Capsule Endoscopy:Clinical Case Vignettes

David J. Hass, MDAssistant Clinical Professor of Medicine

Yale University School of MedicineGastroenterology Center of Connecticut, P.C.

Case # 4

72 year-old male

Profuse diarrhea and night sweats

25 pound weight loss over six months

Case # 4

Slightly cachectic

Physical exam otherwise unremarkable

Case # 4

WBC 18,000 with a slight lymphocytic predominanceNormal chemistriesESR 120

Negative celiac serologiesNormal IgA level, normal chromogranin A levelNegative stool studies

Case # 4

Negative EGDNegative ColonoscopyCT scan – borderline enlarged lymphadenopathyNormal gallium scanNormal small bowel series

A capsule endoscopy was performed….

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Case # 4

Double balloon enteroscopy performed for tissue sampling

Diagnosis: Small bowel diffuse large B-cell lymphoma

Patient underwent CHOP chemotherapy with a good clinical response, dying of an unrelated cause 3 yrs after his diagnosis of lymphoma.

Case # 4Diffuse large B cell lymphoma of the small bowel is an

uncommon neoplasm. In contrast to gastric lymphoma, small bowel B cell lymphomas do not appear to be associated with H pylori.

Capsule endoscopy has proven useful for diagnosis of obscure causes of gastrointestinal illness. In this case, making the diagnosis of a mass lesion that was not found using other methods.