The small intestine is a complex organ with many important bodily functions to include secretion, absorption, digestion and transport. The 7 meters (23 feet) of small intestinal length and its distance from the oral portal of entry has in the past made the jejunum and ileum inaccessible to direct visualization. In the past, disorders of the small intestine to include bleeding, maldigestion, inflammation, neoplasia, and obstruction have been evaluable only with radiologic techniques. Innovations, such as, video capsule endoscopy have made the most distant and hardest to reach segments of the small intestine readily accessible for diagnosis.

The complex anatomy of the small intestine is demonstrated in Video 1 (derived from Visible Human data as compiled on the TolTech VH Dissector). The duodenum and cecum are shown in purple. As the video progresses segments are removed from the jejunum and then from the ileum. The length and tortuosity of the intestine is readily apparent.

Video capsule endoscopy has truly illuminated our understanding of small intestinal disorders. Although capsule endoscopy is only a diagnostic test, it remains a noninvasive, readily available technique to examine the small intestine and guide further intervention with balloon enteroscopy or surgical techniques. The disadvantages of capsule endoscopy include potential capsule entrapment and the inability to precisely locate capsule findings within the 23 feet of small intestine and cost. In previous a issue of www.VHJOE.com, Dr. Radwin addressed the issue of capsule retention.¹ In this Issue, Drs Scott, Abey and Craig attempt to better define where in the bowel a lesion is located.² Further discussion by Dr Radwin adds to the information which is presented. After reading these articles, we hope that readers will be more comfortable both with identification of findings obtained, and even more so, on a decision analysis on what to do when an abnormal finding is identified.

References:

1. Radwin M I. NSAID Enteropathy and Capsule Retention; Complication or Guide to Therapy? http://www.vhjoe.org/Volume8Issue2/8-2-4.htm

2. Scott DR, Abey S, Craig PI. Localisation in the Small Bowel of Lesions Found by Capsule Endoscopy for Obscure Gastrointestinal Bleeding.
http://www.vhjoe.org/Volume8Issue4/8-4-2.htm