Lower gastrointestinal bleeding is a common complication of
Meckel’s diverticulum. Its location within the small bowel, usually 2
feet (60 cm) from the ileocecal valve, makes it difficult to study and
not easily accessible with a traditional endoscope. The use of multiple
diagnostic modalities may give a false negative result, and capsule endoscopy
can be an alternative procedure. In young children, who are not able to swallow
the capsule, the capsule can be delivered via gastroscopy with an overtube,
with the patient under intravenous anesthesia [1].
Reported complication rates of capsule endoscopy (retention of capsule in
stomach and intestine) have ranged from 0.3 % to
20 % [1]
[2].
Retention may necessitate endoscopic retrieval or surgical removal
[1], or observation may suffice so long as the patient is
asymptomatic. Endoscopy may showed the presence of a false lumen
[3], a diverticular-like orifice [4], or a blood-filled structure [5].
We report the case of a 15-year-old male patient referred to our department
with recurrent lower gastrointestinal bleeding with a hemoglobin concentration
of 5 gm/L. He had several diagnostic examinations including computed
tomography and magnetic resonance imaging of the abdomen, colonoscopy,
Meckel’s scan (technetium 99 m pertechnetate) and red blood cell
scan which detected no relevant abnormality. A wireless video capsule endoscopy
study revealed a polyp-like lesion, secondary to everted diverticular mucosa,
protruding from a false lumen presenting as a dark halo zone in the mid portion
of the small bowel ([Fig. 1 a]), 4.5 hours
after capsule introduction, with oozing of blood on a picture taken a few
minutes later ([Fig. 1 b]). An exploratory
laparotomy was performed and a Meckel’s diverticulum with a palpable mass
([Fig. 1 c]) was found. Segmental resection
of the bowel was performed. Examination of the specimen revealed everted
diverticular mucosa ([Fig. 1 d]), which is
compatible with the capsule endoscopic finding ([Fig. 1 a]). An intraoperative finding of
Meckel’s diverticulum with early examination of the surgical specimen can
avoid further unnecessary palpatory and endoscopic exploration of the entire
small bowel.
Fig. 1 a Capsule endoscopy
showed a protruding polyp-like lesion from the lumen with blood oozing (b, white arrow). c Surgical finding
showed a Meckel’s diverticulum with a palpable mass (black arrow), and
the cut section of the resected small bowel with Meckel’s diverticulum
showed protruding everted diverticular mucosa (d).
Endoscopy_UCTN_Code_CCL_1AC_2AF
