Diagnosis of Meckelʼs Diverticula via Double Balloon Enteroscopy

Abstract

Purpose: Meckel's diverticula (MD) are typically found in the ileum and > 50% contain heterotopic gastric or pancreatic mucosa. MD may present with gastrointestinal hemorrhage, intussusception, obstruction, diverticulitis, or perforation. Most MD are diagnosed via technetium-99 scintigraphy or at surgical exploration. Double balloon enteroscopy (DBE) permits direct endoscopic visualization and therapy for lesions in the distal small bowel. We sought to characterize our experience with the diagnosis of MD via DBE. Methods: We retrospectively reviewed DBE performed at two tertiary care centers from 2004-2012 for the diagnosis of MD. Results: We report 8 cases of MD diagnosed via retrograde DBE at two tertiary referral centers (Table 1). All 8 patients had prior negative endoscopic and/or radiologic evaluation and were subsequently referred for device-assisted enteroscopy.Table 1: No Caption available.Conclusion: Retrograde DBE readily detects the presence of MD. While prior series have emphasized MD in the differential diagnosis of obscure bleeding in the young, the median age in our series was 57 years. MD should remain in the differential diagnosis in older patients with bleeding. The endoscopic identification of ectopic gastric mucosa and adjacent ulceration presumably increase the likelihood that MD is the source of obscure bleeding. Further, the ability to tattoo the site facilitates laparoscopic surgical intervention. These cases illustrate that MD can be easily identified via retrograde DBE and should be considered in the differential diagnosis of obscure bleeding in adult patients. Disclosure: Dr. Oleh Haluszka - Consultant Fujinon.Figure: Mucosal ulceration within a MD.Figure: Heterotopic mucosa in the base of a MD.