Capsule endoscopy was recently introduced for endoluminal visualization of the small
bowel [1]. The clinical utility of the procedure is undisputed [2]
[3]
[4], and for most patients, swallowing the capsule (11 × 33 mm in size) does not pose
any problems. However, use of the capsule in small children has not yet been reported.
A 3-year-old boy was admitted to our hospital with chronic iron-deficiency anemia
and tarry stools. The hemoglobin level had ranged from 3.4 to 10.3 over a 2-year period,
despite continuous iron replacement therapy. Upper and lower endoscopy, computed tomography
of the abdomen, Meckel scintigraphy, and a small-bowel follow-through had all been
unremarkable.
Capsule endoscopy was carried out with the patient under general anesthesia. The capsule
was grasped in a polypectomy snare through the endoscope and pushed through the upper
esophageal sphincter. The capsule was placed in the duodenal bulb, to avoid the risk
of gastric retention of a capsule this size. After 54min (approximately 30min after
release), a large polypoid tumor without ongoing bleeding was clearly visualized (Figure
[1]). The rest of the small bowel was normal, with passage of the cecum after a total
time of 4 min 50 s.
Figure 1 Capsule image showing a polypoid lesion in the jejunum, causing partial obstruction
of the lumen.
Based on the capsule endoscopy finding, a minilaparotomy was performed, and a tumor
17 × 15 mm in size was found and resected in the suspected part of the jejunum, 100
cm from the ligament of Treitz (Figure [2]). Histology showed that the lesion consisted of hamartomatous tissue, without no
sign of malignancy. The postoperative course was uneventful, with no recurrence of
anemia.
Figure 2 The resected specimen, a 17 × 15 mm hamartomatous polyp.
This case illustrates the feasibility of capsule endoscopy even in small children,
using an endoscope to insert the capsule. It also shows the low sensitivity of small-bowel
follow-through studies in detecting small to moderate-sized tumors in the small bowel.
