Bleeding Meckel's Diverticulum Research Articles

Systematic review of Meckel's diverticulum in pregnancy.

Meckel's diverticulum (MD) is the most common congenital malformation in the gastrointestinal tract. Limited up-to-date evidence is available regarding MD in pregnancy. We aim to review the available pertinent literature to help support clinical decision making and patient management in the future. The search term 'Meckel's diverticulum' was combined with 'pregnant' or 'pregnancy'. Database searches of EMBASE, Medline and PubMed were conducted. All papers published in English from 01/01/1990 to 01/01/2021 were included. Simple statistical analysis (t-test) was performed. Twenty-seven cases were included. Average age=26.9 years. Average gestation=25.1 weeks. Occurrence: first trimester=3.7%; second trimester=48.1% and third trimester=48.1%. Presenting symptoms: abdominal pain 88.9%; nausea/vomiting 59.3%; fever 18.5%; abdominal distension 18.5%; haematochezia 11.1%; constipation 11.1%; haematemesis 3.7%, diarrhoea 3.7% and asymptomatic 3.7%. Mean duration of preceding symptoms=3.4 days. Diagnostic imaging modalities utilised: ultrasound=40.7%; CT=25.9%; MRI=14.8%; abdominal X-ray=11.1% and endoscopy=7.4%. All cases required definite surgical management: laparotomy=65.4%; laparoscopy=15.4%; C-section=19.2% and unreported=3.8%. Main intra-operative findings: perforated MD=40.7%; intussusception with MD as a lead point=11.1%; bleeding MD=11.1%, inflamed MD=11.1%; small bowel obstruction=11.1%; gangrenous MD=3.7%; volvulus=3.7% and unspecified=7.4%. Mean length from ileocolic junction=51.7cm. Average length of stay was 7.1 days. T-test (p-value=0.12) when comparing management strategy. Three maternal complications and two foetal mortalities. MD and associated pathology are difficult to diagnose in the pregnant cohort. Current imaging demonstrates low diagnostic accuracy and a deviation away from recognised nuclear medicine investigations. Surgery appears the definitive management with both open and laparoscopic approaches utilised. Significant maternal morbidity and foetal mortality are associated with this condition.

Clinical diagnostic predictive score for Meckel diverticulum

Background/Purpose: Meckel diverticulum (MD) is present in 2% of the population. Many practitioner feel the diagnosis relies upon technetium-99 m pertechnetate scintigraphy. When negative, patients undergo additional invasive procedures delaying definitive therapy. This study aims to identify features of bleeding MD and generate a risk score, which could preclude unnecessary testing and facilitate earlier operation.Methods: All patients <18-years-old who presented with hematochezia from 2005 to 2015 were identified. MD diagnosis was based on histopathology of operative tissue. Controls were patients with hematochezia undergoing colonoscopy. A points system was used generate a risk score.Results: A total of 215 patients presented with hematochezia out of which 42 patients with MD were identified. Predictive variables included infant (OR 7, 95%CI 2–29) and toddler (OR 20, 95%CI 8–50) age groups, duration <6 days (OR 18, 95%CI 8–43), presence of large blood volume (OR 16, 95% CI 7–36), hemoglobin <7 g/dL (OR 6, 95% CI 3–15) and transfusion requirement (OR 16, 95% CI 7–38). A score of 6 or higher is highly suggestive of MD.Conclusions: This scoring system identifies children with bleeding MD who may benefit from exploratory surgery without undergoing endoscopy. This novel scoring system can be applied to provide accurate clinical diagnosis, reduce unnecessary tests and allow prompt surgical management.

