Circumferential Peptic Ulceration From Meckel Diverticulum by Capsule Endoscopy

Abstract

A 14-year-old girl presented with episodes of vertigo and syncope. Laboratory data were hemoglobin 6.9 g/dL, mean cell volume 67.4 fL, hematocrit 26.5%, undetectable ferritin, and fecal occult blood was positive. She underwent an extensive workup, including upper gastrointestinal endoscopy, ileocolonoscopy, technetium-99m pertechnetate scan, and ultrasound scan, which proved inconclusive in determining a source of occult gastrointestinal bleeding. Wireless capsule endoscopy disclosed an image that seemed to be a shallow circumferential ulcer around the ileal lumen that was initially supposed to be caused by inflammatory bowel disease. Laparoscopy revealed the presence of a Meckel diverticulum with a wide orifice (Fig. 1). Laparoscopic diverticulectomy was then performed. Gastrointestinal bleeding was caused by peptic ulcer secondary to acid from ectopic gastric mucosa, confirmed by histology.FIGURE 1: Circumferential ulceration around Meckel diverticulum's ostium detected by capsule endoscopy.Obscure small-bowel disorders cannot always be diagnosed accurately by traditional imaging techniques (eg, radiologic, endoscopic) (1–3). False-negative technetium-99m pertechnetate scan may occur if the gastric mucosa mass within the diverticulum is insufficient, or it can result from the rapid dilution of radioactive secondary to fast bleeding from the ectopic mucosa (4,5). Wireless capsule endoscopy is an endoscopic technique that has been shown to be safe and effective and can provide clinically useful information in the management of obscure conditions of the small bowel in children (3–6). The most common indication in children is small-intestine Crohn disease (45%) and second, gastrointestinal obscure bleeding (23%), which is the most common indication in adult practice (6).