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Gut. 2007 April; 56(4): 488.
PMCID: PMC1856859

EDITOR'S QUIZ: GI SNAPSHOT

Answer

From the question on page 463

Capsule endoscopy revealed mucosal ulcers in an area where the capsule showed retention for several hours before passing through. The ulcerations were assumed to be related to the site of the anastomosis. In the remaining small bowel, no ulcers were seen. The differential diagnosis included Crohn's disease, but a recent ileocolonoscopy had been normal. The possibility of NSAID enteropathy was considered, but NSAID use was denied. Surgery was subsequently performed. The anastomosis was resected with histological examination of the resected specimen (fig 11).). Pathology reports confirmed the presence of mucosal ulcers without evidence of other causes such as Crohn's disease. Following an uneventful recovery, haemoglobin levels gradually returned back to normal without iron supplementation over a period of 6 months. After 12 months of follow‐up, the patient was asymptomatic and independent of iron supplementation and blood transfusion.

figure gt97063a.f1
Figure 1 Histopathology of the resected specimen, showing non‐specific ulceration adjacent to normal jejunum. (A) magnification 25×; (B) magnification 100×.

In patients with previous bowel surgery in infancy peri‐anastomotic ulcerations can occur (probably of ischaemic origin), which may present only with obscure gastrointestinal bleeding. The diagnosis can be made by video capsule endoscopy and/or double‐balloon enteroscopy.


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