S2118 Angiographic Diagnosis and Treatment of Adult GI Bleeding from Meckel’s Diverticulum

INTRODUCTION: Meckel's diverticulum is the most common gastrointestinal anomaly resulting from a persistent omphalomesenteric duct. It is usually discovered in children when gastrointestinal (GI) bleeding occurs. This case demonstrates the use of provocative angiography for both the diagnosis and treatment of a bleeding Meckel's diverticulum in an adult. CASE DESCRIPTION/METHODS: A 22-year-old woman with no known past medical history presented to the emergency department with a chief complaint of black stool, lightheadedness and weakness. On exam, her abdomen was soft and non-tender. Rectal exam showed black stool with bloody mucus. Labs were significant for a Hgb of 6.1 (MCV 90.1) from 12.1 one week prior. During her hospitalization she underwent several studies to determine the location of her bleed. Esophagogastroduodenoscopy, colonoscopy, tagged red blood cell scan, and Meckel’s Scan were all normal. Video capsule endoscopy visualized blood in the terminal ileum and cecum mixed with stool, however no lesions were identified in these areas on colonoscopy. Magnetic resonance enterography was without evidence of small bowel inflammation. A visceral arteriogram was performed by interventional radiology, which was negative for bleeding until provocation was done using direct intra-arterial thrombolytic infusion (tissue plasminogen activator) that demonstrated active bleeding in an superior mesenteric artery branch which appeared to be serving a Meckel's diverticulum. Successful embolization was performed with a 3 mm coil and no further bleeding episodes occurred during her hospital stay. One month later she returned for surgical resection. Pathology confirmed Meckel's diverticulum with focal ulceration, underlying granulation tissue, and gastric heterotopia. DISCUSSION: Tc-99m pertechnetate scintigraphy (Meckel's Scan) is helpful in diagnosis of a Meckel’s diverticulum as pertechnetate is taken up by mucin-secreting cells of ectopic gastric tissue. This scan has high sensitivity and specificity in children but is drastically lower in adults as hemorrhage due to ectopic gastric mucosa is primarily a pediatric disease. For adults with suspected bleeding from a Meckel's diverticulum with multiple negative imaging modalities including a Meckel's scan, it is important to continue pursuit of the diagnosis using all means available. This case demonstrates the vital importance of provocation angiography in diagnosis of a Meckel's diverticulum that would have otherwise been missed and therefore left untreated.Figure 1.: Negative Meckel’s Scan. No heterotopic gastric mucosa visualized.Figure 2.: Angiogram before tPA administration. Red arrow indicates suspected Meckel diverticulum served by superior mesenteric artery branch.Figure 3.: Angiogram after tPA administration. Red arrow indicates area of extravasation and active bleeding.

Diagnostic accuracy of high-frequency ultrasound in bleeding Meckel diverticulum in children.

Meckel diverticulum is one of the most important causes of small bowel bleeding in children. Reports suggest that ultrasonography can be used as an alternative examination for children with negative radionuclide scanning results or children with atypical clinical manifestations. To evaluate the diagnostic accuracy of high-frequency ultrasound in children with bleeding Meckel diverticulum. We collected the data of children who were admitted to our hospital for the main symptom of bloody stool from February 2006 to December 2017. Ultrasonography was performed in all children. The final diagnosis was confirmed by pathological analysis or clinical follow-up observation. We evaluated the diagnostic performance of ultrasonography according to the final diagnosis. A total of 784 eligible children were enrolled in the study. Presenting symptoms or findings included black and red stool in 528 (67.3%), bright red stool in 51 (6.5%) and obscure or occult bloody stool in 205 (26.1%). Anemia was diagnosed in 489 (62.4%). Ultrasonography diagnosed Meckel diverticulum with a sensitivity of 93.6% (95% confidence interval [CI] 91.0-95.6%) and a specificity of 98.1% (95% CI 95.9-99.3%). High-frequency ultrasound diagnosis of Meckel diverticulum in children has high sensitivity and specificity.

