Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2018; 6(14): 791-799
Published online Nov 26, 2018. doi: 10.12998/wjcc.v6.i14.791
Meckel’s diverticulum diagnosis by video capsule endoscopy: A case report and review of literature
Diego García-Compeán, Alan R Jiménez-Rodríguez, Ángel N Del Cueto-Aguilera, Gilberto Herrera-Quiñones, José A González-González, Héctor J Maldonado-Garza
Diego García-Compeán, Alan R Jiménez-Rodríguez, Ángel N Del Cueto-Aguilera, Gilberto Herrera-Quiñones, José A González-González, Héctor J Maldonado-Garza, Gastroenterology Service and Department of Internal Medicine, Faculty of Medicine, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey 64700, Nuevo León, México
Author contributions: García-Compeán D designed the research, analyzed the results and wrote the paper; Jiménez-Rodríguez AR performed the bibliographic research; Del Cueto-Aguilera AN performed the bibliographic research and reviewed the research data; Herrera-Quiñones G collected the data; González-González JA analyzed the data; Maldonado-Garza HJ analyzed the final results.
Informed consent statement: Written informed consent was obtained from the patients and their family before all procedures described in the report, as well as for the use of the patients’ clinical information and images for publication.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Open-Access: This 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: Diego García-Compeán, MD, MSc, Professor, Gastroenterology Service and Department of Internal Medicine, Faculty of Medicine, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Madero y Gonzalitos S/N, Monterrey 64700, Nuevo León, México. digarciacompean@prodigy.net.mx
Telephone: +52-81-83487315 Fax: +52-81-89891381
Received: July 23, 2018
Peer-review started: July 23, 2018
First decision: August 30, 2018
Revised: November 2, 2018
Accepted: November 7, 2018
Article in press: November 7, 2018
Published online: November 26, 2018
Processing time: 127 Days and 10.3 Hours
Abstract
BACKGROUND

Meckel’s diverticulum (MD) occurs predominantly in children and adolescents. It is rarely diagnosed in adults. Preoperative diagnosis is difficult due to low sensitivity of the radiological imaging studies. The role of video capsule endoscopy (VCE) in the diagnosis of MD is unknown, and the endoscopic patterns are not defined. We will describe four of our cases of MD evaluated with VCE and make a review of the literature focusing on the endoscopic characteristics.

CASE SUMMARY

We present four cases of MD confirmed by surgery. They were all adult males with ages going from 18 to 50 years, referred to our service from 2004 to 2018, due to obscure gastrointestinal bleeding (OGIB). They had a history of 1 mo to 10 years of overt and occult bleeding episodes. Laboratory blood test showed an iron-deficiency anemia from 4 to 9 g/dL of hemoglobin that required multiple hospitalizations and blood transfusions in all cases. Repeated upper digestive endoscopies and colonoscopies were negative. Small bowel was examined with VCE, which revealed double lumen images in all cases, one with polyps and three with circumferential ulcers in the diverticulum. However, based on VCE findings, preoperative diagnosis of MD was suggested only in two patients. Capsule was retained in one patient, which was recovered with surgery. The anatomopathological report revealed ulcerated ectopic gastric mucosa in all cases.

CONCLUSION

VCE is useful for the diagnosis of MD. However, endoscopic characteristics must be recognized in order to establish preoperative diagnosis.

Keywords: Meckel’s diverticulum; Endoscopic features; Video capsule endoscopy; Wireless capsule endoscopy; Review; Case report

Core tip: Preoperative diagnosis of Meckel’s diverticulum (MD) is practically nonexistent due to the low sensitivity of imaging studies. Video capsule endoscopy (VCE) allows direct examination of the small bowel. However, few publications report evaluating the role of VCE on diagnosis of MD, and the endoscopic characteristics have not been defined. For the above-mentioned, it is highly probable that this disease is under-diagnosed. In this literature review, we focus on the endoscopic features of MD by VCE, and in its clinical and pathological characteristics. Recognition of endoscopic features will increase preoperative diagnosis of this disease.