Case report: caught by the pill cam…literally

Area of Science:

• Gastroenterology
• Oncology
• Radiology

Background:

• Small bowel obstruction is a common surgical issue, often caused by adhesions in patients with prior abdominal surgeries.
• Conservative management is typical, but computed tomography (CT) scans can miss intra-abdominal pathologies.

Observation:

• A patient with prior surgery presented with an atypical small bowel obstruction, initially managed non-operatively based on CT findings.
• The patient re-presented with hematochezia after a pill-cam procedure, and subsequent imaging revealed a new small bowel mass.

Findings:

• The small bowel mass, not visible on prior imaging, was confirmed during a diagnostic laparoscopy.
• Pathology identified the mass as recurrent renal cell carcinoma.

Implications:

• This case underscores the limitations of CT scans in diagnosing all intra-abdominal pathologies.
• It emphasizes the need for thorough investigation and consideration of unusual diagnoses, such as metastatic disease, in patients with recurrent or atypical symptoms.
• Early detection and appropriate management of missed diagnoses are crucial for patient outcomes.