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.
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.