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Published on: October 29, 2014
Acute small bowel perforation after wireless capsule endoscopy in a patient with Crohn's disease: a case report
Dhavan A Parikh1, Janak A Parikh, Gregory C Albers
1Department of Internal Medicine, University of California Davis Health System, 4860 Y Street, Sacramento, California 95817, USA. dhavan15@gmail.com
Introduction:
Wireless capsule endoscopy is an important tool for minimally invasive evaluation of the small bowel, allowing improved diagnostic yield with low complication rates relative to traditional modalities. Recently however, reports on small bowel perforation after wireless capsule endoscopy have surfaced. Here we present the first case of acute small bowel perforation in a middle-aged male in the United States.
Case Presentation:
A 58-year-old male with a presumed quiescent history of Crohn's Disease presented to the Emergency Department in a septic state 48 hours after a wireless capsule endoscopy procedure complaining of abdominal pain, distension, and frequent emesis. A computed tomography scan of the abdomen was suggestive of small bowel perforation and ischemic enteritis. The patient was adequately resuscitated and taken to the operating room for an ileocecectomy and extensive resection of the small bowel. Pathology of the resected specimen revealed an ileal stricture and associated necrotizing ileitis, and a perforation just proximal to the stricture.
Conclusion:
Wireless capsule endoscopy remains the preferred endoscopic imaging method of the small bowel. This case illustrates the importance of appropriate patient selection and evaluation of functional patency of the small bowel prior to wireless capsule endoscopy, especially with the growing role of this procedure in the evaluation of inflammatory bowel disease.
Insights
Wireless capsule endoscopy can cause small bowel perforation, especially in patients with Crohn's Disease. Careful patient selection and patency evaluation are crucial before the procedure.
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Wireless capsule endoscopy is a key tool for small bowel evaluation.
- While generally safe, rare cases of small bowel perforation have been reported.
Observation:
- A 58-year-old male with Crohn's Disease presented with sepsis 48 hours post-capsule endoscopy.
- CT scans indicated small bowel perforation and ischemic enteritis.
Findings:
- Ileal stricture and necrotizing ileitis were found during surgery.
- A perforation proximal to the stricture confirmed the diagnosis.
Implications:
- This case highlights the risk of small bowel perforation with capsule endoscopy.
- Emphasizes the need for pre-procedure evaluation of bowel patency, particularly in IBD patients.
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