Small Bowel Crohnʼs Disease Presenting as Protein-Losing Enteropathy and Iron-Deficiency Anemia Diagnosed by Wireless Capsule Endoscopy

Abstract

Purpose: Introduction: Crohn's Disease (CD) is a subtype of inflammatory bowel disease that can involve any portion of the gastrointestinal tract. It is a transmural disease that usually presents as skipped areas of inflammation, scarring and fistulization. It can present as ileocolonic (37.5%), ileal (26.9%), colonic (9%), jejunal and upper gastrointestinal disease (16.6%). We present a case of a young Hispanic male with small bowel CD diagnosed on Capsule Endoscopy (CE). Case Presentation: A 20-year-old Hispanic male presented to the hospital with anorexia, intermittent diarrhea, and weight loss. Review of systems was negative for any nausea, vomiting, abdominal pain or hematochezia. Physical examination was normal except facial and pedal edema. Laboratory tests revealed significant iron-deficiency anemia, hyoalbuminemia with no proteinuria. Esophagogastroduodenoscopy and colonoscopy with terminal ileoscopy were unremarkable. Subsequent capsule endoscopy revealed multiple small bowel ulcerations (Figure 1), strictures and possible fistula (Figure 2) and was complicated by capsule retention leading to the diagnosis of CD. The capsule endoscope was retrieved laparoscopically under fluoroscopic guidance. The patient had a complicated hospital course and went into clinical remission only after Remicade, azathioprine and mesalamine therapy.Figure 1: No Caption available.Figure 2Conclusion: Capsule endoscopy is a useful tool for the diagnosis of small bowel Crohn's disease and determining the extent of the disease. Major complication associated with CE is capsule retention secondary to a stricture.