Intussusception due to an Inverted Meckel’s Diverticulum Diagnosed by Double-Balloon Enteroscopy

Abstract

An 18-year-old man presented after undergoing multiple investigations for abdominal pain. Retrograde double-balloon enteroscopy showed a protruding red lesion in the ileum with small ulcers, approximately 75 cm proximal to the ileocecal valve, resulting in an intussusception. An inverted Meckel’s diverticulum was strongly suspected. Pressure was applied to the protruding lesion using contrast medium injection after wedging the lumen with a balloon. The intussusception partially reduced, avoiding the need for emergent surgery. Endoscopic tattooing was performed to mark the lesion for subsequent resection. Elective laparoscopy-assisted surgery with minimum laparotomy revealed an inverted Meckel’s diverticulum, which was resected.

Clinical outcomes of minimally invasive surgery for Meckel diverticulum: a multicenter study

“…Although we analyzed the medical records of patients treated at 6 hospitals, the number of patients may be too small to reach a definitive conclusion. Nevertheless, we included more patients than previous studies [4][5][6][7][10][11][12][13][14][15][17][18][19][20]. It must also be highlighted that the low incidence of MD precludes a prospective randomized trial.…”

“…It was first described by Johann Friedrich Meckel in 1808 and is also termed omphalomesenteric duct fistula, cyst, or sinus [ 2 3 ]. Although it is found incidentally during abdominal surgery for other pathologies, it can be associated with several complications, including congenital hernia, intestinal bleeding, bowel obstruction due to intussusception or fibrous band, and panperitonitis due to MD perforation [ 4 5 6 7 ].…”

“…Conventional surgical treatment of MD has involved exploratory laparotomy with simple diverticulectomy, wedge resection, or small bowel resection and anastomosis [ 8 9 ]. With recent advances in laparoscopic techniques, minimally invasive surgery (MIS) has been applied for the treatment (i.e., resection) of MD in several studies [ 4 5 6 7 10 11 12 13 14 15 16 17 18 19 20 ]. These studies revealed that laparoscopic resection of MD is safe and feasible.…”

Intraoperative Endoscopy in Transient Adult Jejunojejunal Intussusception

“…Both antegrade enteroscopy and retrograde enteroscopy have been used to diagnose various types of lead points including gastrointestinal stromal tumor, inverted Meckel's diverticulum, inflammatory fibroid polyp, Peutz-Jeghers syndrome, heterotopic pancreatic mass, malignant melanoma, and mass-forming fibrogranulation from a healed ulcer [25][26][27][28][29][30][31]. Preoperative enteroscopy can also identify signs of bowel ischemia, which occurs in about 15% of cases [1].…”

Double simultaneous intussusception caused by Meckel’s diverticulum and intestinal duplication in a child

“…Intussusception occurs in children of all ages, with predominance in children aged younger than 2 years old. 1 – 3 The most common intussusception is ileocolic intussusception, which accounts for approximately 98%. Double intussusception is rare.…”