2578 Meckel's Diverticulum: A Diverticulum Like No Other

INTRODUCTION: Meckel's diverticulum (MD) is a relatively uncommon cause of gastrointestinal (GI) bleeding in adults. “Often looked for and seldom found,” MD is challenging to diagnose despite the various imaging modalities available. Herein, we present the case of a young man who presented with lower GI hemorrhage and negative endoscopy, bleeding scan, and angiography. Meckel's diverticulum was later diagnosed via scintigraphy scan. We review the noninvasive diagnostic imaging for Meckel's diverticulum, mainly technetium-99m (Tc 99m) pertechnetate scan, and bleeding scan. CASE DESCRIPTION/METHODS: A 26-year-old man presented with multiple episodes of melena. He had acute onset anemia. Workup, including upper endoscopy, colonoscopy, and push enteroscopy were not able to identify the site of bleeding even after repeat procedures. A computed tomography scan with intravenous contrast and mesenteric angiography were also unrevealing. A Technetium 99m bleeding scan was read as negative. Persistent bleeding necessitated recurrent transfusions. Capsule endoscopy was deployed. A Meckel's scan (Tc 99m Pertechnetate scan) revealed an abnormal focus of uptake in the right lower abdomen suggesting the diagnosis of Meckel's diverticulum. The patient underwent laparoscopic resection of the diverticulum and was discharged home (Figures 1 and 2). A retrospective review of the bleeding scan revealed isolated uptake in the location of the Meckel's Diverticulum. Review of the capsule endoscopy revealed a diverticulum in the small bowel in the right lower quadrant without active bleeding (Figure 3). DISCUSSION: Bleeding Meckel's diverticulum is easier to diagnose than MD presenting with other symptoms, but still an outstanding challenge. High suspicion for MD should be sought in the evaluation of a young patient presenting with GI bleeding; the gold standard for diagnosis is the technetium-99m pertechnetate scan or so-called Meckel's scan. Bleeding scan is another noninvasive imaging modality that helps to detect a bleeding MD. Although both scans use Tc 99m, the mechanism is different. Meckel's scan uses Tc 99m, which is secreted by parietal cells in the mucus, thus detecting gastric cells within MD. On the other hand, the bleeding scan works via identifying Tc 99m that is bound to hemoglobin, therefore identifying a bleeding MD. Both scans are noninvasive and safe. The use of either one should be tailored according to the clinical presentation.

Gastrointestinal: An elderly patient with bleeding Meckel's diverticulum treated by double‐balloon endoscopy

Gastrointestinal: An elderly patient with bleeding Meckel's diverticulum treated by double‐balloon endoscopy

Bleeding Meckel Diverticulum: A Retrospective Analysis of Computed Tomography Enterography Findings.

The aim of this study was to evaluate the computed tomography enterography (CTE) characteristics of bleeding Meckel diverticulum. The CTE images of 35 patients with Meckel diverticulum and gastrointestinal bleeding were retrospectively evaluated. Meckel diverticulum was visualized in 33 of 35 patients and located in the right lower abdomen (20/33), midline lower abdomen (8/33), left lower abdomen (3/33), or paramedially near the umbilicus (2/33). The Meckel diverticulum was visualized on the antimesenteric side of the ileum in 16 patients (48.5%) and pointed toward the umbilicus in 10 (30.3%). The diverticulum appeared as a blind-ended tubular (22/33 [66.7%]) or saccular (11/33 [33.3%]) bowel segment. Separated supplying vessel was identified in 15 patients (45.5%) and associated with diverticulum (P = 0.037). The ectopic tissue was pathologically confirmed in 11 (33.3%) of 33 patients and was associated with diverticular nodules (P = 0.002). Awareness of CTE features could aid in the preoperative assessment of bleeding Meckel diverticulum.

