ABCD Arq Bras Cir Dig 2018;31(4):e1409 DOI: /10.1590/0102-672020180001e1409 From the 1 Centro Hospitalar de São João, Gastroenterologia, Porto, Portugal HEADINGS: Meckel diverticulum. Endoscopy, gastrointestinal. Endoscopic capsule. Endocapsule. Gastrointestinal hemorrhage DESCRITORES: Divertículo ileal. Cápsula endoscópica. Endocápsula. Endoscopia gastrointestinal. Hemorragia gastrointestinal Correspondence: Marco Silva E-mail: marcocostasilva87@gmail.com; marcocostasilva87@gmail.com Financial source: none Confict of interest: none Received for publication: 10/01/2017 Accepted for publication: 16/03/2018 INTRODUCTION M eckel’s diverticulum (MD) is the most common congenital malformation of the gastrointestinal tract 4 . In adults, it is usually clinically silent, but can be found incidentally, or may present with a variety of clinical manifestations including gastrointestinal bleeding, intussusception, intestinal obstruction or perforation 3,4 . By other hand, videocapsule endoscopy (VCE) is a powerful diagnostic tool that is especially useful in imaging the small intestine and management of patients with obscure gastrointestinal bleeding 5 . The authors conducted a retrospective analysis of patients with MD diagnosed by VCE, between 2006 and 2015, in a tertiary referral center. All cases were followed for at least 18 months after the diagnosis. CASES REPORT CASE 1 A 15-year-old caucasian male, with non-relevant past medical history. He had no prior history of change in bowel habits or gastrointestinal bleeding and was admitted to the How to cite this article: Silva M, Cardoso H, Peixoto A, Lopes S, Santos AL, Gomes S, Macedo G. The role of capsule endoscopy in urgent evaluation of obscure gastrointestinal bleeding: a case series of Meckel diverticulum. . ABCD Arq Bras Cir Dig. 2018;31(4):e1409. DOI: /10.1590/0102-672020180001e1409 Letter to the Editor THE ROLE OF CAPSULE ENDOSCOPY IN URGENT EVALUATION OF OBSCURE GASTROINTESTINAL BLEEDING: A CASE SERIES OF MECKEL DIVERTICULUM. Papel da videocápsula endoscópica na avaliação urgente de hemorragia digestiva de origem obscura: uma série de casos de divertículo de Meckel Marco SILVA 1 , Hélder CARDOSO 1 , Armando PEIXOTO 1 , Susana LOPES 1 , Ana Luísa SANTOS 1 , Sara GOMES 1 , Guilherme MACEDO 1 emergency department after an episode of lipothymy. He complained of asthenia and hematochezia since the day before. The laboratory tests showed hemoglobin of 10.8 g/ dl. The upper endoscopy was normal and the ileocolonoscpy showed ileal nodular hyperplasia with blood and clots in the ileum. Twenty-four hours later the hemoglobin dropped to 7.9 g/dl and on physical examination he was pale, diaphoretic and hypotensive. VCE (Endocapsule Olympus ® ) performed 24 h after admission identifed the bleeding source as an active bleeding (oozing) from a small diverticulum like orifce in the middle ileum. CASE 2 A 16-year-old caucasian female had past medical history irrelevant. She was admitted due to melena lasting for 24 h. On admission she initiated hematochezia and pale but normotensive. The hemoglobin was 12.9 g/dl on admission but dropped to 7.1 g/dl 24 h later, requiring blood transfusions. Also the upper endoscopy was normal and on the ileocolonoscpy she had fresh clots in the ileum, without other relevant lesions. Then a VCE (PillCam SB 2 ® ) was used revealing a luminal duplication on the terminal ileum (Figure 1). FIGURE 1 - Case 2 videocapsule endoscopy imaging CASE 3 A 14-year-old caucasian male was admitted due to melena. He had melena six months previously, but endoscopy and ilecolonoscopy performed at that time did not showed lesions with active bleeding. On admission, he was pale and hypotensive and laboratory workup revealed hemoglobin of 7.0 g/dl. After hemodynamic resuscitation, an upper endoscopy was performed but, also, did not showed any relevant alterations. The abdominal computer tomography (CT) and the Meckel scan with 99mTc-Na-pertechnetate also did not show relevant fndings. At this time a VCE (PillCam SB 2 ® ) was performed and luminal duplication in the terminal ileum, with signs of active bleeding, was visualized (Figure 2). FIGURE 2 - Case 3 videocapsule endoscopy imaging 1 ABCD Arq Bras Cir Dig 2018;31(4):e1409 LEttEr to thE Editor