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Gut. 2007 May; 56(5): 668.
PMCID: PMC1942158

EDITOR'S QUIZ: GI SNAPSHOT

Answer

From question on page 605

Although other imaging modalities, particularly barium x ray studies, are normally used to evaluate the small bowel, in this case ultrasonography plays an interesting part in that it is able to detect some pathological features such as wall thickening, loop dilatation, localised peritoneal fluid and mesenteric lymphoadenopathy. The ultrasonographic findings are not pathognomonic, but taken together with the clinical context and biological tests may lead to a suspicion of a malabsorption condition.

Capsule endoscopy was performed because gastrointestinal complaints were persistent and suggestive of enteropathy. Capsule endoscopy showed swollen mucosa at the proximal small intestine (fig 1A,B1A,B);); moreover, it highlighted some whipworms in the terminal ileo‐caecal valve, with the appearance of Trichuris trichiura, one of the major nematode species affecting the human bowel; the mucosa in the caecal region was patchily erythematous (fig 1C,D1C,D).). The videocapsule had temporarily followed slow and whip‐like movements of some worms.

figure gt95224a.f1
Figure 1 Capsule endoscopy showed swollen mucosa in the proximal small intestine (A,B); moreover, it captured some images in the terminal ileo‐caecal valve, where there were whipworms with the appearance of Trichuris trichiura, one of ...

The patient was treated with a course of mebendazole and short‐term iron supplementation, showing rapid clinical improvement.

According to the literature, diarrhoea is an occasional complaint of patients with intestinal nematode infection. Despite repeated negative coproparasitologic examination and although alternative explanations for the anaemia and chronic diarrhoea were sought, none was found apart from intestinal nematode infection, which also explains the hypereosinophilia.

Thus, capsule endoscopy may be decisive in the management of patients with inexplicable chronic diarrhoea.


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