Monday, February 15, 2010
This was a cool case. An older lady with occult GI blood loss was sent to her GI doctor for work-up. EGD and colonoscopy were both negative. So they scheduled her for a newer procedure called "capsule endoscopy" which allows direct visualization of the heretofore unaccessible small bowel. Basically you swallow a glorified pill-cam which records a series of pictures as it passes through your intestinal tract. The quality of the images generally isn't great (compared with standard endoscopy) but areas of active bleeding or mucosal ulcerations in the small bowel can often be identified.
This lady swallowed her pill-cam on a Thursday. Five days later, she still hadn't evacuated it in her stool. She ended up in the ER complaining of severe crampy abdominal pain and nausea. The CT above demonstrates the capsule in the RLQ, stuck somewhere in her terminal ileum.
At laparoscopic exploration I found classic manifestations of acute Crohn's disease in her terminal ileum (fat creeping, thickened mesentery, transmural inflammation of bowel wall, etc). So I did the lap ileocecectomy, opened the specimen on the back table and popped out the capsule lodged in the middle of an 8-10 cm stricture.
The capsule found the pathology all right; just not the way it was designed....