Abstract
A 67-year-old man with a history of renal insufficiency due to membranous glomerulonephritis was referred to our endoscopy suite for capsule endoscopy for further evaluation of anemia and recurring positive guaiac fecal occult blood testing. Colonoscopy 8 months earlier and a recent upper gastrointestinal endoscopy had shown no abnormalities. After obtaining informed consent and bowel preparation, wireless capsule endoscopy was done for obscure gastrointestinal bleeding using the PillCam SB video capsule (Given Imaging, Yoqneam, Israel). The capsule study showed rapid small-bowel transit (24 minutes) and angiodysplasias in the right hemicolon. In addition, to our surprise and in contrast to the previously negative colonoscopy, we also found a polypoid lesion in the right hemicolon measuring about 1 cm in diameter ([Fig. 1]). The patient was scheduled for complete colonoscopy with argon plasma coagulation and polypectomy the following day. Argon plasma coagulation of the angiodysplasias in the cecum and sigmoid colon was carried out successfully. In the ascending colon we found a flesh-colored pill, which had been mistaken for an adenomatous polyp at capsule endoscopy ([Fig. 2]). The mucus surrounding the tablet was easily washed off through the colonoscope. [Fig. 3] shows a multivitamin tablet with a similar appearance.
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