Retrograde Balloon Enteroscopy for Diagnosis of Meckel Diverticulum.

Abstract

A 16-year-old previously healthy male presented with fatigue, dyspnea, and decreased exercise tolerance for 3 weeks. His hemoglobin was 7.8 g/dL and his ferritin was 4 g/mL. His heme-occult stool was positive and his C-reactive protein was normal. A Tc-99m scan to evaluate for ectopic gastric mucosa was negative. Our patient was not premedicated with Ranitidine before his Meckel's scan. He required blood transfusions, and further work-up including magnetic resonance enterography, upper endoscopy, and colonoscopy were normal. A capsule endoscopy showed areas of erythema and nonactively bleeding ulcerations in the ileum (Fig. 1). He underwent a balloon endoscopy that reached the distal jejunum, which was normal and the area of the distal jejunum reached was tattooed. A second capsule endoscopy showed ulcerated ileal mucosa beyond the tattooed area. A balloon colonoscopy was performed and showed a Meckel diverticulum in the proximal ileum (Fig. 2A), the site was then tattooed for rapid identification during a laparoscopic surgery (Fig. 2B). When multiple imaging and endoscopy techniques cannot detect the site of gastrointestinal bleeding, balloon enteroscopy is an alternative and a safe technique to evaluate for small bowel disease.FIGURE 1: Erythema and superficial ulceration of terminal ileum.FIGURE 2: (A) Meckel diverticulum in the proximal ileum and (B) Meckel diverticulum in the proximal ileum with tattoo.