Abstract
IntroductionWireless capsule endoscopy is an important tool for minimally invasive evaluation of the small bowel, allowing improved diagnostic yield with low complication rates relative to traditional modalities. Recently however, reports on small bowel perforation after wireless capsule endoscopy have surfaced. Here we present the first case of acute small bowel perforation in a middle-aged male in the United States.Case presentationA 58-year-old male with a presumed quiescent history of Crohn’s Disease presented to the Emergency Department in a septic state 48 hours after a wireless capsule endoscopy procedure complaining of abdominal pain, distension, and frequent emesis. A computed tomography scan of the abdomen was suggestive of small bowel perforation and ischemic enteritis. The patient was adequately resuscitated and taken to the operating room for an ileocecectomy and extensive resection of the small bowel. Pathology of the resected specimen revealed an ileal stricture and associated necrotizing ileitis, and a perforation just proximal to the stricture.ConclusionWireless capsule endoscopy remains the preferred endoscopic imaging method of the small bowel. This case illustrates the importance of appropriate patient selection and evaluation of functional patency of the small bowel prior to wireless capsule endoscopy, especially with the growing role of this procedure in the evaluation of inflammatory bowel disease.
Highlights
Introduction: Wireless capsule endoscopy is an important tool for minimally invasive evaluation of the small bowel, allowing improved diagnostic yield with low complication rates relative to traditional modalities
A computed tomography scan of the abdomen was suggestive of small bowel perforation and ischemic enteritis
Wireless capsule endoscopy remains the preferred endoscopic imaging method of the small bowel. This case illustrates the importance of appropriate patient selection and evaluation of functional patency of the small bowel prior to wireless capsule endoscopy, especially with the growing role of this procedure in the evaluation of inflammatory bowel disease
Summary
Since its conception in 2000, wireless capsule endoscopy (WCE) has become an established tool for minimally invasive evaluation of the small bowel (SB). Case presentation A 58-year-old Caucasian male with a reported 30 year history of CD presented to his gastroenterologist with intermittent diarrhea controlled by bismuth subsalicylate (Kaopectate) He denied any recent flares or pharmacologic management. He presented with severe hypotension requiring vasopressors His physical exam was positive for icteric sclera, a distended abdomen with increased bowel sounds, and marked tenderness in the right lower quadrant. Given the patient’s hemodynamic instability the abdomen was initially closed with a 2 mm GORE-TEX (WL Gore & Associates Inc., Flagstaff, AZ) patch and loose suture He required 12 subsequent operations for various complications and was discharged after 1 month with an ileostomy and colostomy. A perforation was noted just proximal to the stricture where the capsule endoscope was found
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