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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.

Abstract

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.

Authors+Show Affiliations

Department of Medicine, Division of Gastroenterology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.Department of Medicine, Division of Gastroenterology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan. Shinozaki Medical Clinic, Utsunomiya, Tochigi, Japan.Department of Medicine, Division of Gastroenterology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.Nasu Red Cross Hospital, Otawara, Tochigi, Japan.Nasu Red Cross Hospital, Otawara, Tochigi, Japan.Department of Medicine, Division of Gastroenterology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.Department of Medicine, Division of Gastroenterology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.Department of Medicine, Division of Gastroenterology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.Department of Medicine, Division of Gastroenterology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan.Department of Medicine, Division of Gastroenterology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan. ireef@jichi.ac.jp.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31240623

Citation

Hiraoka, Yuji, et al. "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." Clinical Journal of Gastroenterology, 2019.
Hiraoka Y, Shinozaki S, Yano T, et al. 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. Clin J Gastroenterol. 2019.
Hiraoka, Y., Shinozaki, S., Yano, T., Igarashi, T., Honma, K., Ushio, J., ... Yamamoto, H. (2019). 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. Clinical Journal of Gastroenterology, doi:10.1007/s12328-019-01003-8.
Hiraoka Y, et al. 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. Clin J Gastroenterol. 2019 Jun 25; PubMed PMID: 31240623.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Hiraoka,Yuji, AU - Shinozaki,Satoshi, AU - Yano,Tomonori, AU - Igarashi,Takahiro, AU - Honma,Koichi, AU - Ushio,Jun, AU - Sunada,Keijiro, AU - Takezawa,Takahito, AU - Takahashi,Haruo, AU - Lefor,Alan Kawarai, AU - Yamamoto,Hironori, Y1 - 2019/06/25/ PY - 2019/02/02/received PY - 2019/06/15/accepted PY - 2019/6/27/entrez KW - Abscess KW - Crohn’s disease KW - Double-balloon endoscopy KW - Meckel’s diverticulum JF - Clinical journal of gastroenterology JO - Clin J Gastroenterol N2 - 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. SN - 1865-7265 UR - https://www.unboundmedicine.com/medline/citation/31240623/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 L2 - https://dx.doi.org/10.1007/s12328-019-01003-8 DB - PRIME DP - Unbound Medicine ER -