Digestive and Liver Disease - Volume 48 - Supplement 2

Abstracts of the 22

National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231

e147

percentage perforate the bowel, leading to acute abdomen and

requiring surgical intervention. Foreign bodies such as dentures,

fish bones, chicken bones, toothpicks and cocktail sticks have been

known to cause bowel perforation

Impaction, perforation, or obstruction often occurs at GI angulations

or narrowing. Hence, patients with previous GI tract surgery or

congenital gut malformations are at increased risk

Material and methods:

We report the case of a 75 years-old male

patient without previous surgery presented with intermittent

abdominal cramps and diarrhea of 2 months’ duration. Two months

earlier, he had also experienced hematochezia on three occasions.

On physical examination, bowel sounds were normal and there

was no abdominal organ enlargement, tenderness, or rebounding

pain. Digital rectal examination was unremarkable. Physical

examination showed a diffuse tenderness of abdomen without

defense. Clinical and biochemical data were negative. An x-ray of

the abdomen showed in hypogastrium a calcific body compatible

with bone fragment that was projected at the level of the sigmoid

colon. Excluded perforation we proceeded to recto-sigmoidoscopy

previous preparation with macrogol.

Results:

At 25 cm from the anal verge, the mucosa was edematous

and hyperemic and an impacted foreign body was present. We

proceeded to remove it using biopsy forceps, a silk tie was looped

around the impacted bone and then gently pulled caudally as it

exited the anus. No evidence of perforation or other complications

except presence of one pressure ulcer on the mucosal wall. After

removal of the bone, the patient became asymptomatic without any

residual symptom.

Conclusions:

It is therefore described a case in which poorly

suggestive symptoms and a non-specific examination has allowed

early detection and to target a targeted endoscopy with a rapid

resolution of symptoms. Our patient was not aware of the ingestion

of the foreign body.

Osseous esophageal foreign bodies are potentially dangerous as

the risk perforation always exist. Safe extraction or dislodgment

of an osseous foreign body can almost always be performed with

the endoscope stating an adequate preliminary evaluation and the

selection of proper equipment. After recognition of the impacted

foreign body, the patient was managed endoscopically with

resolution of symptoms.

P.05.2

FIRST CASE OF SMALL BOWEL ADENOCARCINOMA DETECTED

WITH THE NEW 360° PANORAMIC-VIEWING CAPSULE

ENDOSCOPY SYSTEM

Marino R.*

, Tontini G.

, Lumachi V.

, Gendarini A.

, Leoni P.

Gastroenterology and Digestive Endoscopy Unit, AO Lodi,

Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San

Donato, Milano, Italy,

Gastroenterology and Digestive Endoscopy,

IRCCS Policlinico San Donato, Milano, Italy

Background and aim:

Small bowel tumors (SBT) are rare, accounting

for only 1-3% of all gastrointestinal neoplasms [1]. Nonetheless,

among patients undergoing small bowel capsule endoscopy (SBCE),

neoplastic lesions can be detected in 2-9% of cases [2,3]..

Material and methods:

Here, we report the case of a 52 years

old outpatient presented for iron deficiency anaemia (Hb 7,4 g/dl,

ferritin 7 ng/ml), asthenia and dark discharge stools occurred after

oral intake of non-steroidal anti-inflammatory drugs without any

gastroprotection.

An immediate esophagogastroduodenoscopy showed antral ero

sive gastritis with no evidence of Helicobacter pylori infection

and subsequent ileo-colonoscopy was negative. Overt bleeding

stopped spontaneously and patient received medical treatments

based on proton pump inhibitors (esomeprazole 40 mg/24h) and

iron supplement. One month later, blood tests revealed persistent

iron deficiency anaemia (Hb 9 g/dl, MCV 72 fL, ferritin 10 ng/ml)

and positive fecal occult bleeding tests (3/3 samples). Therefore,

SBCE was performed using the newly introduced CapsoCam® SV1

(CapsoVision Inc, Saratoga, USA).

Results:

The SBCE explored the entire small bowel and the video

image quality always scored as optimal. The lateral view allowed a

clear visualization of an ulcerated nonbleeding lesion with central

depression in the proximal jejunum (fig A). The following

enteroscopic inspection confirmed the lesion site and the

macroscopic appearance (fig B). Histological analysis lead to the

diagnosis of adenocarcinoma and to surgical resection.

Conclusions:

The newly introduced CapsoCam® SV1 is a wire-free

device for SBCE with long lasting battery life, and 12-20 frames per

second captured by four lateral cameras to enable a 360° panoramic

view of the entire small bowel [4,5]. CapsoCam® SV1 has a detection

rate and a safety profile comparable to other SBCE with frontal view

in patients suffering from obscure gastro-intestinal bleeding or

with suspected Crohn disease [4-6]. This represents the first case of

jejunal adenocarcinoma discovered with Capsocam® SV1. Further

study should now evaluate the role of CapsoCam® SV1 as a new

standard in patients suspected for to have SBT.

References

1. Neugut A, et al. Cancer Epidemiol Biomarkers Prev 1999; 7:243-51

2. Cobrin GM, et al. Cancer 2006;107:22-27

3. Rondonotti E, et al. Endoscopy 2008; 40 (6): 488-495

4. Pioche M, et al. Endoscopy 2014 ; 46(6) : 479-84

5. Friedrich K, et al. J Gastroenterol Hepatol 2013 ; 28(9):1496-501

6. Tontini GE, et al. Accepted abstract UEG Week 2015

P.05.3

A RARE CASE OF GASTROINTESTINAL BLEEDING

Padula D.*, Lenti M.V., De Quarti A., Biagi F., Carnevale Maffe’ G.,

Alvisi C., Miceli E., Corazza G.R.

IRCCS Fondazione Policlinico San Matteo, Pavia, Italy

Background and aim:

A 48 old male was admitted to our clinic

for investigate a recurrent low gastrointestinal pain. In 2013 he

presented an episode of important lower gastrointestinal bleeding

causing severe anaemia which subsided spontaneously. In that

occasion a colonoscopy showed dilated tortuous sub-mucosal

veins through the entire explored tract (until the trasverse colon).

A contrast abdominal TC excluded vascular stenosis. Two sessile

polyps found in the sigma were excised in a second time, the

histology revealed a tubular adenoma with severe dysplasia. A