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Retained capsule endoscope leading to the identification of small bowel adenocarcinoma in a patient with undiagnosed Crohn disease

Authors
Journal
Annals of Diagnostic Pathology
1092-9134
Publisher
Elsevier
Publication Date
Volume
13
Issue
6
Identifiers
DOI: 10.1016/j.anndiagpath.2009.06.011
Keywords
  • Crohn Disease
  • Intestinal Neoplasms
  • Adenocarcinoma
  • Capsule Endoscopy
Disciplines
  • Biology
  • Medicine

Abstract

Abstract Small intestinal neoplasia is a rare condition that frequently presents a diagnostic challenge. We describe the case of a 70-year-old patient who presented with several years of chronic, intermittent abdominal pain, previously diagnosed as irritable bowel syndrome. Radiographic evaluation, including upper gastrointestinal series with small bowel follow-through and computed tomography, demonstrated dilated small bowel with possible strictures. Colonoscopy and upper endoscopy were unrevealing. Attempted capsule endoscopy resulted in capsule retention. Subsequent laparoscopy led to the identification of severe, active Crohn disease with strictures, ulcers, crypt abscesses, pyloric metaplasia, and transmural inflammation. Extensive flat and polypoid high- and low-grade dysplasia were present, as well as an area of well-differentiated adenocarcinoma invading into the muscularis propria. We discuss the epidemiology, pathogenesis, and diagnosis of small bowel malignancy.

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