Acute small bowel perforation after wireless capsule endoscopy in a patient with Crohn's disease: a case report
1 Department of Internal Medicine, University of California Davis Health System, 4860 Y Street, Sacramento, California 95817, USA
2 Department of General Surgery, University of California Los Angeles Medical Center, 200 UCLA Medical Plaza, Los Angeles, CA 90095, USA
3 Department of Gastroenterology, University of California Irvine Medical Center, 101 The City Drive, Orange CA 92868, USA
Cases Journal 2009, 2:7607 doi:10.4076/1757-1626-2-7607Published: 31 July 2009
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.
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.
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.