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'Pill cam' related small bowel perforation

Case contributed by Dr Andrew Dixon

Presentation:

Patient with known Crohn's disease presents with acute abdominal pain 3 days following ingestion of a 'Pill Cam' (video capsule endoscopy).

Patient Data:

Age: 45
Gender: Female
Modality: X-ray

A dense metallic radio-opaque foreign body is seen in the right hemipelvis. 

Modality: CT

Metal containing 'Pill Cam' is seen within the small bowel at the proximal margin of a segment of terminal ileal Crohn's disease. There are locules of gas seen outside the bowel adjacent to the Pill Cam consistent with perforation. There is also a pocket of free gas seen laterally in the right iliac fossa and a small volume of free fluid. Proximal to the Pill Cam there is faeculent appearing material within the small bowel which is mildly dilated with multiple air-fluid levels consistent with at least partial small bowel obstruction

Case Discussion:

Rare case of small bowel perforation related to a pill cam becoming obstructed at the proximal margin of a segment of terminal ileitis. 

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