Multifocal small-bowel carcinoid tumor causing obscure recurrent gastrointestinal bleeding diagnosed by capsule endoscopy

Abstract

A 38-year-old woman presented to our hospital with a 2-day history of passing black tarry stools. She had a history of recurrent obscure gastrointestinal bleeding, manifested by hematochezia and iron-deficiency anemia for 2 years, and had had six negative upper endoscopies and six negative colonoscopies prior to this presentation. A small-bowel series and computed tomography of the abdomen were both negative. Because conventional studies failed to find a source of bleeding and because the bleeding persisted, the patient was referred for a small-bowel video capsule endoscopy (Given Imaging Ltd., Yoqneam, Israel). The study was limited due to prolonged retention of the capsule in the stomach but nevertheless it revealed multiple submucosal masses in the distal ileum, some of which were umbilicated and ulcerated, with stigmata of recent bleeding ([Fig. 1], Videos 1, 2).