based on broad information also including history, histology, imaging, and laboratory tests.
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