Meckel’s diverticulum is a remnant of the omphalomesenteric duct, which is normally
obliterated between the 5th and 8th week of gestation. It occurs in 2 % of the population
[1] and it is often an incidental finding. Anatomically, Meckel’s diverticulum comprises
all layers of the intestinal wall and, in approximately 50 % of cases, contains ectopic
tissues which can cause complications. Meckel’s diverticulum can cause abdominal pain,
bleeding, and intestinal obstruction but is rarely symptomatic (4 %) [2]. Adult intussusception
due to an inverted Meckel’s diverticulum has also been reported [3].
We report the case of a 42-year-old man who was referred to our institution because
of mild microcytic anemia (hemoglobin 10.9 g/dL) and a positive fecal occult blood
test. Family and past medical history were unremarkable. The patient underwent outpatient
gastroscopy and colonoscopy, with negative macroscopic results. Histological analysis
of the duodenum, stomach, and colon specimens was inconclusive.
While awaiting a video capsule endoscopy appointment, the patient was admitted to
our emergency department because of right lower abdominal pain. Computed tomography
of the abdomen revealed a suspicious intussusception of the ileum, which was due to
the presence of a tumor. A retrograde single-balloon enteroscopy (GIFQ180; Olympus,
Tokyo, Japan) revealed the presence of an inverted Meckel’s diverticulum with eroded
apex in the distal ileum (70 – 90 cm proximal to the ileocecal valve). We marked the
site with a tattoo (Spot; GI Supply, Mechanicsburg, Pennsylvania, USA) and an endoclip
for laparoscopic segmental ileum resection ([Video 1]). Histological analysis of the surgical specimen confirmed the diagnosis of inverted
Meckel’s diverticulum and also showed the presence of inflamed heterotopic pancreatic
tissue, as described in the literature in 5 % of cases [4]. At follow-up 2 months
later, the patient had no symptoms and normal hemoglobin levels.
Video 1 Retrograde single-balloon enteroscopy for a symptomatic, unusual ileal polypoid lesion.
In conclusion, intussusception of Meckel’s diverticulum is a rare but important clinical
entity with nonspecific presenting symptoms. Diagnosis of Meckel’s diverticulum intussusception
should be considered and radiologically suspected. Enteroscopy can guide the appropriate
surgical or endoscopic management.
Endoscopy_UCTN_Code_CCL_1AC_2AH
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