Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 7, 2016; 22(17): 4416-4420
Published online May 7, 2016. doi: 10.3748/wjg.v22.i17.4416
Inverted Meckel’s diverticulum preoperatively diagnosed using double-balloon enteroscopy
Kosuke Takagaki, Satoshi Osawa, Tatsuhiro Ito, Moriya Iwaizumi, Yasushi Hamaya, Hiroe Tsukui, Takahisa Furuta, Hidetoshi Wada, Satoshi Baba, Ken Sugimoto
Kosuke Takagaki, Tatsuhiro Ito, Moriya Iwaizumi, Yasushi Hamaya, Ken Sugimoto, First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
Satoshi Osawa, Department of Endoscopic and Photodynamic Medicine, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
Takahisa Furuta, Center for Clinical Research, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
Hiroe Tsukui, Satoshi Baba, Department of Diagnostic Pathology, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
Hidetoshi Wada, First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
Author contributions: Takagaki K and Osawa S wrote the paper; Iwaizumi M, Hamaya Y, Furuta T and Sugimoto K contributed to the paper design and coordination; Takagaki K, Ito T and Osawa S performed the double-balloon enteroscopy; Wada H performed laparoscopic surgery; Tsukui H and Baba S contributed to the pathological examination.
Informed consent statement: The patient has provided permission to publish this paper, and the identity of the patient has been protected.
Conflict-of-interest statement: The authors declare no conflicts of interest associated with this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Satoshi Osawa, MD, PhD, Department of Endoscopic and Photodynamic Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu 431-3192, Japan. sososawa@hama-med.ac.jp
Telephone: +81-53-4352261 Fax: +81-53-4349447
Received: December 23, 2015
Peer-review started: December 24, 2015
First decision: January 13, 2016
Revised: January 22, 2016
Accepted: February 22, 2016
Article in press: February 22, 2016
Published online: May 7, 2016
Abstract

An inverted Meckel’s diverticulum is a rare gastrointestinal congenital anomaly that is difficult to diagnose prior to surgery and presents with anemia, abdominal pain, or intussusception. Here, we report the case of 57-year-old men with an inverted Meckel’s diverticulum, who was preoperatively diagnosed using double-balloon enteroscopy. He had repeatedly experienced epigastric pain for 2 mo. Ultrasonography and computed tomography showed intestinal wall thickening in the pelvis. Double-balloon enteroscopy via the anal route was performed for further examination, which demonstrated an approximately 8-cm, sausage-shaped, submucosal tumor located approximately 80 cm proximal to the ileocecal valve. A small depressed erosion was observed at the tip of this lesion. Forceps biopsy revealed heterotopic gastric mucosa. Thus, the patient was diagnosed with an inverted Meckel’s diverticulum, and single-incision laparoscopic surgery was performed. This case suggests that an inverted Meckel’s diverticulum should be considered as a differential diagnosis for a submucosal tumor in the ileum. Balloon-assisted enteroscopy with forceps biopsy facilitate a precise diagnosis of this condition.

Keywords: Inverted Meckel’s diverticulum, Double-balloon enteroscopy, Small bowel tumor, Epigastric pain, Heterotopic gastric mucosa

Core tip: An inverted Meckel’s diverticulum is a rare congenital anomaly of the gastrointestinal tract which is difficult to diagnose prior to surgery. This case report represents the utility of double-balloon enteroscopy for the precise preoperative diagnosis of an inverted Meckel’s diverticulum.