The use of video capsule ileoscopy in pediatric patients is becoming more common.
The technique has been used in cases of obscure small-bowel bleeding, polyposis, Crohn’s
disease, and, occasionally, to investigate the anatomical anomalies of the gastrointestinal
tract that are typically encountered in this age group [1]
[2].
We report here the case of a 15-year-old patient with symptoms characteristic of intestinal
bleeding and severe anemia, who required repeated transfusions. The hematochemical
parameters (erythrocyte sedimentation rate, CRP (c-reactive protein), antineutrophil
cytoplasmic antibodies, anti-Saccharomyces cerevisiae antibodies (ASCA), antiendomysium antibodies, and the transglutaminases), and esophagogastroduodenoscopy
and colonoscopy examinations, including histology, were normal.
Suspecting a Meckel’s diverticulum, a scintigraphic evaluation was performed, which
showed an accumulation of tracer in the gastric area, anomalously located at the level
of the hypochondrium on the right side. Video capsule endoscopy revealed a small umbilicated
mass projecting into the lumen at the level of the mid-ileum (Figure [1]). At surgery, the young patient was found to have intestinal duplication associated
with intestinal malrotation (Figure [2]), and the diagnosis was subsequently confirmed histologically (Figure [3]).
Figure 1 A video capsule image showing an umbilicated mass projecting into the lumen at the
level of the mid-ileum.
Figure 2 The surgical specimen, showing an intestinal duplication. The communication between
the intestinal lumen and the duplication is clearly visible.
Figure 3 Histological view showing intestinal mucosa, with typical villi, on the left-hand
side, and gastric mucosa on the right.
Ileoscopy using a video capsule is a well-known technique for the investigation of
adult patients, but it can also be used in the pediatric age group. It is a very useful
tool for the diagnosis of jejuno-ileal disease (e. g. polyposis, Crohn’s disease,
Meckel’s diverticulum) due to its high sensitivity and specificity in comparison with
traditional radiological techniques. A uniform iconography should be adopted for a
better endoscopic definition of these diseases, which, though rare, can be clearly
detected using the video capsule technique [3].
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