Inverted Meckel’s diverticulum diagnosed using capsule endoscopy: A case report

Martinez, I.; Calvo, Marta; Martínez-Porras, José Luís; Garcia, Lucia Gomez-Pimpollo; Rodríguez, José Luis Martín; León, Carmen; Panero, José Luis Calleja

doi:10.3748/wjg.v27.i36.6154

Cited by 9 publications

(7 citation statements)

References 17 publications

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“…In the literature review including the present case, bloody stool was observed in 55/74 (74.3%) of adults and 3/9 (33.3%) of children, with a significant difference ( p = 0.019) ( Table 1 ). Although it may not be sufficient to conclude that the diagnosis of inverted Meckel’s diverticulum is usually delayed in pediatric cases because of the absence of bloody stool, eight pediatric cases, excluding the present case, resulted in ileus due to intussusception, and imaging findings of intussusception were observed significantly more often in children than in adults ( p = 0.001) [ 2 , 3 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. On the other hand, adult cases may have significantly more anemia due to chronic intestinal hemorrhage ( p < 0.0001) ( Table 1 ), because the adult cases do not present with the acute onset of intussusception, unlike the pediatric cases.…”

Section: Discussionmentioning

confidence: 69%

“…In total, 94 related articles were retrieved. There were 29 articles for 74 adult [ 3 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ] and 9 pediatric (age < 18 years) [ 2 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ] cases including the present case] that reported the course of each case in detail. These included 55 male and 28 female patients with onset ages of 2 to 78 years.…”

Section: Discussionmentioning

confidence: 99%

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A Pediatric Case of Inverted Meckel’s Diverticulum Presenting with Cyclic Vomiting-like Symptoms: A Case Report and Literature Review

et al. 2022

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Asymptomatic Meckel’s diverticulum cases are not uncommon, leading to diagnostic difficulties in cases of atypical presentations with only gastrointestinal symptoms other than bloody stool. A nine-year-old boy diagnosed as having cyclic vomiting because of recurrent abdominal pain and vomiting for 6 months was referred to our institute and hospitalized due to worsening symptoms. After admission, abdominal ultrasonography showed the multiple concentric ring sign and a pseudokidney sign at the lower ileum, leading to the diagnosis of ileo-ileal intussusception, but the gastrointestinal symptoms and ultrasonic findings disappeared spontaneously. Transanal, double-balloon, intestinal endoscopy demonstrated a pedunculated polyp-like structure, and surgical resection was performed. An inverted diverticulum was found in the resected intestinal lumen, and ectopic gastric mucosa was identified histologically, leading to the diagnosis of inverted Meckel’s diverticulum. In pediatric cases involving periodic attacks of vomiting and abdominal pain, unnecessary emergent surgery could be avoided by cautious imaging evaluation and consideration of ileo-ileal intussusception with advanced lesions of an inverted Meckel’s diverticulum as a differential diagnosis, without facilely diagnosing cyclic vomiting. In addition, previous reports of inverted Meckel’s diverticulum were reviewed, and the results were compared between adult and pediatric groups in each category.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

A Pediatric Case of Inverted Meckel’s Diverticulum Presenting with Cyclic Vomiting-like Symptoms: A Case Report and Literature Review

et al. 2022

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“…The capsule endoscopy performed for our patient revealed a suspected polypoid lesion protruding into the intestinal lumen in the terminal ileum, but detailed images could not be obtained. Although the diagnostic accuracy of capsule endoscopy for inverted MDs is unknown because of the limited data [ 2 ], in our patient's case it seemed difficult for the capsule endoscopy to capture the whole image when the MD was inverted in the isoperistaltic direction as shown in the CT scan. It was likely that the capsule endoscopy passed over the inverted MD and overlooked the adenocarcinoma at the tip of the diverticulum.…”

Section: Discussionmentioning

confidence: 98%

“…Meckel’s diverticulum (MD) has been reported to invert into the ileal lumen; such cases are referred as an 'inverted MD' and can cause gastrointestinal bleeding, ulceration, small bowel obstruction, and/or intussusception [ 2 ]. The possible causes of this inversion are as follows: (1) intestinal peristalsis in the segment of bowel proximal to the MD, (2) movability of the tip of an unfixed MD to the mesentery or the intestine, and (3) negative intraluminal pressure which occurs with the passage of intestinal contents [ 4 – 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…The common complications of MD include intestinal obstruction, intussusceptions, diverticulitis, volvulus, and gastrointestinal bleeding. It has also been reported that MD can be inverted into the lumen of the ileum, which causes abdominal pain and anemia [ 2 ]. Although most MD-related diseases are observed incidentally and are benign in nature, malignant neoplasms occur in ~ 0.5–3.2% of MD cases [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

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An adenocarcinoma in an inverted Meckel’s diverticulum with intussusception

Miwa¹,

Sato²,

Hirano³

et al. 2023

surg case rep

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Background Adenocarcinoma in an inverted Meckel's diverticulum with intussusception has not been reported to date. We discuss the clinical issues concerning this rare condition and review the relevant literature. Case presentation A 71-year-old Japanese female was referred to our hospital for further investigation of severe anemia. Computed tomography revealed a tumorous lesion in the terminal ileum. Capsule endoscopy did not provide detailed images. Exploratory laparoscopy revealed intussusception in the terminal ileum. An intraluminal tumor 70 cm proximal to the ileocecal valve was observed to be the lead point. Partial resection including the tumor was performed. Macroscopically, a polypoid tumor at the tip of an inverted diverticulum-like structure was observed. The tumor was histologically composed of adenocarcinoma accompanied by gastric and pyloric gland metaplasia in the background mucosa, which was confirmed by immunohistochemical staining. Based on these characteristics, this tumor is considered to have developed from the ectopic gastric mucosa in a Meckel's diverticulum. Conclusions When we encounter patients with unfamiliar lesions in the small bowel, we need to differentiate Meckel's diverticulum related disease. Meckel's diverticulum can invert into the lumen of the small bowel and cause an intussusception, and has potential of malignant transformation.

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