Meckelʼs Diverticulum Active Bleeding Detected by Capsule Endoscopy

Abstract

Purpose: Diagnosing Meckel's diverticulum (MD) before surgery is still a challenge, although the clinical, histopathological and imagiologic features of MD are well known. Several modalities have been proposed for evaluating patients with gastrointestinal hemorrhage from a presumable small bowel source. Even in acute bleeding episodes, repeated diagnostic workups and invasive procedures (angiography, intraoperative enteroscopy) are several times inconclusive. We present two cases, a 14 and 16 years old patients, admitted to our hospital due to recurrent severe gastrointestinal bleeding (6 gr/dl drops of hemoglobin). Both underwent upper gastrointestinal endoscopy and ileocolonoscopy, and although no bleeding lesions had been identified, fresh clots were noticed in terminal ileum. Within the first 24 hours of presentation both performed capsule endoscopy (Endocapsule Olympus). In 5 and 6 hours respectively, the bleeding source was identified as an active bleeding oozing from a small diverticulum like orifice in the middle ileum. Surgical resection of the ileal segment confirmed the presence of the diverticulum with ectopic gastric mucosa. There was no recurrence of bleeding at follow-up after surgery. Both cases illustrate the usefulness of capsule endoscopy availability and its role in investigating acute small bowel bleeding in this age group.