Diagnosis and minimally invasive surgical treatment of bleeding Meckel's diverticulum in children using double-balloon enteroscopy.

BACKGROUND/PURPOSE: To demonstrate the diagnosis of bleeding Meckel's diverticulum (MD) using double-balloon enteroscopy (DBE) and to highlight the utility of this technique for guidance in minimally invasive surgery.

MATERIALS AND METHODS: From August 2011 to September 2014, 21 pediatric patients with bloody diarrhea underwent transanal DBE examinations. When a lesion such as MD or a tumor was detected, the enteroscopic light source was brought as close to the umbilicus as possible. A small incision was made at the umbilicus, and the lesion indicated by the enteroscopic light source was pulled out of the umbilicus for lesion removal and intestinal anastomosis. If no lesion was detected, the DBE exam was ended after the scope had been advanced at least 200 cm into the ileum. All patients were followed closely after discharge.

RESULTS: Fourteen children were diagnosed with MD and underwent successful removal via an umbilical incision using enteroscopic light guidance; a standard resection was then performed. Two patients were diagnosed with lymphoma and successfully treated using the same method. Five patients had negative enteroscopic findings. Of these, a 4-year-old boy had recurrent bloody diarrhea and a negative laparoscopic evaluation after 7 months. In 4 patients, bloody diarrhea did not recur during follow-up.

CONCLUSIONS: DBE is an ideal tool for the diagnosis and minimally invasive treatment of bleeding MD in children.