Answer
From question on page 196
This patient suffered from yellow nail syndrome with intestinal lymphangiectasia, which is a very rare condition. Treatment of these patients is mainly symptomatic but localised lymphangiectasia in the small intestine would potentially be curable with surgical resection. Therefore, the extent of lymphangiectasia was determined by use of capsule endoscopy, a novel and efficient method to visualise the small intestine.
Capsule endoscopy showed swollen mucosa with thick and short villi covered with opalescent “milky” fluid throughout the small intestine (fig 2). Importantly, capsule endoscopy revealed that the lymphangiectasia was generalised throughout the small intestine, which excluded this patient from surgery. Biopsies taken from the proximal small intestine showed short and widened villi and lymphangiectasia (fig 3). Thus capsule endoscopy may be decisive in the management of patients with yellow nail syndrome and protein loosing enteropathy.
Figure 2 Capsule endoscopic image showing swollen mucosa with thick, short, and whitish villi and intraluminal opalescent “milky” fluid in the jejunum.
Figure 3 Microphotograph of duodenal biopsy showing dilated lymphatics in the lamina propria consistent with intestinal lymphangiectasia.