Problemi speciali
Il diverticolo di Meckel nell’era della videocapsula: una diagnosi un po’ meno difficile
Meckel diverticulum in the era of video capsule endoscopy: a less difficult diagnosis
Giuseppa Patti1, Matteo Bramuzzo1, Grazia Di Leo2, Stefano Martelossi2, Alessandro Ventura2
1Scuola di Specializzazione in Pediatria, Universitŕ di Trieste
2Clinica Pediatrica, IRCCS Pediatrico “Burlo Garofolo”, Trieste
Febbraio 2012 - pagg. 107 -110
Abstract
The possibility of using video capsule endoscopy for diagnosing is known. Nevertheless only
case reports or small case series have been published to date. Data of patients referred
to our Pediatric department who were diagnosed with Meckel diverticulum from January
2009 to February 2011 were analysed. 8 cases, 5 males and 3 females were identified.
Intestinal bleeding was the most common clinical manifestation (6 patients) while abdominal
pain and iron deficiency anaemia were the presenting sign for two patients. Seven of
these patients underwent video capsule endoscopy and in 6 a 99Tc scintigraphy was also
performed. In 5 cases video capsule endoscopy images were suggestive of Meckel diverticulum.
Scintigraphy was positive in 3 out of 6 patients. Both tests were positive in 2 patients
and in 1 patient both were negative and diagnosis was made by a laparoscopic exploration.
Video capsule endoscopy allowed the diagnosis in 2 of 3 patients who had a negative
scintigraphy to be made. In conclusion, even though the association of video capsule
endoscopy and scintigraphy allowed correct diagnosis in most patients, their negativity does
not completely exclude the diagnosis of Meckel diverticulum. Therefore, in presence of a
strongly suggestive presentation, laparoscopic exploration remains unavoidable.
Suggerite dall'AI
Classificazione MeSH
Bibliografia
1. Cserni G. Gastric pathology in Meckel’s diverticulum.
Review of cases resected between
1965 and 1995. Am J Clin Pathol 1996;106:782-5.
2. Levy AD, Hobbs CM. From the archives of
the AFIP. Meckel diverticulum: radiologic features
with pathologic correlation. Radiographics
2004;24:565-87.
3. Kusumoto H, Yoshida M, Takahashi I, Anai
H, Maehara Y, Sugimachi K. Complications
and diagnosis of Meckel’s diverticulum in 776
patients. Am J Surg 1992;164:382-3.
4. Al-Onaizi I, Al-Awadi F, Al-Dawood AL. Iron
deficiency anaemia: an unusual complication
of Meckel’s diverticulum. Med Princ Pract
2002;11:214-7.
5. Park JJ, Wolff BG, Tollefson MK, Walsh EE,
Larson DR. Meckel diverticulum: the Mayo
Clinic experience with 1476 patients (1950-
2002). Ann Surg 2005;241:529-33.
6. Nassimbeni G, Del Santo M, Buri L, Ventura
A. Persisting abdominal pain in an 11-yearold
without an appendix. Lancet 1997;349:920.
7. Petrokubi RJ, Baum S, Rohrer GV. Cimetidine
administration resulting in improved
pertechnetate imaging of Meckel’s diverticulum.
Clin Nucl Med 1978;3:385-8.
8. Sfakianakis GN, Conway JJ. Detection of ectopic
gastric mucosa in Meckel’s diverticulum
and in other aberrations by scintigraphy: ii. indications
and methods: a 10-year experience. J
Nucl Med 1981;22:732-8.
9. Swaniker F, Soldes O, Hirschl RB. The utility
of technetium 99m pertechnetate scintigraphy
in the evaluation of patients with Meckel’s
diverticulum. J Pediatr Surg 1999;34:760-4.
10. Higaki S, Saito Y, Akazawa A, et al. Bleeding
Meckel’s diverticulum in an adult. Hepatogastroenterology
2001;48:1628-30.
11. Dillman JR, Wong KK, Brown RK, Frey
KA, Strouse PJ. Utility of SPECT/CT with
Meckel’s scintigraphy. Ann Nucl Med 2009;
23:813-5.
12. Shalaby RY, Soliman SM, Fawy M, Samaha
A. Laparoscopic management of Meckel’s
diverticulum in children. J Pediatr Surg 2005;
40:562-7.
13. Triester SL, Leighton JA, Leontiadis GI, et
al. A meta-analysis of the yield of capsule endoscopy
compared to other diagnostic modalities
in patients with obscure gastrointestinal
bleeding. Am J Gastroenterol 2005;100:2407-18.
14. Fritscher-Ravens A, Scherbakov P, Bufler
P, et al. The feasibility of wireless capsule endoscopy
in detecting small intestinal pathology
in children under the age of 8 years: a multicentre
European study. Gut 2009;58:1467-72.
15. Mylonaki M, Fritscher-Ravens A, Swain P.
Wireless capsule endoscopy: a comparison
with push enteroscopy in patients with gastroscopy
and colonoscopy negative gastrointestinal
bleeding. Gut 2003;52:1122-6.
16. Marmo R, Rotondano G, Piscopo R, Bianco
MA, Cipolletta L. Meta-analysis: capsule enteroscopy
vs. conventional modalities in diagnosis
of small bowel diseases. Aliment Pharmacol
Ther 2005;22:595-604.
17. Atay O, Mahajan L, Kay M, Mohr F, Kaplan
B, Wyllie R. Risk of capsule endoscope
retention in pediatric patients: a large singlecenter
experience and review of the literature.
J Pediatr Gastroenterol Nutr 2009;49:196-201.
18. Li F, Gurudu SR, De Petris G, et al. Retention
of the capsule endoscope: a single - center
experience of 1000 capsule endoscopy procedures.
Gastrointest Endosc 2008;68:174-80.
Corrispondenza: martelossi@burlo.trieste.it