Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Oct 16, 2016; 8(18): 679-683
Published online Oct 16, 2016. doi: 10.4253/wjge.v8.i18.679
Balloon-assisted enteroscopy for suspected Meckel’s diverticulum and indefinite diagnostic imaging workup
Guilherme Francisco Gomes, Eduardo Aimore Bonin, Rafael William Noda, Leandro Totti Cavazzola, Thiago Ferreira Bartholomei
Guilherme Francisco Gomes, Eduardo Aimore Bonin, Rafael William Noda, Thiago Ferreira Bartholomei, Endoscopy Unit, Nossa Senhora das Graças Hospital, Curitiba 81830, Brazil
Leandro Totti Cavazzola, Universidade Federal do Rio Grande do Sul, Porto Alegre 91740, Brazil
Author contributions: Gomes GF, Bonin EA and Bartholomei TF acquired the data and wrote and revised the manuscript; Noda RW and Cavazzola LT contributed to writing and revising the manuscript.
Institutional review board statement: This case report is exempt from Institutional review board standards.
Informed consent statement: The patients involved in this study gave written informed consent authorizing use and disclosure of their protected health information.
Conflict-of-interest statement: All the authors have no conflicts of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Guilherme Francisco Gomes, MD, Endoscopy Unit, Nossa Senhora das Graças Hospital, Rua Mon Ivo Zanlorenzi, 1850 CEP 81210000, Curitiba 81830, Brazil. guilfgomes@gmail.com
Telephone: +55-41-32406505 Fax: +55-41-32068090
Received: April 27, 2016
Peer-review started: April 27, 2016
First decision: June 12, 2016
Revised: July 13, 2016
Accepted: August 27, 2016
Article in press: August 29, 2016
Published online: October 16, 2016
Processing time: 169 Days and 17.4 Hours
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.

Keywords: Double-balloon enteroscopy; Meckel’s diverticulum; Diagnosis

Core tip: Meckel’s diverticulum (MD) is estimated to affect 1%-2% of the general population and has 4%-6% risk of causing symptoms during a lifetime. In adults, it may cause occult massive bleeding and the preoperative detection rate is low; patients with undiagnosed MD 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, providing visualization of the diverticular ostium. We report here the use of double-balloon enteroscopy for diagnosing 4 adults with symptomatic MD who had negative diagnostic imaging workup.