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 60-year-old Italian man arrived at our department with abdominal distension and acute periumbilical pain. Over the two preceding years, our patient had undergone an extensive negative workup performed for recurrent episodes of abdominal pain and diarrhea, including comprehensive blood and stool studies, CT, abdominal ultrasound, esophogastroduodenoscopy, colonoscopy, barium enema and small bowel follow-through. Twenty-four hours prior to his arrival, our patient had undergone CE, the results of which were still pending.\nOn admission, our patient was febrile. His physical examination revealed a distended abdomen with increased bowel sounds and marked tenderness in the right lower quadrant. Laboratory tests showed a white blood cell count of 16,300 cells/mL (normal: 4,500 to 10,500 cells/mL) and hemoglobin of 10.7g/dL (normal: 12g/dL to 16g/dL).\nA CT scan of his abdomen was performed and showed the presence of the capsule endoscope located in his distal ileum and a stricture along with extensive small bowel distension, a thickened bowel wall and loculated free air (Figure ). Our patient underwent an urgent laparotomy. During the surgical exploration, an ileum perforation was noted proximal to an inflammatory-like stricture located in his distal ileum (Figure ), which led to the resection of the inflamed segment with ileocolic anastomosis. Histology confirmed the diagnosis of Crohn’s disease. His postsurgical course was uneventful, and our patient was discharged 10 days later and treated subsequently with medications for Crohn’s disease with good results.