ABSTRACT
Meckel's diverticulum can be present in up to 1.2% of the population. It is usually diagnosed as an imaging finding, but it can present with complications such as digestive bleeding, intestinal obstruction, diverticulitis, ulcers, and perforation, more frequently in childhood or infancy. The diagnosis workup for this condition will depend on their clinical manifestation, the most frequent being gastrointestinal bleeding of obscure origin or small intestinal bleeding. In this context, although capsule endoscopy is the preferred technique, its diagnostic yield for the detection of Meckel's diverticulum is not entirely clear and it has not been compared in a controlled studies with other diagnostic methods. Here we report the diagnosis of a Meckel diverticulum and its intestinal complications by means of capsule endoscopy in a patient with iron deficiency anemia and gastrointestinal bleeding
El divertículo de Meckel puede estar presente en el 1,2% de la población general. Usualmente es diagnosticado como un hallazgo, pero puede presentarse con mayor frecuencia en la niñez o infancia por sus complicaciones como hemorragia digestiva, obstrucción intestinal, diverticulitis, úlceras y perforación. El enfrentamiento diagnóstico de esta condición dependerá de la manifestación clínica, siendo lo más frecuente hemorragia digestiva de origen oscuro o de intestino delgado. En este contexto, si bien la cápsula endoscópica es la técnica de elección, su rendimiento diagnóstico para la detección del divertículo de Meckel no es del todo claro y no ha sido comparado de forma controlada con otras técnicas diagnósticas. En el presente caso se reporta el diagnóstico de un divertículo de Meckel y sus complicaciones intestinales mediante cápsula endoscópica en una paciente con anemia ferropriva y hemorragia digestiva.
Subject(s)
Humans , Female , Adolescent , Capsule Endoscopy/methods , Meckel Diverticulum/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
Objective To improve the knowledge and early diagnostic rate of primary small intestinal tumor.Methods From August 2012 to August 2017,hospitalized patients with pathological diagnosis of primary small intestinal tumor (excluding duodenal neoplasm) from Peking Union Medical College Hospital were retrospectively enrolled.The data of clinical manifestations,laboratory examinations,imaging,endoscopy examination,pathological findings and treatment were collected and analyzed.Results A total of 180 patients with primary small intestinal tumor were enrolled.The common clinical manifestations included abdominal pain (76 cases,42.2 ％),gastrointestinal bleeding (64 cases,35.6％),and abdominal distension (30 cases,16.7％),and 22 (12.2％) patients had no overt clinical symptoms.The sensitivity of carbohydrate antigen 19-9 (CA19-9) in the diagnosis of small bowel adenocarcinoma was 57.1％ (12/21).The diagnostic rates of computed tomography enterodysis (CTE),positron-emission computed tomography (PET)/computed tomography (CT),and abdominopelvic enhanced CT were 96.5％ (83/86),100.0％ (29/29),and 91.5％ (43/47),respectively.The diagnostic small intestinal tumor patients of barium radiography (14 cases),abdominopelvic magnetic resonance imaging (MRI) (eight cases),small bowel endoscopy (18 cases) and capsule endoscopy (eight cases) were seven,six,fifteen and six cases,respectively.Among 180 patients,14 (7.8％) patients were considered gynecological tumors by imaging examination before surgery,seven (3.9％) patients underwent emergency operation because of intestinal obstruction,four (2.2％) patients underwent emergency surgery due to gastrointestinal bleeding,and four (2.2％) patients underwent emergency surgery because of intestinal perforation.Histopathological type included gastrointestinal stromal tumor (117 cases,65.0％),lymphoma (25 cases,13.9％) and adenocarcinomas (21 cases,11.7％).Except seven patients with intestinal lymphoma who received chemotherapy,the rest 173 patients underwent surgical resection.Conclusions Primary small bowel tumor has no specific clinical manifestations.It should be alert on patients without positive findings by regular gastroendoscopy and colonendoscopy examination but with symptoms of abdominal pain,gastrointestinal bleeding and intestinal obstruction.CTE should be the first choice for patients with symptoms but unclear diagnosis.
ABSTRACT
Introducción: las técnicas de imagen tienen un importante papel en el diagnóstico de la enfermedad inflamatoria intestinal constituyendo la Tomografía Computarizada una técnica novedosa por su amplia perspectiva. Objetivos: describir la importancia de la Tomografía Computarizada en la valoración de la enfermedad inflamatoria intestinal e identificar los principales signos tomográficos de esta condición mediante la caracterización de la Enfermedad de Crohn. Material y Métodos: se realizó una búsqueda bibliográfica automatizada consultando las bases de datos de sistemas MEDLINE (motor de búsqueda PubMed) seleccionando aquellas más recientes y de mayor relevancia, preferentemente publicadas en el período del 2007 al 2012 utilizando como descriptores: enterografía por Tomografía Computarizada, enteroclisis por Tomografía Computarizada y Enfermedad de Crohn. Posteriormente, tras un proceso de análisis y síntesis se realizó la redacción del artículo. Desarrollo: se efectúa enfoque comparativo de las principales técnicas por imagen utilizadas en la enfermedad inflamatoria intestinal resaltando la utilidad de la Tomografía Computarizada en la valoración de la pared y lesiones extraluminales asociadas. Además son enunciados los principales hallazgos tomográficos en el diagnóstico, evolución y complicaciones de las mismas teniendo como entidad tipo la Enfermedad de Crohn. Conclusiones: la Tomografía Computarizada constituye una técnica novedosa en la valoración de la enfermedad inflamatoria intestinal, al superar las técnicas convencionales. Además nuevas generaciones de tomógrafos multicorte permitirán mejor valoración de los cambios morfológicos estructurales.
Introduction: image techniques play an important role in the diagnosis of inflammatory bowel diseases and computerized tomography constitutes a novel technique due to its wide scope. Objectives: to describe the importance of computed tomography in the assessment of inflammatory bowel disease and identify the tomographic findings by means of characterising features of Crohn´s disease. Material and Methods: it was made a review through automatized data base MEDLINE (PubMed as search engine) using computed tomography enterography, computed tomography enteroclysis and Crohn´s disease as descriptors. The review was based on the critical analysis of relevant publications, most appearing from 2007 to 2012 . Development: in the present revision article, we carried out a comparative approach of the main imaging techniques used in the inflammatory bowel disease pointing out the usefulness of computed tomography to evaluate the wall and extraluminal lesions and the main tomographic findings in the diagnosis, evolution and their complications were stated taking the Crohn´s disease as an entity type. Conclusions: computed tomography is a novel imaging study in the assessment of inflammatory bowel disease which goes beyond conventional imaging investigations. New generations of multislice computed tomography may provide a better assessment of structural morphologic changes.