Question: A 74-year-old man was referred for evaluation of weight loss and diarrhea. His past medical history included depression, hypertension, and atrial fibrillation. Additionally, he underwent an aortic valve replacement and mitral valve repair. Six years ago, the patient had an anterior resection owing to rectal carcinoma. Current medications were warfarin (Coumadin), ramipril, and dutasteride (Avodart). Blood and stool tests were nonrevealing. A computed tomography scan f the abdomen did not disclose any significant findings. Colonoscopy was normal except for a 3-mm tubular adenoma, which was resected. No random biopsies were taken. Gastroscopy showed a hyperemic mucosa in the antrum and nodular mucosa in the duodenal bulb. Random biopsies were taken from the antrum and the duodenum. Pathology revealed subtotal villous atrophy, represent Marsch 3A consistent with celiac disease. Tissue transglutaminase immunoglobulin A was twice the upper limit of normal. The patient was started on a gluten-free diet without any improvement. Considering his lack of improvement despite of a strict diet for 12 months with continuous positive serology, a video capsule endoscopy was performed after 12 hours of fasting. The findings are shown in Figure A and B. What are the findings on video capsule and how are they connected to the patient’s complaints? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. The capsule endoscopy revealed several intact dead ants in the jejunum. The patient denied deliberate or inadvertent ingestion of ants. There are only a few cases of insects findings on endoscopy described in the literature, and most of them are bees or wasps.1Lynch J.P. Rothstein R.D. A gastric “bee-zoar”.N Engl J Med. 1997; 336: 1763-1764Crossref PubMed Scopus (7) Google Scholar,2Shah D. Tsang T.-K. Bee sting dysphagia.An Intern Med. 1998; 129: 253Crossref PubMed Scopus (5) Google Scholar A recent case report described an 80-year-old male whose upper endoscopy revealed a large peptic ulcer and, in its base, a dead intact ant.3Shaoul R. Rainis T. The new meaning of “ant-acid”.Gastrointest Endosc. 2008; 67: 748Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar We believe this is likely an incidental finding that does not relate to the patient complaints. Nevertheless, this finding on capsule has not been described previously in the literature and needs to be recognized as yet another possible rare finding on capsule endoscopy.