A 74-year-old man with hypertension, old cerebral infarction, and alcoholic liver disease was referred to our hospital for intermittent abdominal pain around the navel. A physical examination revealed tension of the abdominal wall. His body temperature was 36.6 °C and weight and height were 71 kg and 166 cm, respectively. Laboratory results indicated the following: hemoglobin 10.7 g/dL, white blood cells 8,200/μL, C-reactive protein 0.89 mg/dL, and albumin 2.4 g/dL. Results from a kidney function test and clotting function examination were within the normal range. His history revealed that at the age of 71, he had been hospitalized for suspected infectious enteritis, as an abdominal computed tomography (CT) scan showed multiple wall thickness of the ileum. Because treatment with antibiotics proved successful, a close examination was not performed at that time. Though esophagogastroduodenoscopy results were unremarkable at this time, an abdominal CT scan showed the same observation previously (Fig. ). For further evaluation of the small bowel, capsule endoscopy was recommended.\nThe patient ingested a novel tag-less AgileTM patency capsule (Given Imaging Ltd., Yoqneam, Israel) for the evaluation of intestinal stenosis prior to capsule endoscopy. Eighteen hours after ingestion, he was referred to our hospital because of progressive abdominal distention and worsening terrible abdominal pain. The physical examination revealed marked tenderness. Laboratory tests indicated a white blood cell count of 25,000/μL. A CT scan showed the patency capsule trapped in his terminal ileum and intraperitoneal air (Fig. ). Emergent surgery was performed. During the surgical exploration, an ileum perforation was found proximal to the stricture of the terminal ileum in which the patency capsule was impacted (Fig. ). The sclerotic change of the ileum was recognized at 100-cm length from the ileocecal valve. An ileocolic resection, including the removal of the sclerotic ileum, was performed at this time (Fig. ). Pathological examination of the surgical specimen showed transmural inflammation and multiple ulcers with perforation of the small intestine, consistent with Crohn's disease. Following the operation, the condition of the patient's Crohn's disease has improved and is well controlled with drug therapy.
A 55-year-old Italian woman was referred to our division when she complained of severe cramping abdominal pain and vomiting approximately 36 hours after ingestion of a capsule endoscope.\nOver the preceding years, she had undergone an extensive workup for recurrent postprandial cramping pain and iron deficiency anemia, including an abdominal ultrasound, upper endoscopy, colonoscopy and small bowel follow-through radiograph, all of which showed negative results. The physical examination on her admission revealed a mildly distended abdomen with increased bowel sounds. Laboratory tests showed normal results except for a red blood cell count of 3.15 million/mL (normal: 4.0 million to 5.4 million/mL) and hemoglobin of 9.8g/dL (normal: 12g/dL to 16g/dL). A plain abdominal film demonstrated a retained capsule in her small bowel without clear-cut signs of bowel obstruction. The endoscopist obtained images from the CE revealing a suspected neoplastic-like stricture in her mid-small bowel (Figure ). Over the following 24 hours, our patient experienced progressive abdominal distention, worsening abdominal pain and vomiting, as well as development of leukocytosis. A computed tomography (CT) scan was then performed showing that the capsule was trapped in her proximal ileum, and that there was extensive small bowel dilatation along with free peritoneal air (Figure ). Our patient underwent an urgent laparotomy during which an ileal perforation was found (Figure ) proximal to a neoplastic-like stricture in the mid-ileum. An ileal resection with end-to-end anastomosis was therefore performed. Her postoperative course was uneventful, and our patient was discharged seven days later. Pathology confirmed the diagnosis of a well-differentiated ileal adenocarcinoma penetrating the entire wall and the mesentery, without lymph node invasion. Eleven months later, our patient had been treated with chemotherapy and was feeling generally well.