Incidental Small Bowel Adenocarcinoma Upon Surgical Evaluation of a Retained Endoscopic Video Capsule in a Patient With Crohns Disease

Abstract

A 28-year-old male with Crohns disease presented with hematochezia and severe anemia. Upon evaluation, no source of bleeding was identified with colonoscopy or esophagogastroduodenoscopy; therefore, a video capsule was placed. Following capsule placement, the patient developed severe abdominal pain. Abdominal X-ray revealed the capsule at the ileocecal valve, indicating it was possibly stuck in a stricture. To reduce inflammation, intravenous steroids were started to assist with capsule passage. Following unsuccessful passage and continual abdominal pain, surgical investigation visualized a mass arising from a jejunal Crohns stricture. Despite multiple inspections of the resected small bowel, the capsule was not located. Intraoperative X-ray revealed the capsule inside the large bowel, indicating capsule passage through the stricture. Final pathology revealed metastatic poorly differentiated adenocarcinoma. This case demonstrates management of a retained capsule in Crohns patients and emphasizes the importance of considering small bowel adenocarcinoma in Crohns patients with obstructive signs.

Gastroenterol Res. 2021;14(3):199-203
doi: https://doi.org/10.14740/gr1403