University of Mississippi Medical Center Jackson, MS, United States
Kane Edwards, MD, Adam M. Parker, MD, Pegah Hosseini-Carroll, MD University of Mississippi Medical Center, Jackson, MS
Introduction: Historically, visualization of the small bowel (SB) was a challenging task. Today, current technology has innovated the field of gastroenterology and its reach throughout the gastrointestinal (GI) tract. Video capsule endoscopy (VCE) was developed to diagnose and evaluate conditions such as iron deficiency anemia (IDA), GI bleeds, Crohn’s disease, and malignancy. However, additional applications continue to emerge in clinical practice.
Case Description/Methods: A 41-year-old male with a ventricular thrombus on anticoagulation presented to the hospital with dizziness, dyspnea, and melena. Vitals signs and physical exam were benign. Labs were remarkable for IDA with a hemoglobin of 4.8 g/dL and platelet count of 28 TH/cmm. The patient received multiple transfusions and anticoagulation was held, after discussion with cardiology. Hemodynamics and blood counts remained stable. Gastroenterology was consulted for suspected GI bleeding and recommended bidirectional endoscopy. The patient tested positive for coronavirus. Due to stability and a suspected chronic process, the patient was started on a proton pump inhibitor and endoscopy was delayed until the patient convalesced.
Endoscopy was unremarkable for any source of anemia. Gastric biopsies demonstrated growth of Helicobacter heilmannii. VCE was scheduled due to ongoing melena, without a definitive source. VCE was remarkable for nonbleeding angioectasias in the SB and a live hookworm (HW) embedded into the SB mucosa with bleeding. Stool ova and parasite exams were negative x3. The patient was started on quadruple therapy along with albendazole.
Discussion: VCE has limitations, but it can aid in diagnoses. Angioectasias may be contributing to this patient’s IDA, but a visualized HW on VCE warrants treatment. HW can cause anemia due to blood loss and consumption along with nutritional deficiencies. This patient had severe IDA but lacked systemic eosinophilia which normally peaks 5-6 weeks after infection. The ova/parasite exam was also negative; however, this test is insensitive. After treatment and iron replacement, counts continued to improve without further transfusions. Recent guidelines state that iron supplementation is an acceptable treatment for IDA without an etiology on endoscopy. However, this patient likely would not have improved with iron alone and would have required VCE. The ongoing melena triggered the VCE which led to a definitive diagnosis for blood loss and earlier resolution to the problem.
Disclosures: Kane Edwards indicated no relevant financial relationships. Adam Parker indicated no relevant financial relationships. Pegah Hosseini-Carroll indicated no relevant financial relationships.
Kane Edwards, MD, Adam M. Parker, MD, Pegah Hosseini-Carroll, MD. P2597 - Capsule Endoscopy: An Unexpected Find in the United States, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.