Clinical presentation
A 48 year old man presented with a two year history of abdominal pain aggravated by eating, weight loss of 20 kg in one year, and a positive test for occult blood in stool. In order to avoid postprandial tenesmus he had cut down his meals to a minimum, despite a normal appetite. The patient had no history of previous surgery or serious illness. On physical examination the abdomen was soft and no mass was palpable.
Laboratory examinations did not reveal any pathological findings. On abdominal computed tomography, several fatty structures with a size of 1.5 cm in apparent continuity with the bowel wall were seen. Abdominal ultrasound, computer tomography of the pancreas, and repeated gastroscopy and colonoscopy did not yield findings that were able to explain the patient's complaints.
Question
Video capsule endoscopy of the small bowel was performed (fig 1). What abnormalities were seen? What is the likely diagnosis?
Figure 1 Video capsule endoscopy (Given Imaging Ltd) of the jejunum.
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