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

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

Publication History

Publication Date:
13 January 2010 (online)

Table of Contents

    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]).

    Zoom Image

    Fig. 1 Necrotic area of mucosa.

    Zoom Image

    Fig. 2 Diffuse ulceration and blood in the lumen.

    Zoom Image

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

    Zoom Image

    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

        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

        Zoom Image

        Fig. 1 Necrotic area of mucosa.

        Zoom Image

        Fig. 2 Diffuse ulceration and blood in the lumen.

        Zoom Image

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

        Zoom Image

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