David J. Hass, MDAssistant Clinical Professor of MedicineYale University School of MedicineGastroenterology Center of Connecticut, P.C.

Case

30 year-old male

Recurrent abdominal pain and loose stools

WBC 12. Hct 31. CRP 14.

Stool studies negative

Case

Appears well, but fatigued.

Lungs clear to auscultation, normal cardiac exam

Hyperactive bowel sounds, right lower quadrant tenderness and minimal guarding

Exam otherwise unremarkable

Case

CT scan revealing for thickened proximal ileal loop

Colonoscopy negative with deep ileal intubation

Small bowel series negative

Case

Capsule endoscopy performed.

Case

Capsule endoscopy revealed:Apthous ulcerationsCongested mucosaHemorrhagic mucosa

Findings consistent with small bowel Crohns Disease

Case

Patient initiated on budesonide 9 mg daily

Considerable improvement with complete resolution of abdominal pain.

CBC normalized

Case

Capsule endoscopy is superior to conventional techniques for early detection of Crohns disease.

By early detection of small bowel lesions, CE can lead to earlier diagnosis and treatment, resulting in improved quality of life.

References

Gastrointestinal Endoscopy 2006;63(4):539-545.

Triester et al. Am J Gastroenterol 2006;101:954-964.

Faigel, DO and Cave, DR. Capsule Endoscopy. 2008 Elsevier Inc:91-104.