Jejunal hematoma interception, invaginating process observed by capsule endoscope. There are several case reports on jejunal interception due to bypossess of Pugh-Jegas syndrome, consists of the hematoma. Jejunal interception without obstruction shows sometimes invagination and reduction repeatedly. Capsule endoscopy is a suitable modality to examine small bowel in natural condition because it does not require preparation or sedation interfering peristalsis. We show that the capsule endoscope could depict solitary jejunal hematoma in the process of invaginating into distal jejunum. Patient was 54-year-old female. She was referred to emergency room due to dyspnea and unconsciousness. There were no abnormal findings on neurological or cardiovascular examinations. She had slight tenderness in epigastric area and anemia hemoglobin 6.7. There were any abnormal findings neither on esophageal gastroenteroscopy, EGD, nor on colonoscopy. She had not any mucocutaneous pigmentation either. To search for bleeding points, computed tomography with contrast medium was performed. CT in the left figure indicated typical target sign and the distal dilation suggested in the susception in the jejunum. It did not show overt bleeding in the small bowel or a perfect obstruction as there were no proximal dilation. Positron emission CT in the right figure shows the tumor-like mass as the invaginated area. There were no hot spot, suggested malignant tumor in small bowel nor other organ. Tumor marker CEA, CEA-99 were within normal limits. Under these conditions, no overt bleeding, no obvious obstruction, only one lesion. We chose capsule endoscopy at first to determine which approach transoral or transrenal is better as the balloon endoscopy. Now let me show you capsule endoscopic video with capsule loci. We can recognize tumor at the 30-centimeter distal point from the thrice ringment. Life-surfing capsule camera fixed on tumor as surfboard were sliding through the jejunum by peristalsis. The loci indicated five to six centimeter invagination until detachment of capsule from the tumor. Enteroballoon enteroscopy was performed. We detected the hematomas tumor at the suggested location by capsule endoscope and got biopsy specimen for histological evaluation. Simultaneously, enema with contrast medium was performed. Enema with contrast medium was performed. Granular flat elevation was depicted. Balloon enteroscopy did not show clear interception on this photo. Patient accepted the surgery to be afraid of repeated interception, though the histology of biopsy specimen did not clarify malignancy. Left photo shows receptor specimen with large granular polypoid elevation within four centimeter yellow ring. The right one shows histopathological image, a toxin neogene stain, which figure out radially branching muscularis, mucosa, and the growth of the lamina propria without atypia. Those were compatible to hematoma, but were not those of typical Pugh-Diegart polyp. To our disappointment, patient did not allow us to check the mutation within STK11 gene. In conclusion, adult jejunal interception due to solitary hematoma polyp is rare. Capsular endoscopy is a useful modality to observe tumor invaginating or reducing in real time. Thank you very much for your kind attention.

jejunal hematoma

capsule endoscopy

tumor observation

anemia

surgery recommendation