Abstract
IntroductionInverted Meckel’s diverticulum has usually been misdiagnosed in the cases based on computed tomography images presented in the literature. The final diagnosis was made intra-operatively or by pathology reports after surgery. Despite this, preoperative diagnosis could be made successfully by using endoscopic ultrasound with double-balloon endoscopy prior to surgery.Case presentationA 60-year-old Japanese woman with severe anemia complained of several episodes of black stool over the preceding 2 years. Abdominal computed tomography showed a 3.0-cm low-density tumor in the ileum, suggesting a diagnosis of intestinal lipoma. Examination of the tumor by endoscopic ultrasound with double-balloon endoscopy revealed a hypo-echoic layer corresponding to the muscularis propria, and a hyper-echoic layer corresponding to the fat tissue. These findings, which suggested that the tumor included areas outside the intestinal serosa, are not typical for a lipoma, despite the existence of a hyper-echoic layer corresponding to fatty tissue. We then considered a diagnosis of inverted Meckel’s diverticulum.ConclusionLipoma and inverted Meckel’s diverticulum are difficult to differentially diagnose by computed tomography. Polypectomy is the preferred therapeutic approach when a lipoma is present; however, polypectomy in a patient with Meckel’s diverticulum requires full-thickness resection. Situations where polypectomy is performed without preparing for full-thickness resection can be avoided by first making a precise diagnosis using double-balloon endoscopy and endoscopic ultrasound.
Highlights
Inverted Meckel’s diverticulum has usually been misdiagnosed in the cases based on computed tomography images presented in the literature
Situations where polypectomy is performed without preparing for full-thickness resection can be avoided by first making a precise diagnosis using double-balloon endoscopy and endoscopic ultrasound
Inverted Meckel’s diverticulum has usually been misdiagnosed in the cases based on computed tomography (CT) images presented in the literature [1]
Summary
DBE is an innovative method that facilitates disease treatment and enables pathological assessment by biopsy throughout the entire small intestine [4]. DBE can be used as an alternative diagnostic tool in cases where video capsule endoscopy is contraindicated due to the characteristics of the ileus or diverticulum. DBE is a powerful tool for intestinal treatment and an alternative to laparotomy. In this case, DBE and EUS revealed the existence of serosa in the polyp, which means that the polyp includes the extraluminal adipose tissue. Meckel’s diverticulum can be diagnosed by recognizing the double-lumen sign (composed of true lumen and an anti-mesenteric-sided Meckel’s diverticulum) during DBE. The combination of DBE and EUS can diagnose an inverted diverticulum that appears to be a polyp.
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