Capsule Endoscopy for Refractory Iron Deficiency Anemia in Crohn’s Disease: Captivating Pathology, Hybrid Therapy

Published:February 04, 2018DOI:
      Question: A 34-year-old woman with a history of Crohn’s disease and a 100-cm terminal ileal resection for bowel obstruction 11 years prior was referred to the gastroenterology clinic for evaluation of treatment-refractory iron deficiency anemia. She endorsed having 1 formed bowel movement daily and denied abdominal pain, blood in stool, nausea, vomiting, fever, or chills. She was previously treated with 6-mercaptopurine, but this was discontinued 1 year prior secondary to leukopenia. Recent esophagogastroduodenoscopy and colonoscopy were both unremarkable, and an abdominal radiograph 3 months prior showed fecal material throughout the colon, without dilated loops of bowel or other abnormalities. Video capsule endoscopy was, therefore, performed to assess for occult bleeding in the small bowel, with the final capsule image shown in Figure A. Two weeks later, the patient developed acute abdominal pain, and a computed tomography scan of the abdomen and pelvis was obtained (Figure B).
      To read this article in full you will need to make a payment
      AGA Member Login
      Login with your AGA username and password.
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Li F.
        • Gurudu S.R.
        • De Petris G.
        • et al.
        Retention of the capsule endoscope: a single-center experience of 1000 capsule endoscopy procedures.
        Gastrointest Endosc. 2008; 68: 174-180
        • Mishkin D.S.
        • Schroy P.C.
        Double-balloon endoscopy: extending the arm of the gastroenterologist.
        Gastroenterology. 2006; 131: 969-971
        • Enns R.A.
        • Hookey L.
        • Armstrong D.
        • et al.
        Clinical practice guidelines for the use of video capsule endoscopy.
        Gastroenterology. 2017; 152: 497-514