SHM Converge Scientific Abstract ePoster Gallery-Two Birds With One Stone: Steroids as Both Treatment and Diagnostic Test for Retained Video Capsule Endoscope Due to Ileal Disease

Two Birds With One Stone: Steroids as Both Treatment and Diagnostic Test for Retained Video Capsule Endoscope Due to Ileal Disease

Back to course

Pdf Summary

This case highlights video capsule endoscopy (VCE) retention as a complication in suspected Crohn’s disease and shows how corticosteroids can serve both therapeutic and diagnostic roles.<br /><br />A 57-year-old man with rheumatoid arthritis treated with methotrexate, hydroxychloroquine, and etodolac (an NSAID) presented with acute abdominal pain, nausea, and vomiting. He had a history of recurrent abdominal pain and underwent VCE six weeks earlier for possible Crohn’s disease. The capsule revealed multiple small-bowel ulcerations but did not pass, likely because of multifocal ileal narrowing. A Medrol dose pack was tried without improvement.<br /><br />On evaluation, he had mild leukocytosis and elevated CRP. CT imaging showed partial small bowel obstruction from a distal ileal stricture proximal to the retained capsule, with additional areas of small-bowel narrowing.<br /><br />Given concern for inflammatory ileal disease, corticosteroid therapy was retried. This led to rapid clinical improvement, improved CT findings, and eventual spontaneous passage of the retained capsule. The patient was then diagnosed with Crohn’s disease and started on adalimumab.<br /><br />The case emphasizes several points: capsule retention should be considered when patients with suspected strictures undergo VCE; steroid responsiveness may suggest an inflammatory rather than fibrotic stricture; and patency capsule testing or CT enterography should be considered before VCE when strictures are suspected. While VCE is useful, retention remains the most important adverse event, and management depends on whether the obstruction is inflammatory, fibrotic, or complicated by bleeding or severe obstruction requiring surgery.

Asset Subtitle

Kidus Shiferawe

Meta Tag

Author List Claire Collins, Hirotaka Kato, Kidus Shiferawe, Omer Hamad, Savannah Ray

Category Clinical Vignettes

Concept Capsule Retention

Concept Capsule Endoscopy

Concept Small-Bowel Stricture

Concept Glucocorticoid Therapy

Concept Inflammatory Stenosis

Distinguished Non-Finalist

Presenter Organization University of Kentucky College of Medicine

Presenting Author Kidus Shiferawe

Track Adult

Keywords

video capsule endoscopy

capsule retention

Crohn's disease

small bowel obstruction

ileal stricture

corticosteroids

inflammatory stricture

patency capsule

CT enterography

adalimumab

Capsule Retention

Capsule Endoscopy

Small-Bowel Stricture

Glucocorticoid Therapy

Inflammatory Stenosis