Cryptogenic multifocal ulcerous stenosing enteritis diagnosed and managed with intraoperative enteroscopy: a case report

Background Cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) is a rare small intestinal disorder characterized by multifocal superficial ulcerations and short-segment circumferential strictures. Because the lesions are discontinuous and confined to the mucosa/submucosa, preoperative assessment of disease extent is often inadequate. Intraoperative enteroscopy may enable direct mucosal visualization and guide segmental resection, yet its role in CMUSE remains inadequately described, and whether it confers any advantage over conventional surgical assessment cannot be established from a single case. Case summary A 58-year-old Han Chinese man presented with recurrent small-bowel obstruction for 20 years. Each episode had resolved with conservative management, but the cause had never been identified. He was admitted to our hospital with recent symptom exacerbation; he had no musculoskeletal or joint disorder and no chronic use of aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), or over-the-counter analgesics, and his only remote exposure was a 1–2-week course of an over-the-counter analgesic taken two years earlier after operative fixation of a left shoulder fracture. Contrast-enhanced CT enterography revealed localized ileal wall thickening, routine endoscopic examinations were unremarkable. Capsule endoscopy was performed after thorough counseling regarding the risk of retention, with the understanding that retention, should it occur, would confirm and localize obstructive strictures. Two stenosing ulcerations were visualized while the capsule was retained between them. The patient subsequently underwent exploratory laparoscopy. Intraoperative enteroscopy through a limited enterotomy provided direct visualization of the entire small bowel and identified four circumferential strictures, all of which were included in a tailored segmental resection. Histopathology showed superficial ulcerations confined to the mucosa and submucosa with fibrotic stricture formation, consistent with CMUSE. The postoperative course was uneventful, and he remained symptom-free at 10-month follow-up. Conclusion In this patient, intraoperative enteroscopy enabled intraoperative mucosal assessment of the entire small bowel, defined the extent of disease, and guided tailored segmental resection; these observations are limited to a single case and do not establish a bowel-preserving advantage over conventional surgical assessment. Capsule endoscopy in suspected stricturing small-bowel disease requires caution and patency assessment; if retention occurs it may provide localizing information, but this does not justify its use in patients with suspected strictures.