Recurrent intestinal inflammation with a perianal abscess is not always Crohn’s disease: a patient with a complex Meckel’s diverticulum diagnosed by double-balloon endoscopy

• Published in: Clinical journal of gastroenterology Vol. 13; no. 1; pp. 26 - 30
• Main Authors: Hiraoka, Yuji, Shinozaki, Satoshi, Yano, Tomonori, Igarashi, Takahiro, Honma, Koichi, Ushio, Jun, Sunada, Keijiro, Takezawa, Takahito, Takahashi, Haruo, Lefor, Alan Kawarai, Yamamoto, Hironori
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.02.2020
• Subjects: Abdominal Surgery; Case Report; Colorectal Surgery; Gastroenterology; Hepatology; Medicine; Medicine & Public Health; Surgical Oncology; Meckel’s diverticulum; Abscess; Double-balloon endoscopy; Crohn’s disease
• ISSN: 1865-7257; 1865-7265
• DOI: 10.1007/s12328-019-01003-8

Recurrent intestinal inflammation and refractory perianal abscesses are typical manifestations of Crohn’s disease. However, these conditions are not always due to Crohn’s disease. A 25-year-old male with recurrent perianal abscesses for 1 year, suspected to be due to Crohn’s disease, was referred for further evaluation. Computed tomography scan showed a perianal abscess abutting the small intestine. A complicated Meckel’s diverticulum was suspected based on these findings. Meckel’s diverticulum scintigraphy was negative. Bidirectional double-balloon endoscopy (DBE) identified a long diverticulum in the ileum. In this long diverticulum, a tight stricture was seen 5 cm distal to the diverticular opening. A selective contrast study showed a 10 cm diverticulum distal to the stricture, with three strictures in the long diverticulum. Inflammation of the Meckel’s diverticulum due to bacterial overgrowth was suspected as a cause of the refractory perianal abscesses. Laparoscopic diverticulectomy was performed, and the specimen showed a 10 cm diverticulum containing post-inflammatory changes with scar formation. The perianal abscess was confirmed to be caused by an inflamed Meckel’s diverticulum. The patient has been asymptomatic for 6 years after resection. DBE before exploratory laparotomy should be considered to investigate the cause of an abscess that could be secondary to small intestinal pathology.