Una bambina con sanguinamento intestinale cronico occulto: utilità e limiti della videocapsula endoscopica

Meckel’s diverticulum is the most common congenital malformation of the gastrointestinal tract due to persistence of the congenital omphalomesenteric duct. Bleeding from Meckel’s diverticulum due to ectopic gastric mucosa is the most common clinical presentation, especially in the paediatric age group. It is still frequently misdiagnosed preoperatively. The Authors introduce the case of a 14-year-old child who presented with severe anaemia, syncope, rectal bleeding, and no abdominal pain. The patient underwent extensive workup including upper gastrointestinal endoscopy, ileo-colonscopy, technetium- 99m pertechnetate scan and ultrasound scan that proved inconclusive in determining a source of bleeding. Small bowel capsule endoscopy was performed twice: the first time it disclosed the presence of a small bowel angiodisplasia that was supposed to be the cause of the gastrointestinal obscure bleeding. The second time it detected a stenotic structure of the lower ileum and shallow ulcers on the edge of the stenosis. Laparoscopy was performed, identifying Meckel’s diverticulum, and the patient underwent a small bowel resection.