© Georg Thieme Verlag KG Stuttgart · New York
Capsule endoscopic detection of bleeding Meckel’s diverticulum, with capsule retention in the diverticulum
15 September 2010 (online)
A 20-year-old man was admitted to hospital with episodes of passing painless bloody stools and syncope. When he arrived, he was in a state of shock with severe dehydration. Laboratory data showed a hemoglobin (Hb) level of 8.6 g/dL. Esophagogastroduodenoscopy and colonoscopy did not show the cause of bleeding.
Capsule endoscopy (PillCam SB 2; Given Imaging, Yoqneam, Israel) was then carried out. The video sequence showed a stenotic structure of the lower ileum and shallow ulcers with oozing on the edge of the stenosis ([Fig. 1]).
Fig. 1 Video capsule endoscopy demonstrating stenotic lumen and shallow ulcers with oozing at the edge of the stenosis.
Gradually, the area around the capsule filled with blood, and the capsule stayed in exactly the same position for the last 3.5 hours of the battery’s life.
To confirm the diagnosis and collect the capsule, enteroscopy with a double-balloon enteroscope (EN-450P5/20; Fujinon, Saitama, Japan) was performed under fluoroscopic guidance via the anal route 1 day after capsule endoscopy. A large diverticulum, in which there was a shallow ulcer and with stenosis in the middle, was found about 60 cm proximal to the ileocecal valve ([Fig. 2 a]).
Fig. 2 a Double-balloon enteroscopy looking down the diverticulum about 60 cm proximal to the ileocecal valve. b The capsule is retained at the bottom of the diverticulum, and a shallow ulcer is on the edge of the stenosis.
Fig. 3 a Contrast material was injected during double-balloon enteroscopy. The capsule appears in the diverticulum. b The diverticulum is clearly revealed through a fluoroscope by the double-contrast method with barium and air, and is approximately 10 × 4 cm.
A 10 × 4-cm diverticulum was clearly indicated through a fluoroscope by the double-contrast method with barium and air ([Fig. 3 b]). The diameter of the stenotic lumen was approximately 9 mm. The diagnosis of a Meckel’s diverticulum was made.
A 10 × 4-cm inflamed Meckel’s diverticulum approximately 60 cm distal to the ileocecal valve was confirmed on later laparotomic diverticulectomy ([Fig. 4]).
Fig. 4 A 10 × 4-cm inflamed Meckel’s diverticulum approximately 60 cm distal to the ileocecal valve was confirmed on later laparotomic diverticulectomy.
The resected specimen confirmed the presence of inflamed, congested small-bowel mucosa with focal ulceration within the diverticulum penetrating all layers of the bowel wall. The postoperative course was uneventful.
Competing interests: None
- 1 Mylonaki M, MacLean D, Fritscher-Ravens A, Swain P. Wireless capsule endoscopic detection of Meckel’s diverticulum after nondiagnostic surgery. Endoscopy. 2002; 34 1018-1020
- 2 Moon J H, Park C H, Kim J H. et al . Meckel’s diverticulum bleeding detected by capsule endoscopy. Gastrointest Endosc. 2006; 63 702-703
- 3 Shelton J H, Newsome T W, Ford III K L. et al . Inverted Meckel’s diverticulum presenting as iron deficiency anemia. Endoscopy. 2006; 38 E93-E94
- 4 Sy E D, Chen M D, Yang Y J. et al . Obscure gastrointestinal bleeding due to Meckel’s diverticulum: unusual capsule endoscopic findings as polyp-like lesion. Endoscopy. 2008; 40 E203
- 5 Yu W K, Yang R D. M2A video capsule lodged in the Meckel’s diverticulum. Gastrointest Endosc. 2006; 63 1071-1072
Y. Tanaka, MD
Department of Gastroenterology
Aso Iizuka Hospital