Small Bowel Metastasis from Renal Cell Carcinoma Identified on Capsule Endoscopy

An elderly man presented with iron deficiency anemia and intermittent rectal bleeding. His past medical history was significant for a renal cell carcinoma resected 9 years earlier. After a colonoscopy and upper endoscopy were unremarkable, he underwent a small bowel capsule endoscopy, which revealed an ulcerated mass in the jejunum (Figure 1 and Video 1). Surgical resection was performed, and the pathology revealed metastatic renal cell carcinoma, clear cell type (Figure 2). The pathology was compared to the tumor from the patient's prior nephrectomy and was found to be identical. While renal cell carcinoma only accounts for 7% of metastases to the small bowel,1 these have occurred even up to 20 years after initial surgery.2 This case highlights the benefits of capsule endoscopy in the diagnosis of small bowel lesions, including metastatic renal cell carcinoma.1,2 Figure 1 An ulcerated mass is seen in the jejunum on small bowel capsule endoscopy. Figure 2 Histology of the jejunal mass confirms a renal cell carcinoma, clear cell type. Video 1 Small bowel video capsule endoscopy shows an ulcerated mass in the jejunum, which proved to be a renal cell carcinoma metastasis. Click here to view.(1.9M, mpg)