Balloon‐assisted enteroscopy for symptomatic Meckel's diverticulum: High diagnostic accuracy and possible endoscopic intervention

Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract, with reported prevalence of 1% to 3% and male predominance. As MD is usually asymptomatic and discovered incidentally, the true prevalence and characteristics are still unclear. Most MD patients are identified with the onset of complications, including bleeding, intussusception, diverticulitis, or bowel obstruction. Bleeding is the most common complication.1 MD is also the most common cause of obscure gastrointestinal bleeding in children and young adults. Diagnosis is challenging because no standardized diagnostic criteria are available. Before the introduction of balloon-assisted enteroscopy (BAE), the diagnostic accuracy of conventional modalities (computed tomography, small-bowel follow-through, angiography, or Technetium-99 m pertechnetate scintigraphy) was limited. Technetium-99 m pertechnetate scintigraphy (Meckel's scan) is a well-established tool for the diagnosis of MD, with high accuracy in children.2, 3 However, accuracy is not as high (less than 50%) in adults,4 because some MD patients may have little or no ectopic gastric tissue within the diverticulum. Capsule endoscopy is recommended as a first-line diagnostic tool for suspected small bowel bleeding in patients without bowel stenosis, but it has a limited role in MD because the bowel lumen cannot be inflated and good visibility of the distal small bowel is required.5 The development of BAE (including single-balloon and double-balloon enteroscopy) has provided a new diagnostic tool with high accuracy for MD.6 BAE also provides the possibility of treatment. Selected MD patients have reportedly been treated with endoscopic intervention.7-9 One recent study showed that BAE has the highest accuracy for diagnosis of a bleeding MD in adults, with diagnostic accuracy higher than that of a Meckel's scan (85.0% vs 21.4%, P < 0.001).5 When MD is suspected but conventional modalities provide no definite conclusion, retrograde BAE could be an alternative tool for confirmation of the diagnosis with high accuracy. Although the accuracy of BAE in patients with MD is high, some challenges persist in clinical practice. First, BAE is an invasive procedure and requires bowel preparation. Second, MD may be overlooked when the orifice is small or hidden by a mucosal-fold. To date, reports of BAE for MD have mostly employed double-balloon enteroscopy, while single-balloon enteroscopy has rarely been reported.10, 11 In this issue of the journal, Wei et al reported the clinical experience with single-balloon enteroscopy for diagnosis of adult MD in a single medical center in Taiwan. Compared to double-balloon enteroscopy, single-balloon enteroscopy is easier to perform and less time-consuming, and a previous meta-analysis found that the diagnostic rate is similar in patients with small bowel diseases.12 This technique could be considered as a first-line diagnostic tool in selected cases with strongly suspected MD. However, a conventional noninvasive modality (especially a Meckel's scan) should be performed first in children and young adults because retrograde BAE is a technical and invasive procedure and not available at some medical institutions. For symptomatic MD, surgical intervention is the standard method of treatment, and can prevent recurrent complications. BAE can be used for endoscopic intervention in selected patients with MD. Some cases with inverted MD were successfully resected with BAE.7, 8 As inverted MD can resemble a pedunculated polyp, careful manipulation during endoscopic intervention is necessary to prevent complications.11 Wei et al reported that some cases did not have recurrent bleeding on follow-up after endoscopic hemoclipping, but the possibility still exists because of the retained MD. Close follow-up is recommended. In conclusion, retrograde BAE could provide a reliable and useful modality with high diagnostic accuracy and the possibility of endoscopic intervention in selected patients with MD. The author declares no conflict of interest. The author transfers all copyright ownership of the above manuscript to the journal in the event the work is published.

An unsuspected bleeding Meckel's diverticulum in an adult detected on mesenteric angiography.

Meckel's diverticulum is usually asymptomatic and found in almost 2% of the population. Haemorrhage from a Meckel's diverticulum is common in children but rare in adults. Here we report a case of 20 years old male with recurrent gastrointestinal bleeding. Meckel's diverticulum was diagnosed due to abnormal vascularity on mesenteric angiography and embolization was performed. Diagnosis was correlated with other radiological imaging and later elective resection was performed. This case is reported to emphasize the potential role of mesenteric angiography in the detection and management of bleeding Meckel's diverticulum and correlation with other radiological imaging.

