Endoscopy 2010; 42: E39
DOI: 10.1055/s-0029-1215319
Unusual cases and technical notes

© Georg Thieme Verlag KG Stuttgart · New York

Diffuse enteric ischemia due to Wegener’s granulomatosis revealed by capsule endoscopy (with video)

C.  Liatsos1 , N.  Kyriakos1 , I.  Vasilakos2 , G.  Veloudis3 , D.  Patrikos2 , C.  Fragopoulos4 , D.  Tambakopoulos1 , E.  Panagou1
  • 1Department of Gastroenterology, 401 Army General Hospital Athens, Greece
  • 2Department of Rheumatology, 401 Army General Hospital Athens, Greece
  • 3Department of Surgery, 401 Army General Hospital Athens, Greece
  • 4Department of Pathology, 401 Army General Hospital Athens, Greece
Further Information

Publication History

Publication Date:
13 January 2010 (online)

A 26-year-old man with an unremarkable medical history presented with arthralgia and abdominal pain. Two days after admission, while under investigation for multiple arthritis, he suffered hematochezia, weakness, and low blood pressure. Esophagogastroduodenoscopy showed no abnormalities, but colonoscopy and retrograde ileoscopy revealed clots of blood through the whole enteric lumen. No sign of active bleeding was found. Mesenteric angiography was normal. Capsule endoscopy was performed 2 days later and revealed findings compatible with enteric ischemia (necrotic areas of mucosa, diffuse ulceration and blood in the lumen), mainly in the ileum ([Figs. 1], [2]; [Video 1]). A few days later, due to severe deterioration of his condition (acute abdomen), the patient underwent surgery. Surgical exploration revealed intraluminal inflammation, ulcerations, and necrotic areas in several sites in the ileum, in agreement with the findings of capsule endoscopy. A partial enterectomy with ileostomy was performed. Histological examination of the resected ileum showed injuries to the enteric wall and the mesentery of the terminal ileum compatible with necrotic–granulomatous vasculitis of small and intermediate-sized vessels (Wegener’s granulomatosis) ([Figs. 3], [4]).

Fig. 1 Necrotic area of mucosa.

Fig. 2 Diffuse ulceration and blood in the lumen.

Fig. 3 A medium-sized artery in the mesentery with necrotizing vasculitis (H&E, orig. mag. × 25).

Fig. 4 At higher magnification, a Langerhans-type giant cell can be seen (H&E, orig. mag. × 100).


Quality:

Video 1 Capsule endoscopy shows findings compatible with enteric ischemia: necrotic areas of the mucosa, ulcerations, erythema, edema, and blood in the lumen of the ileum.

During the postoperative follow-up, the patient is doing well. We emphasize the role of capsule endoscopy: (i) in finding the cause of the gastrointestinal bleeding, (ii) in guiding the surgeon to surgical intervention when a serious clinical entity appeared, and (iii) in the early diagnosis of ischemic–necrotic enterocolitis even in this rare case of intestinal involvement in Wegener’s granulomatosis.

Endoscopy_UCTN_Code_CCL_1AC_2AD

    C. Liatsos, MD, PhD 

    Department of Gastroenterology, 401 Army General Hospital

    PO 833
    ZC 19009
    Rafina – Dioni
    Athens
    Greece

    Fax: +30-210-7494095

    Email: nikos_kiriakos@yahoo.gr