Usefulness of colon capsule endoscopy for diagnosing multiple angiodysplasia of the small intestine in a hemodialysis patient

Abstract

We report the case of a 71-year-old male hemodialysis (HD) patient. He was suffering from diabetic nephropathy and had been on HD since 2009. At the end of 2015, he experienced chest discomfort, anorexia, and dyspnea on exertion, and his blood test data showed severe anemia. We suspected gastrointestinal hemorrhaging, although we could not identify the origin of the bleeding on a computed tomography (CT) scan, gastroscopy, or colonoscopy, and there were technical difficulties relating to the insertion of the colonoscope. The patient’s hemoglobin levels returned to normal ; however, he developed severe anemia 4 months later. No abnormalities that were indicative of a bleeding source were detected during a CT scan and scintigram performed to detect gastrointestinal bleeding, but colon capsule endoscopy revealed multiple angiodysplasia lesions of the small intestine, which were considered to be the source of the bleeding. As the patient’s lesions were wide ranging and inactive, conservative therapy involving the use of nafamostat mesilate during HD was initiated, and his hemoglobin values improved. This case report highlights the usefulness of colon capsule endoscopy for diagnosing multiple angiodysplasia of the small intestine in HD patients.