PMC10130678_01
Heterotopic pancreas in Meckel's diverticulum under double balloon enteroscopy. Trans-anal double balloon enteroscopy showed double tube sign (A) in ileum and ulceration at the far-end bottom of the blind-ending tube (B-D). FICE, flexible spectral imaging color enhancement; AVE, automatic vascular enhancement.
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Thus, small intestine bleeding was suspected and double balloon enteroscopy was adopted which revealed double duct sign at about 100 cm proximal to ileocecal valve and indicated existence of diverticulum (Figure 1A). Further, ulceration was found and the far-end bottom of the blind-ending tube (Figure 1B-1D).
Surgical resection sample of Meckel's diverticulum. Laparoscopic appearance of Meckel's diverticulum (A), and post-surgery gross anatomy (B).
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Finally, heterotopic pancreas in Meckel's diverticulum was diagnosed based on double balloon enteroscopy and verified by further pathology study of surgical specimen (Figure 2A,2B).
Pathology of Meckel's diverticulum at low (A) and high magnification (B) (hematoxylin and eosin, x40, x100).
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While a diverticula-like mass with 3 cm x 2 cm in size was found in the intestine at about 1 meter away proximal to the ileocecal valve, with clear boundary and then complete resection was conducted (Figure 3A). Pathology study showed heterotopic pancreas in Meckel's diverticulum with negative margins on both sides of ectopic pancreas (Figure 3B).