Cryptogenic multifocal ulcerative stenosing enteritis (CMUSE) diagnosed by retrograde motorized spiral enteroscopy

Area of Science:

• Gastroenterology
• Internal Medicine
• Pathology

Background:

• A 59-year-old woman presented with chronic abdominal pain and iron-deficiency anemia.
• Initial upper and lower gastrointestinal endoscopies were inconclusive, necessitating further investigation.

Observation:

• Wireless videocapsule endoscopy revealed an inflammatory stricture in the small bowel, leading to capsule retention.
• Retrograde motorized spiral enteroscopy identified an ulcerative stricture 60 cm proximal to the ileocecal valve.

Findings:

• Clinical, imaging, endoscopic, and histological findings were consistent with cryptogenic multifocal ulcerative stenosing enteritis (CMUSE).
• Initial treatment with budesonide enabled spontaneous capsule evacuation and symptom relief.

Implications:

• This case highlights CMUSE as a rare cause of small bowel obstruction and anemia.
• Successful management involved budesonide, with azathioprine introduced for immunosuppression but later discontinued due to pancreatitis, necessitating a return to budesonide therapy.