A 63-year-old female presented with iron-deficiency anaemia (haemoglobin 44 g/L, ferritin 190 mcg/L). After unremarkable upper and lower gastrointestinal endoscopies and biopsies, she was referred for wireless capsule endoscopy (WCE).\nThe WCE study demonstrated an area of ulceration and stenosis in the distal jejunum. The capsule failed to pass the pathology within the duration of the capsule's battery life (approximately 14 hours). Four days following ingestion, the patient presented with 48 hours of increasing generalised abdominal pain and nausea, but no vomiting. She had a mild fever of 37.8°C. On examination, the abdomen was distended and tympanic on percussion and generally tender, but there was no guarding. A plain abdominal X-ray () demonstrated multiple dilated loops of small bowel and air-fluid levels, suggestive of a small bowel obstruction. The wireless capsule can be seen in the left lower quadrant of the abdomen. A computed tomography (CT) scan of the abdomen () demonstrated the wireless capsule in the distal ileum, 15 cm proximal to the ileocaecal junction with evidence of perforation at this level. There was diffuse thickening of the terminal ileum distal to site of perforation.\nAt laparotomy, there was four-quadrant feculent peritonitis. The site of terminal ileum perforation was on the antimesenteric border, 15 cm from the ileocaecal valve, with the wireless capsule in situ (). There was a 5 cm segment of markedly thickened ileum distal to the site of perforation. The resected specimen was histologically consistent with Crohn's disease. The patient recovered well and was discharged from hospital five days after her operation.
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.