Meckel’s diverticulum contains all layers of the small bowel wall and is usually treated
by surgery [1]
[2]. Inverted Meckel’s diverticulum is rare, with only two reports of endoscopic resection
[3]
[4]. As preoperative diagnosis of an inverted Meckel’s diverticulum is difficult [5], it was not diagnosed prior to resection in either case, and consequently perforation
due to endoscopic resection was reported in one case [3]. In the current case, we diagnosed the condition preoperatively, and subsequently
used two detachable snares prior to resection to prevent hemorrhage or perforation.
We then safely treated the inverted Meckel’s diverticulum using endoscopic full-thickness
resection with double-balloon enteroscopy (DBE).
A 78-year-old man was admitted to our institution because of anemia and a positive
fecal occult blood test. Abdominal ultrasound identified a hypoechoic polypoid lesion,
with a hyperechoic head ([Video 1]). A contrasted abdominal computed tomography scan also identified an elongated pedunculated
polypoid lesion, with fat tissue in its center, in the distal ileum ([Video 1]). Capsule endoscopy demonstrated a submucosal tumor-like lesion ([Video 1]), and selective contrast-enhanced radiography indicated an elongated intraluminal
polypoid lesion that was approximately 8 cm in size ([Video 1]). Retrograde DBE indicated that the polypoid lesion exhibited intestinal villous
mucosa on the surface at the head and typical mucosal features at the stalk of the
antimesenteric attachment ([Fig. 1]). This indicated that the lesion was an inverted Meckel’s diverticulum, and endoscopic
full-thickness resection with DBE was attempted.
Video 1: According to clinical findings, we diagnosed the lesion as an inverted Meckel’s
diverticulum preoperatively. Therefore, using two detachable snares before resection
to prevent hemorrhage or perforation, we safely treated the condition using endoscopic
full-thickness resection with double-balloon enteroscopy.
Fig. 1 Retrograde double-balloon enteroscopy for an inverted Meckel’s diverticulum. a The polypoid lesion exhibited intestinal villous mucosa on the surface at the head.
b The polypoid lesion exhibited typical mucosal features, such as Kerckring’s folds,
at the stalk of the antimesenteric attachment.
First, the stem of the polyp was closed with two detachable snares before resection
to prevent hemorrhage or perforation. Then, conventional polypectomy with DBE was
performed. The resection surface was closed with four clips after the polypectomy
([Fig. 2], [Video 1]).
Fig. 2 Endoscopic resection of an inverted Meckel’s diverticulum. a First, the stem of the polyp was closed with two detachable snares before resection
to prevent hemorrhage or perforation. b Conventional polypectomy with double-balloon enteroscopy was then performed safely
without acute adverse events. c, d The resection surface was closed with four clips after the polypectomy.
Histopathological analysis revealed an 80 × 10 mm inverted Meckel’s diverticulum without
ectopic tissue ([Video 1]). The patient was discharged 2 days later without adverse events.
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