The online version of this article (doi:10.1186/1752-1947-6-328) contains supplementary material, which is available to authorized users.
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.
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.
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.
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.
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.
Authors’ original file for figure 113256_2012_2299_MOESM1_ESM.tiff
Authors’ original file for figure 213256_2012_2299_MOESM2_ESM.tiff
Authors’ original file for figure 313256_2012_2299_MOESM3_ESM.tiff
Authors’ original file for figure 413256_2012_2299_MOESM4_ESM.tiff
Authors’ original file for figure 513256_2012_2299_MOESM5_ESM.tiff
- Endoscopic ultrasound with double-balloon endoscopy for the diagnosis of inverted Meckel’s diverticulum: a case report
Junko Morio Akiyama
- BioMed Central