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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

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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.

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Abbreviations

DBE:

Double-balloon endoscopy

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Authors and Affiliations

  1. Department of Medicine, Division of Gastroenterology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan

    Yuji Hiraoka, Satoshi Shinozaki, Tomonori Yano, Jun Ushio, Keijiro Sunada, Takahito Takezawa, Haruo Takahashi & Hironori Yamamoto

  2. Shinozaki Medical Clinic, Utsunomiya, Tochigi, Japan

    Satoshi Shinozaki

  3. Nasu Red Cross Hospital, Otawara, Tochigi, Japan

    Takahiro Igarashi & Koichi Honma

  4. Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan

    Alan Kawarai Lefor

Authors
  1. Yuji Hiraoka
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  2. Satoshi Shinozaki
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  3. Tomonori Yano
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  4. Takahiro Igarashi
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  5. Koichi Honma
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  6. Jun Ushio
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  8. Takahito Takezawa
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  11. Hironori Yamamoto
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Corresponding author

Correspondence to Hironori Yamamoto.

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Conflict of interest

Author H.Y. has a patent for double-balloon endoscopy system produced by FUJIFUILM Corporation. He also has a consultant relationship in FUJIFUILM Corporation and has received honoraria, grants and royalties from the company. Other authors have no conflict of interest to disclose. The funding source had no role in the design, practice, or analysis of this study.

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All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Informed consent was obtained from all patients for being included in the study.

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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 13, 26–30 (2020). https://doi.org/10.1007/s12328-019-01003-8

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  • DOI: https://doi.org/10.1007/s12328-019-01003-8

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