Portal de Periódicos da CAPES

S2879 Incidental Pollinators During Capsule Endoscopy

2020; Lippincott Williams & Wilkins; Volume: 115; Issue: 1 Linguagem: Inglês

10.14309/01.ajg.0000713564.41536.28

1572-0241

Brian Sowka, Thu Nguyen, Padmavathi Mali, James Groskreutz,

Foreign Body Medical Cases

INTRODUCTION: Foreign body ingestions are usually accidental and related to food items but other uncommon, intentional ingestions are not rare. Other uncommon ingestions occur intentionally in psychiatric disease, alcohol intoxication, and prison inmates. Insect foreign body ingestion is rare with three cases involving bees found in the literature including the esophagus and stomach. In these cases patients presented with significant symptoms immediately after ingestion including dysphagia thought to be related to stings. We present an unusual case of a patient who without knowledge of ingestion or symptoms incidentally was found to have three bees during a capsule endoscopy. CASE DESCRIPTION/METHODS: A 61 year old male presented with a two year history of intermittent hematochezia along with diarrhea. Past medical history and exam were unremarkable. Prior evaluation to the visit included normal complete blood count, negative infectious workup, Clostridium difficile toxin, and positive immunochemical fecal occult blood test. A colonoscopy showed scattered diverticulosis and small internal hemorrhoids; an EGD showed moderate gastritis with negative H. pylori biopsies, a hiatal hernia, and multiple gastric polyps. Without an obvious bleeding source discovered a small bowel video capsule endoscopy was performed. A submucosal mass was discovered 40 minutes after passage from the stomach. Three different bees were viewed during small bowel capsule endoscopy. Two were located close together in the duodenum and one distally in the jejunum without evidence of injury. The patient stated while outside walking his dog he may have swallowed a nit accidently but denied any symptoms.. DISCUSSION: Small foreign bodies typically pass through the intestinal tract without difficulty in 80% of cases. Indications for removal are sharp objects, disk batteries, or obstructive symptoms. There have been three case reports in the literature that document significant symptoms from bee ingestion. In these cases each patient was aware they ingested a foreign body and became symptomatic shortly after including an anaphylactic presentation. There is potential for significant morbidity with bee ingestion from the presence of a sharp stinger containing venom. As demonstrated in our patient unless the stinger injects the gastrointestinal tract the bee may safely pass without incident.Figure 1.: Submucosal mass 40 minutes after stomach.Figure 2.: Foreign body, bee in the duodenum.Figure 3.: Foreign body, bee in the duodenum.