Simple diverticulectomy is adequate for management of bleeding Meckel diverticulum

It is unclear whether simple diverticulectomy, rather than segmental bowel resection (SBR), is adequate treatment for gastrointestinal bleeding (GIB) secondary to Meckel diverticulum (MD). There is concern that ulcers in the adjacent bowel may continue to bleed if only the diverticulum is removed. This study seeks to determine if diverticulectomy is satisfactory treatment for bleeding MD. A multi-institution, retrospective review was performed for patients with a diagnosis of MD and GIB who underwent simple diverticulectomy or small bowel resection. Exclusion criteria were comorbid surgical conditions and other causes of GIB. The primary outcome was post-operative bleeding during the initial hospitalization. Secondary outcomes were bleeding after discharge, transfusion or additional procedure requirement, re-admission, and overall complications. There were 59 patients who met study criteria (42 diverticulectomy, 17 SBR). One patient in the SBR group had early post-operative bleeding (p = 0.288). There was one re-admission (p = 0.288) and three total complications in the SBR group (p = 0.021). There were no cases of bleeding or other complications in the diverticulectomy group. This study suggests that simple diverticulectomy is adequate for treatment of GIB caused by MD. Furthermore, diverticulectomy appears to have a lower overall complication rate.

Optimizing surgical resection of the bleeding Meckel diverticulum in children

PurposeMeckel diverticula containing gastric heterotopia predispose to local hyperacidity, mucosal ulceration, and gastrointestinal bleeding in children. Eradication of acid-producing oxyntic cells is performed by either of two surgical methods: segmental enterectomy including the diverticulum or diverticulectomy only. MethodsRetrospective review of all children having surgical resection of a Meckel diverticulum at a tertiary-referral children's hospital from 2002 to 2016 was performed. Demographic data, surgical method, pathological specimens, and outcomes were evaluated. Results102 children underwent surgical resection of a Meckel diverticulum during the study period. 27 (26.5%) children presented with bleeding, of which 16 (59%) had diverticulectomy only, and 11 (41%) had segmental ileal resection. All Meckel diverticula in children presenting with bleeding contained gastric heterotopia, and resection margins were free of gastric mucosa. Histologically, 19 specimens showed microscopic features of ulceration, on average 2.95mm (SD 4.49) from the nearest gastric mucosa (range: 0–16mm). Mean length of hospitalization after ileal resection was 4.0days (SD 1.2) compared to 1.6days (SD 0.9) for diverticulectomy only (p<0.001), with no re-bleeding occurrences. ConclusionIn the operative management of children having a bleeding Meckel diverticulum, diverticulectomy-only completely eradicates gastric heterotopia without increased risk of continued bleeding or complications and significantly shortens hospitalization. Level of evidenceTreatment Study: Level III.

Tubular intestinal duplication harboring gastric ectopia accurately diagnosed by Tc-99m pertechnetate single-photon emission computed tomography/computed tomography meckel's scan

A 7-year-old girl with an episode of hematochezia and melena, suspicious for bleeding Meckel's diverticulum, was referred for a Tc-99m pertechnetate Meckel's scan. On dynamic planar scan, apart from prompt gastric visualization an oval-shaped, area of inhomogeneous tracer uptake was observed in the left lower quadrant of the abdomen. Subsequent single-photon emission computed tomography/computed tomography localized this to intestinal lumen, thus establishing the diagnosis of intestinal duplication (ID) with functional gastric mucosa. Surgical exploration confirmed the presence of a tubular ID in a distance of 1.5 m from the ileocecal valve and pathologic examination showed gastric mucosa lining the lumen of the duplication.

Diagnosis of Bleeding Meckel's Diverticulum in Adults.

