Endoscopy 2002; 34(7): 588-590
DOI: 10.1055/s-2002-33209
Case Report
© Georg Thieme Verlag Stuttgart · New York

Wireless Capsule Endoscopy in a Patient with Obscure Occult Bleeding

M.  Hahne1 , H.  E.  Adamek1 , D.  Schilling1 , J.  F.  Riemann1
  • 1Dept. of Gastroenterology, Ludwigshafen Hospital (Academic Hospital of the University of Mainz), Ludwigshafen, Germany
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Publikationsverlauf

Submitted 16 October 2001

Accepted after Revision 22 January 2002

Publikationsdatum:
12. August 2002 (online)

A case of obscure/occult bleeding in a 39-year old man with a 7-year history of chronic fatigue and iron-deficiency anemia is presented here. Esophagogastroduodenoscopy, push enteroscopy, ileocolonoscopies, and a magnetic resonance imaging small-bowel follow-through did not reveal any abnormalities. Multiple inflammatory lesions with fibrin-covered ulcers and petechial bleeding in the area of the lower jejunum and ileum were diagnosed only with capsule endoscopy. One ulcer located near the ileocecal valve was then biopsied during a repeat ileocolonoscopy, and the histology showed signs of Crohn's enteritis. The further treatment approach was changed, with medical treatment being initiated and intraoperative enteroscopy being averted. Wireless capsule endoscopy clarified the cause of the obscure/occult bleeding in this patient and contributed to the diagnosis and endoscopic imaging of an isolated Crohn's enteritis, which is the cause of bleeding in approximately 10 - 20 % of cases of occult bleeding.

References

  • 1 Appleyard M, Fireman Z, Glukhovsky A. et al . A randomized trial comparing wireless capsule endoscopy with push enteroscopy for the detection of small bowel lesions.  Gastroenterology. 2000;  119 1431-1438
  • 2 Appleyard M, Glukhovsky A, Swain P. Wireless capsule endoscopy for recurrent small bowel bleeding.  N Engl J Med. 2001;  344 232-233
  • 3 Riemann J F, Martin W R. Morbus Crohn. In: Hahn EG, Riemann JF (eds) Klinische Gastroenterologie. 3rd ed. Stuttgart, New York; Thieme 1996: 887
  • 4 Homan W P, Tang C K, Thorbjarnarson B. Acute massive hemorrhage from intestinal Crohn's disease: report of seven cases and review of the literature.  Arch Surg. 1976;  111 901-905
  • 5 Ray G, Banerjee P K, Ghoshal U C. et al . Etiology and management of obscure gastrointestinal bleed: an appraisal from eastern India.  Indian J Gastroenterol. 2001;  20 90-93
  • 6 Lopez M J, Cooley J S, Petros J G. et al . Complete intraoperative small-bowel endoscopy in the evaluation of occult gastrointestinal bleeding using the sonde enteroscope.  Arch Surg. 1996;  131 272-277

J. F. Riemann, M.D.

Dept. of Internal Medicine C · Ludwigshafen Hospital

Bremserstrasse 79 · 67063 Ludwigshafen · Germany

Fax: + 49-621503-4114

eMail: MedCLu@t-online.de