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 71-year-old man was admitted to the department of gastroenterology with diffuse abdominal pain. Through the previous 12 months, the patient had experienced episodes of vomiting and watery diarrhea of increasing intensity as well as weight loss. Both abdominal ultrasound and MRI had shown signs of terminal ileitis. Despite also having undergone a full colonoscopy and gastroscopy without confirmation of inflammatory bowel disease, the patient was suspected of having Crohn's disease. Six months prior to admission, the patient had swallowed a capsule endoscope, and the image feed was deemed normal.\nOn presentation, an abdominal CT-scan was performed (), showing mechanical small bowel obstruction with suspicion of metallic foreign body and perforation. Lab results showed C-reactive protein (CRP) of 204 mg/L.\nThe patient was taken to theater for a laparotomy. In the terminal ileum, approximately 5 cm from the ileocecal valve, a stenosis and a foreign body were found. Adhesions, chronic inflammation, and fibrinous cover characterized the area. A small perforation with localized fecal peritonitis was discovered near the ileocecal valve. A right hemicolectomy and distal ileectomy (60 cm) with an ileostomy were performed. On further inspection of resection, a capsule endoscope was found impacted in a stenosis (). The stenosis was histologically verified as Crohn's disease. The ileostomy was later reversed without complications.