Background and AimsVarious modalities have been used to diagnose Meckel's diverticulum (MD) in practice, but with their diagnostic accuracy deemed to be unsatisfactory for clinical practice. Moreover, the usefulness of these modalities has not been evaluated for the diagnosis of bleeding MD in adults, due to the relative rarity of this condition. Therefore, the aim of our multicenter study was to determine the most accurate modality for the preoperative diagnosis of bleeding MD in adults.MethodsWe conducted a retrospective analysis of the diagnostic accuracy for small bowel bleeding associated with MD of different modalities in patients ≥18 years old who underwent assessment for MD, with confirmation at the time of explorative surgery. Diagnostic accuracy of the different modalities was evaluated against the diagnosis obtained using technetium-99m pertechnetate scintigraphy (also known as Meckel's scan), considered to be the gold standard for the diagnosis of bleeding MD in pediatrics.ResultsThirty-five adults were identified with bleeding in MD over the study period, between 2005 and 2012. Among these patients, only 24 (68.6%) were diagnosed with MD preoperatively. The mean (95% confidence interval) diagnostic accuracy of selected modalities was as follows: Meckel’s scan, 21.4% (5.7%-51.2%); capsule endoscopy, 35.7% (14.0%-64.4%); balloon-assisted enteroscopy (BAE), 85.0% (61.1%-96.0%); angiography, 0.0% (0.0%-80.2%); computed tomography, 31.8% (14.7%-54.9%); and small-bowel follow-through, 62.5% (25.9%-90.0%). The diagnostic accuracy was significantly higher for BAE than for Meckel’s scan (P = 0.001).ConclusionsAmong available diagnostic modalities, BAE provides the highest accuracy for the diagnosis of bleeding MD in adults and, therefore, should be considered as the preferred modality for preoperative diagnosis.

88歳発症Meckel憩室出血の1例

88歳発症Meckel憩室出血の1例

Diagnosis and minimally invasive surgical treatment of bleeding Meckel's diverticulum in children using double-balloon enteroscopy

Background/PurposeTo demonstrate the diagnosis of bleeding Meckel's diverticulum (MD) using double-balloon enteroscopy (DBE) and to highlight the utility of this technique for guidance in minimally invasive surgery. Materials and MethodsFrom August 2011 to September 2014, 21 pediatric patients with bloody diarrhea underwent transanal DBE examinations. When a lesion such as MD or a tumor was detected, the enteroscopic light source was brought as close to the umbilicus as possible. A small incision was made at the umbilicus, and the lesion indicated by the enteroscopic light source was pulled out of the umbilicus for lesion removal and intestinal anastomosis. If no lesion was detected, the DBE exam was ended after the scope had been advanced at least 200cm into the ileum. All patients were followed closely after discharge. ResultsFourteen children were diagnosed with MD and underwent successful removal via an umbilical incision using enteroscopic light guidance; a standard resection was then performed. Two patients were diagnosed with lymphoma and successfully treated using the same method. Five patients had negative enteroscopic findings. Of these, a 4-year-old boy had recurrent bloody diarrhea and a negative laparoscopic evaluation after 7months. In 4 patients, bloody diarrhea did not recur during follow-up. ConclusionsDBE is an ideal tool for the diagnosis and minimally invasive treatment of bleeding MD in children.

Bleeding Meckel's Diverticulum in an Infant - A Case Report

Meckel’s diverticulum is a congenital diverticulum. Mostly it is asymptomatic. In children the commonest complication is lower GI bleeding. High index of suspicion is required for its diagnosis. Technetium-99m pertechnetate scan is useful to detect ectopic gastric mucosa. Surgical treatment of symptomatic Meckel’s diverticulum is diverticulectomy or ileal resection.DOI: http://dx.doi.org/10.3126/jnps.v34i1.9523J Nepal Paediatr Soc 2014;34(1):54-56

