The Value Of Double Balloon Enteroscopy In Diagnosis And Treatment Of Young Meckel’s Diverticulum Bleeding

Objective : To explore the clinical application value of double-balloon enteroscopy in diagnosis and treatment of young meckel’s diverticulum bleeding.Research method:Retrospective analysis of clinical data of 11 cases of Meckel’s diverticulum bleeding in young patients who were diagnosed and treated by double-balloon enteroscopy between July 2010 and April 2018.We record patient’s clinical performance,examination,treatment,pathology and follow-up data.Results:(1)General Information: There were 9 males and 2 females with an average age of 24 years and a duration of 2 days to 13 years.All of them were treated with blood for the first time.527.27±367.0 ml;fecal occult blood tests were positive,the lowest hemoglobin value(74.27±24.58)g/L,8 cases of blood transfusion treatment,total length of hospital stay(16.82±5.29)days.(2)Examination: 11 cases were examined with electronic gastroscopy,colonoscopy,abdominal ultrasound,8 cases of abdominal enhanced CT,1 case of barium meal,1 case of ECT Meckel diverticulography,no cause of bleeding was found;5 cases of abdominal angiography,1 Hemorrhage vessels were found in 6 cases,capsule endoscopy in 6 cases,and suspected ileal diverticulumin 1 case.Eleven patients in the above examination considered the possibility of intestinal bleeding or ileal diverticulum hemorrhage,further examination of double-balloon enteroscopy found ileal diverticulum and bleeding lesions,initial diagnosis of Meckel’s diverticulum bleeding.(3)Double-balloon enteroscopy revealed one case of diverticulitis active oozing,and titanium clips successfully stopped bleeding.One case of acute hemorrhage secondary to hemorrhagic shock,after interventional embolization did not continue bloody stool.Eleven patients eventually received laparoscopic surgery and were discharged from the hospital.(4)Pathology: Postoperative pathology showed 8 cases of ectopic gastric mucosal tissue and 3 cases of small intestinal mucosal tissue.Double-balloon enteroscopy biopsy was performed in 6 cases.The pathology showed 2 cases of ectopic gastric mucosa and 4 cases of small intestinal mucosa.Compared with postoperative pathology,the coincidence rate was 66.7%.(5)Follow-up:Postoperative follow-up of 10 months to 8 years,2 cases were lost to follow-up,and no other cases had gastrointestinal bleeding.Conclusions:(1)For patients with Meckel’s diverticulum bleeding,doubleballoon enteroscopy can directly detect and observe the size and shape of the diverticulum,and can be treated with microscopic hemostasis.It has high clinical application value and can be used as the first choice for examination.(2)The basic treatment for Meckel’s diverticulum bleeding is surgery,especially laparoscopic surgery,and it has good long-term efficacy.