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01.12.2012 | Case report | Ausgabe 1/2012 Open Access

Journal of Medical Case Reports 1/2012

Endoscopic ultrasound with double-balloon endoscopy for the diagnosis of inverted Meckel’s diverticulum: a case report

Zeitschrift:
Journal of Medical Case Reports > Ausgabe 1/2012
Autoren:
Akihiro Araki, Kiichiro Tsuchiya, Shigeru Oshima, Eriko Okada, Shinji Suzuki, Junko Morio Akiyama, Toshimitsu Fujii, Ryuichi Okamoto, Mamoru Watanabe
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1752-1947-6-328) contains supplementary material, which is available to authorized users.

Competing interests

The authors have no financial or other interests in the manufacture or distribution of any equipment, device, or drug mentioned in this article. The authors declare that they have no competing interests.

Authors’ contributions

AA, KT, SO, EO, SS, JMA and TF performed the DBE; AA was a major contributor to the writing, analysis, and interpretation of patient data for gastrointestinal bleeding. RO and MW were major contributors to the writing and proofreading of the manuscript. All authors read and approved the final manuscript.

Abstract

Introduction

Inverted 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 presentation

A 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.

Conclusion

Lipoma 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.

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Zusatzmaterial
Authors’ original file for figure 1
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Authors’ original file for figure 2
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Authors’ original file for figure 3
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Authors’ original file for figure 4
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Authors’ original file for figure 5
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Literatur
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