Capsule Endoscopy for Suspected Small Bowel Bleeding in Patients with Portal Hypertension

BACKGROUND/AIMS: In Korea, limited data are available on small bowel bleeding in patients with portal hypertension. This study reports on the use of capsule endoscopy in cases of suspected small bowel bleeding in patients with portal hypertension. METHODS: Capsule endoscopy was used at our hospital to evaluate small bowel disease in 501 cases from July 2003 to June 2010. Of those cases, nine patients with portal hypertension due to liver cirrhosis with suspected small bowel bleeding were selected for the study. A retrospective analysis was performed using data from medical records. RESULTS: Six of the nine (66.7%) patients were males with an average age of 53.4 years. The average hemoglobin level was 8.1 g/dL. Abnormalities noted during capsule endoscopy included portal hypertensive enteropathy in all nine cases (100%), jejunal varices in four (44.4%), jejunal and ileal angiodysplasia in five (55.5%), multiple small bowel erosions in one (11.1%), granularity of the jejunal mucosa in one (11.1%), and small bowel erythema in three (33.3%). Active bleeding from jejunal varices was detected in two patients (22.2%). Despite having no obvious active bleeding during the capsule endoscopy, four patients (44.4%) were diagnosed with portal hypertensive enteropathy with obscure small bowel bleeding. CONCLUSIONS: Capsule endoscopy is a useful diagnostic tool for the evaluation of small bowel bleeding in patients with portal hypertensive enteropathy. Additional prospective and multicenter studies on the use of capsule endoscopy are needed to evaluate the incidence and clinical importance of portal hypertensive enteropathy.

A Case of Transient Small Intestinal Intussusceptions in an Adult / 대한소화기내시경학회지

Intussusception occurs when a segment of the bowel invaginates into the lumen of an adjacent distal segment. Intussusception in adults is a rare disease, accounting for only 5% of all cases. Asymptomatic small bowel intussusception in adults without a lead point is usually transient. When the length of the intussusception is less than 3.5 cm, it can be managed conservatively. This case was an asymptomatic small bowel intussusception without a lead point, which was discovered incidentally during an abdominal computed tomography scan. Spontaneous reduction in the intussusception was observed without any complications while maintaining conservative treatment only.

A Case of Pneumatosis Cystoides Intestinalis in Which Endoscopic Ultrasonography Was Useful for the Diagnosis / 대한소화기내시경학회지

Pneumatosis cystoides intestinalis (PCI) is an uncommon condition in which submucosal or subserosal gas cysts are present within the bowel wall. We report a case of a 37-year-old man with no medical history. He underwent a colonoscopy for screening purposes, which revealed multiple and variably sized submucosal tumors in the ascending colon. Endoscopic ultrasonographic (EUS) finding showed multiple hyperechogenic regions with distal acoustic shadowing within the submucosa of the ascending colon. A computed tomography scan showed multiple air-filled cystic masses in the ascending colon. EUS appears to be effective for the diagnosis of PCI.