Crohn’s disease diagnosis during pregnancy with small bowel capsule endoscopy

Abstract

A 22 year-old African American female presented for further evaluation of loose stools, abdominal pain and recent abnormal CT scan. She had a past history of diarrhea and abdominal cramping around the time of her menses. 1 year prior to evaluation she developed a change in her stool pattern with daily loose watery stools that occured 3–4 times per day. These occured immediately after eating. There was no blood in her stools and there were no nocturnal bowel movements. She also complained of intermittent, fleeting abdominal pain lasting 2 minutes. This has occured in variable locations throughout the abdomen. There was an increase in symptoms with stress. Fiber supplementation improved the form of her bowel movements. An abdomino-pelvic CT scan was performed to further evaluate these symptoms with the fidings of some possible thickening of the small bowel wall in multiple loops raising the question of inflammatory bowel disease. Shortly after the CT scan the patient was found to be pregnant and she was referred for further diagnostic evaluation. Physical examination was unrevealing with a flat, soft abdomen. Bowel sounds were normal. The abdomen was non-tender and there were no masses noted. It was elected to evaluate her small bowel with capsule endoscopy instead of barium to avoid further Xray exposure with a barium study. Capsule study was performed with the Given capsule system.The transit time of the capsule to the colon was 3 hours and 22 minutes. In the terminal ileum there was edema, submucosal hemorrhage and ulceration consistent with Crohn's disase. Capsule endoscopy has most commonly been used for evaluating occult GI bleeding. Diagnosis of other small bowel disease is in evolution. The capsule evaluation allowed for differentiating IBS type symptoms from Crohn's disease in a pregant patient and allowed for intiation of the appropriate medical therapy.