Clinical Case Summary

Clinical Case: MC, 63 year old female with no background history of note presented in April 2022 with abdominal pain and altered bowel habit. Initial investigations were all normal apart from a thickened jejunum on MR enterography suggestive of small bowel Crohn’s disease. Symptom resolution was noted on an initial course of oral budesonide. MC re-presented in July 2023 with weight loss and obstructive type abdominal pain. Repeat imaging was normal.
MC was referred for capsule endoscopy in October 2023 following persistence of symptoms. Following successful patency test, capsule endoscopy demonstrated multiple large ulcers and submucosal lesions in the distal jejunum. Budesonide was recommenced to obtain symptom resolution and double balloon enteroscopy (DBE) was performed to obtain definitive histological diagnosis.
DBE was unsuccessful and a repeat capsule was administered on the same day as DBE. Capsule endoscopy demonstrated resolution of ulceration but persistence of multiple submucosal lesions concerning for small bowel malignancy.
MC was referred for a SB resection which identified multiple mural abnormalities in the ileum. Subsequent histology diagnosed multiple well differentiated neuroendocrine tumours ranging from 6-11mm (pT3(m)N1). MC was referred to neuroendocrine services & oncology for further follow-up.
Discussion: MC presents as a common clinical scenario with an uncommon diagnosis. The case demonstrates the importance of performing thorough small bowel imaging in patients with potential small bowel pathology. Small bowel tumours present a very specific diagnostic challenge given their location. This case demonstrates the importance of capsule endoscopy in the diagnosis of small bowel tumours.