Lee Jae Min, Jeen Chan Dong, Kim Seung Han, Lee Jong Soo, Nam Seung Joo, Choi Hyuk Soon, Kim Eun Sun, Keum Bora
Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
Turk J Gastroenterol. 2014 Apr;25(2):212-5. doi: 10.5152/tjg.2014.6044.
Meckel's diverticulum is a common anomaly of the small intestine and occasionally presents as obscure gastrointestinal hemorrhage. Before operation, it is difficult to diagnose by imaging, especially in adults. Conventional abdominal computed tomography and endoscopy have limitations for the diagnosis of Meckel's diverticulum. Diagnostic methods in patients with small bowel lesions include enteroclysis, angiography, push enteroscopy, and capsule endoscopy; however, all of these techniques have low diagnostic yields to detect Meckel's diverticulum. Recently, computed tomographic enterography has been reliable in assessing small bowel disease. We present 3 cases of Meckel's diverticulum with bleeding in adults who were diagnosed by computed tomographic enterography. The bleeding source was not found in the total colonoscopy, and Tc-99m pertechnetate scans were negative in these patients. However, outpouching structures of the distal ileum with enhancement were detected by computed tomographic enterography. All patients underwent small bowel segmental resection. Meckel's diverticulum was confirmed by histopathology of the resected ileum segment, and the type of heterotopic tissue was gastric mucosa.
梅克尔憩室是小肠常见的先天性异常，偶尔表现为不明原因的胃肠道出血。术前通过影像学检查难以诊断，尤其是在成人中。传统的腹部计算机断层扫描和内镜检查对梅克尔憩室的诊断存在局限性。小肠病变患者的诊断方法包括小肠灌肠造影、血管造影、推进式小肠镜检查和胶囊内镜检查；然而，所有这些技术检测梅克尔憩室的诊断率都很低。近年来，计算机断层扫描小肠造影在评估小肠疾病方面一直很可靠。我们报告3例成人梅克尔憩室出血患者，通过计算机断层扫描小肠造影确诊。全结肠镜检查未发现出血源，这些患者的锝-99m高锝酸盐扫描均为阴性。然而，计算机断层扫描小肠造影检测到回肠末端有强化的憩室样结构。所有患者均接受了小肠节段切除术。切除的回肠段组织病理学证实为梅克尔憩室，异位组织类型为胃黏膜。
