Double-Balloon Enteroscopy for the Diagnosis of Meckel's Diverticulum in a 50-Year-Old Man With Obscure Gastrointestinal Bleeding

A 50-year-old man presented to an outside facility with a 5-day history of intermittent hematochezia. This was associated with symptoms of fatigue, dyspnea on exertion, and headache. Blood work revealed hemoglobin of 7.9 gm/dL, and he was transfused 4 units of packed red blood cells. Esophagogastroduodenoscopy and colonoscopy were nonrevealing, and the patient was transferred to our facility for further care. Repeat esophagogastroduodenoscopy and colonoscopy with intubation of the terminal ileum were nondiagnostic and without evidence of bleeding. Patient had recurrent hematochezia, and a red blood cell scan demonstrated a focal area of mild increased activity to the left of the midline just above the level of the aortic bifurcation. Subsequent mesenteric angiogram and capsule endoscopy (CE) were nondiagnostic. A retrograde double-balloon enteroscopy (DBE) was performed and showed a Meckel's diverticulum (MD) at 100 cm proximal to the ileocecal valve (Figure A, arrow). The patient subsequently underwent a laparoscopy with removal of an MD at approximately 60 cm proximal to the valve (Figure B). Pathology revealed a 2.3 × 1.5 cm MD (Figure C) with a focus of gastric mucosa without ulceration. The postoperative course was uneventful, and patient was discharged home 2 days later in good condition. He continues to do well without any evidence of recurrent gastrointestinal bleeding (GIB) 1 year after surgery.

• 
  • View Large Image
  • Download to PowerPoint