Wednesday, April 27, 2005

The Answer

Dr. Bard Parker and Mr. McGinni were correct -- this is a small bowel endoscopy camera ("pill camera"), not usually seen on abdominal X-Rays. It is used to visualize the vast area of the small bowel, previously difficult to visualize endoscopically. This lady's story, however, is a bit more complicated.

After an upper endoscopy, which was relatively normal, the small bowel endoscopy camera study was recommended and performed about 6 months ago. The findings were pretty nonspecific, but she does not remember passing the camera. She eventually made her way to an enteroclysis (a very thorough X-Ray study of the small bowel), where this little guy was seen sitting in the distal ileum, bumping up against the first of five radiation-induced small bowel strictures beyond which it could not pass. The appearance of the bowel proximal to this was unremarkable, and I suspect that the stricture looked fairly similar to the ileocecal, it appeared like a normal study. Because patients have this procedure done as an outpatient, it is unusual to have any radiographic study which shows the capsule, so the radiologists may misinterpret the picture as showing something outside the abdominal cavity.