English

BACKGROUND: Although Meckel's diverticulum is the most prevalent congenital abnormality of the gastrointestinal tract; it has varied presentations and often becomes a diagnostic challenge. PATIENTS AND METHODS: This was a retrospective study of all children who had underwent surgery for Meckel's Diverticulum in the department of Pediatric Surgery, S. Nijalingappa Medical college and H.S.K Hospital, Bagalkot between February 2009 and February2013. RESULT: A total of 17 patients (10male and 7 female) aged from 1month to 13 years with a diagnosis of Meckel's Diverticulum were evaluated and analyzed, looking at age, gender, clinical features, investigations, histopathological findings and surgical interventions. All patients were symptomatic and presented with various clinical features like intestinal obstruction(29.4%), perforated Meckel's Diverticulum(23.5%), diverticulitis(17%), intussusceptions(11.7%), patent vitellointestinal duct ( Meckel's prolapse) (11.7%), Littre's hernia(5.8%). All the cases were investigated and underwent surgical intervention Meckel's diverticulectomy/ resection anastomosis and were followed up. Most common post-operative complication was wound infection. CONCLUSION: A Preoperative diagnosis of complicated Meckel's Diverticulum may be challenging because of the overlapping clinical and imaging features of the other acute surgical and inflammatory conditions of the abdomen, hence it is necessary to maintain a high incidence of suspicious in the pediatric age group. INTRODUCTION: Meckel's diverticulum (MD) is one of the most common congenital abnormalities of the gastrointestinal tract, occurring in approximately 2% of the population. Nearly two centuries have passed since its first description by Johan Friederich Meckel. Meckel's diverticulum is a true intestinal diverticulum that results from the failure of the vitelline duct to obliterate during the fifth week of fetal development. 1 It contains all normal layers of the intestinal wall and, in approximately 50 percent of cases, contains tissue from other sites (ectopic tissue), 60-85% of which is gastric mucosa and 5-16% pancreatic tissue. 2 In the majority of cases, it is asymptomatic. However, it is prone to complications, especially in children, due to ectopic epithelial lining and various bands, reflective of its embryological development. Although the lifetime risk of a Meckel's diverticular complication varies from 4 to 34%, more than 50 to 60% of the patients who develop symptoms are younger than 2 years of age.3 Harper et al. suggested that a bleeding MD should be identifiable scintigraphically using 99mTc pertechnetate, since it is concentrated by gastric mucosa.4 The Tc99 Meckel's scan has a reported sensitivity of 81 to 90%.5 The purpose of this study was to review the various presentations of Meckel's diverticulum, to estimate the epidemiologic features and the extent of this clinical entity at our center and to review the detection techniques and treatment options.

Easy airway management using the i-gel™ supraglottic airway in a patient with Treacher Collins syndrome.

Easy airway management using the i-gel™ supraglottic airway in a patient with Treacher Collins syndrome.

Mesenteric location of Meckel′s diverticulum: Is it really uncommon?

One child aged 16 months was admitted to hospital with history of bleeding per rectum and unremarkable physical examination findings. Technetium-99 m scintigraphy scan was positive for bleeding Meckel's diverticulum. Intra-operatively, diverticulum was detected on the mesenteric border of the ileum; the antimesenteric border of ileum being normal. Since the diverticulum was located at the base of the mesentery, resection and anastomosis was preferred instead of wedge resection. Histology revealed presence of antral type gastric mucosa showing chronic peptic ulceration apart from intestinal mucosa. Patient is doing well in follow-up.

The PillCam Detection of Meckel's Diverticulum

Meckel's diverticulum (MD) is an uncommon cause of obscure gastrointestinal (GI) bleeding in adults, and its preoperative diagnosis is not the rule, the current radionuclide and radiologic diagnostic modalities being rather inaccurate. The advent of capsule endoscopy and device-assisted enteroscopy now allows for early detection of bleeding MD, provided they are performed in the setting of ongoing bleeding. This report presents a short capsule endoscopy video involving an young man with obscure-overt GI bleeding and typical appearance of MD, confirmed at surgery afterwards. This article is part of an expert video encyclopedia.