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October 3, 2018

Image challenge: Similar in size but different in detail

What was the metallic object found in a patient with a 10-year history of severe abdominal pain? 

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Gastroenterology clinical image challenge: A 67-year-old man presented with abdominal pain. The patient had a 10-year history of rather severe abdominal pain that occurred every six months and lasted for less than one week at a time. More recently, however, the pain evolved to occur weekly and lasted for 36 to 48 hours. These pains were located in the lower abdomen, increased over several hours, were colicky in nature and invariably ended in multiple emesis. His only abdominal surgery was an appendectomy 13 years ago. He also had lost a total of 50 pounds of weight over the past two years. Therefore, computed tomography (CT) enterography was ordered to evaluate recurrent abdominal pain and unintentional weight loss.


On CT enterography, streak artifact was noted in the cecum consistent with the presence of some metallic object (Figure). On a scout image, a 24 × 9-mm, densely radiopaque ovoid foreign body could be observed in the right lower quadrant of the abdomen and was interpreted as a capsule endoscope in the cecum.


What is this radiopaque metallic object seen in the abdomen?


To find out the diagnosis, read the full case in Gastroenterology or download our Clinical Image Challenge app through AGA App Central, which features new cases each week. Sort and filter by organ, most popular or favorites. AGA App Central is available in both the Apple App Store and Google Play.


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