A 58-year-old Caucasian male with a reported 30 year history of CD presented to his gastroenterologist with intermittent diarrhea controlled by bismuth subsalicylate (Kaopectate). He denied any recent flares or pharmacologic management. A colonoscopy was negative for classical findings of CD and the patient next underwent WCE to document possible disease in the SB. On the evening of the procedure the patient reported poorly localized abdominal pain and copious non-bilious/non-bloody emesis. Over the next 48 hours he experienced progressive abdominal distention and presented to the Emergency Department. He denied the chronic use of NSAIDs or a history of prior abdominal operations.\nOn admission the patient was febrile, tachycardic and tachypneic. He also presented with severe hypotension requiring vasopressors. His physical exam was positive for icteric sclera, a distended abdomen with increased bowel sounds, and marked tenderness in the right lower quadrant. He had a WBC of 13.9 × 109/L (4.5-11.0 × 109/L) and platelet count of 79 × 109/L (150-450 × 109/L). His creatinine was 203.3 umol/L (58-111 umol/L) and total bilirubin was 171 umol/L (3-22 umol/L). A CT scan of the abdomen/pelvis revealed a capsule endoscope located near the terminal ileum along with diffusely thickened bowel wall, fat stranding in the right lower quadrant, hemorrhagic ascities and loculated free air (), reported as ischemic enteritis and SB perforation.\nAfter adequate resuscitation the patient was taken to the operating room where an ileocecectomy was performed, including removal of 160 cm of SB. The capsule endoscope found just proximal to the stricture. Given the patient’s hemodynamic instability the abdomen was initially closed with a 2 mm GORE-TEX (WL Gore & Associates Inc., Flagstaff, AZ) patch and loose suture. He required 12 subsequent operations for various complications and was discharged after 1 month with an ileostomy and colostomy. Pathology of the resected specimen showed an ileal stricture 15 cm proximal to the ileocecal valve, with associated necrotizing ileitis. A perforation was noted just proximal to the stricture where the capsule endoscope was found.
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.