Successful Wireless Capsule Endoscopy for a 2.5-Year-Old Child: Obscure Gastrointestinal Bleeding From Mixed, Juvenile, Capillary Hemangioma-Angiomatosis of the Jejunum

• Published in: Pediatrics (Evanston) 2006-02, Vol.117 (2), p.539-543
• Main Authors: Kavin, Hymie, Berman, James, Martin, Thomas L, Feldman, Ansley, Forsey-Koukol, Kimberly
• Format: Article
• Language: English
• Subjects: Angiomatosis - complications; Angiomatosis - diagnosis; Angiomatosis - pathology; Angiomatosis - surgery; Biological and medical sciences; Capsules; Care and treatment; Child, Preschool; Children & youth; Digestive system; Digestive system. Abdomen; Endoscopes, Gastrointestinal; Endoscopy; Endoscopy, Gastrointestinal; Female; Gastrointestinal bleeding; Gastrointestinal hemorrhage; Gastrointestinal Hemorrhage - etiology; General aspects; Hemangioma, Capillary - complications; Hemangioma, Capillary - diagnosis; Hemangioma, Capillary - surgery; Hemorrhage; Humans; Investigative techniques, diagnostic techniques (general aspects); Jejunal Neoplasms - complications; Jejunal Neoplasms - diagnosis; Jejunal Neoplasms - pathology; Jejunal Neoplasms - surgery; Medical diagnosis; Medical sciences; Medical treatment; Neoplasms, Multiple Primary - diagnosis; Neoplasms, Multiple Primary - surgery; Pediatrics; Physical examinations
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2005-0710

The lesion responsible for obscure gastrointestinal bleeding in the pediatric population may not be determined with standard primary endoscopic methods. Wireless capsule endoscopy, now a first-line modality for evaluation of the small bowel in the adult population, is a tool that may be useful among children. We report a case of a 2.5-year-old girl who presented with melenic stools. Upper and lower endoscopy, Meckel scans, and mesenteric angiography yielded negative results. Wireless capsule endoscopy identified numerous abnormal, dilated, blood vessels in the proximal jejunum, with associated fresh blood. The patient underwent surgical exploration, with resection of the affected portion of the jejunum. Pathologically, the dilated blood vessels were consistent with mixed, juvenile, capillary hemangioma-angiomatosis of developmental or congenital origin. The patient fared well postoperatively, with no additional bleeding in 9 months of follow-up monitoring. This case report highlights the use of capsule endoscopy in the diagnosis and successful treatment of gastrointestinal bleeding in a young infant. This is the youngest reported patient treated with the use of wireless capsule endoscopy in the pediatric population.