Meckel’s diverticulum on third-generation video capsule endoscopy: intradiverticular ulcer, ectopic gastric mucosa, and active bleeding

摘要

Video 1 Appearances of a Meckel’s diverticulum on third-generation video capsule endoscopy. Georg Thieme Verlag. Please enable Java Script to watch the video.Download A Meckel’s diverticulum was suspected. A ~(99 m)Tc pertechnetate scintigraphy scan was performed, which confirmed the presence of ectopic gastric mucosa, corresponding to a probable Meckel’s diverticulum ([Fig. 2]). Surgery allowed the excision of a diverticulum of 6 × 2 × 1 cm that was found 70 cm above the ileocecal valve. Histological examination confirmed the presence of ectopic fundal mucosa within the diverticulum ([Fig. 3]). The patient left hospital 3 days after the surgery and has not re-presented with any further recurrence of bleeding. Fig. 2 ~(99 m)Tc pertechnetate scintigraphy (Meckel’s scan) showing ectopically located gastric mucosa. Fig. 3 Histological appearance on hematoxylin, eosin, and saffron (HES) staining showing ectopic fundal mucosa. Meckel’s diverticulum is a vestigial remnant of the omphalomesenteric duct, located on the antimesenteric border of the ileum, within 100 cm above the Bauhin’s valve. About 50 % of symptomatic Meckel’s diverticula have been found to contain ectopic tissue, especially gastric mucosa (35 % – 45 %), which can cause ulceration and hemorrhage; 75 % of hemorrhagic Meckel’s diverticula contain gastric ectopic mucosa [1]. Abdominal CT is an insensitive test for detection, especially in adults. In patients with obscure gastrointestinal bleeding, small-bowel video capsule endoscopy is a potentially interesting test for the diagnosis of Meckel’s diverticulum, with a positive predictive value up to 85 % [2]. ~(99 m)Tc pertechnetate scintigraphy (Meckel’s scan), which specifically detects gastric mucosa, is more sensitive in a pediatric population (85 % – 90 %) than in adult patients (60 %). This test is particularly effective when there are symptoms related to the ectopic gastric mucosa, such as bleeding [3].Endoscopy_UCTN_Code_CCL_1AC_2AFEndoscopy E-Videos https://eref.thieme.de/e-videos Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online.This section has its own submission website at https://mc.manuscriptcentral.com/e-videos.