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Wireless capsule endoscopy in a patient with obscure occult bleeding
M Hahne1, H E Adamek, D Schilling
1Dept. of Gastroenterology, Ludwigshafen Hospital (Academic Hospital of the University of Mainz), Ludwigshafen, Germany.
Endoscopy
|August 10, 2002
Summary
Capsule endoscopy identified obscure gastrointestinal bleeding in a patient with chronic fatigue and anemia. This led to the diagnosis of Crohn's enteritis, enabling targeted medical treatment and avoiding surgery.
Area of Science:
- Gastroenterology
- Diagnostic Endoscopy
Background:
- Obscure/occult gastrointestinal bleeding presents a diagnostic challenge, often requiring extensive investigations.
- Chronic fatigue and iron-deficiency anemia can be significant indicators of underlying gastrointestinal pathology.
Observation:
- A 39-year-old male with a 7-year history of chronic fatigue and iron-deficiency anemia presented with obscure bleeding.
- Standard endoscopic and imaging techniques, including esophagogastroduodenoscopy, push enteroscopy, ileocolonoscopies, and MRI small-bowel follow-through, were inconclusive.
Findings:
- Capsule endoscopy revealed multiple inflammatory lesions with fibrin-covered ulcers and petechial bleeding in the jejunum and ileum.
- Histological examination of an ulcer biopsy confirmed Crohn's enteritis, specifically an isolated form.
- This diagnosis explained the patient's obscure bleeding, occurring in 10-20% of such cases.
Implications:
- Capsule endoscopy is crucial for diagnosing obscure gastrointestinal bleeding when conventional methods fail.
- Early diagnosis of Crohn's enteritis allows for prompt initiation of medical management, potentially averting invasive procedures.
- This case highlights the diagnostic utility of capsule endoscopy in identifying subtle inflammatory bowel disease manifestations.