Presenter Status
Fellow
Abstract Type
Case Report
Primary Mentor or Principal Investigator
Dr. Thomas Attard
Presentation Type
Poster
Start Date
19-5-2026 11:00 AM
End Date
19-5-2026 12:00 PM
Abstract Text
Background:
Double balloon enteroscopy (DBE) is a novel technique increasingly used for the visualization of the small intestine. It is used to investigate overt gastrointestinal (GI) bleeding or iron deficiency anemia without a clear source and to evaluate for small intestinal polyps, strictures, neoplasms, and inflammatory bowel disease. In particular, it can be highly valuable in patients with Peutz-Jeghers syndrome (PJS) and familial adenomatous polyposis (FAP). Complications such as pancreatitis, perforation, and bleeding have been reported but occur rarely. Here, we report the case of an 11-year-old female who developed symptomatic hyponatremia after DBE, resulting in a tonic-clonic seizure.
Conclusions:
DBE has gained popularity as a valuable tool for the evaluation and treatment of small intestinal pathology. It is typically indicated after other imaging modalities have been exhausted and has largely replaced intraoperative enteroscopy. It is particularly useful in pediatric patients with GI bleeding, polyposis syndromes, inflammatory bowel disease, strictures, Meckel’s diverticulum, and small bowel tumors.
Although less frequently used in pediatrics, DBE complications are rare and have mainly included pancreatitis, perforation, and bleeding in adults. Here, we describe a unique case of symptomatic hyponatremia requiring PICU admission and treatment following DBE. To our knowledge, this is the first reported case of DBE leading to symptomatic hyponatremia and seizure in a pediatric patient.
Overall, DBE is well-tolerated and safe in pediatric populations. In adults, complication rates are approximately 1.7%, with therapeutic DBE associated with increased complications (4.3%). For example, post-polypectomy bleeding is more likely following the removal of larger polyps. Our patient initially had hematemesis, likely a complication of polypectomy. Post-DBE pancreatitis has been reported at a rate of 0.3%–1.8%. Severe complications, such as perforation, are rare, particularly in children. Although our patient’s lipase was elevated, her abdominal ultrasound was unremarkable, and her pain was resolved without intervention. It is likely that the elevated lipase resulted from procedural trauma to the pancreas, a theory previously suggested in the literature.
Other case reports have described symptomatic hyponatremia in adults following substantial free water intake during bowel preparation for colonoscopy. In our case, the patient ingested approximately four liters of water during bowel preparation and received a significant amount of sterile water for intra-procedural irrigation. These factors, in addition to potential increased ADH secretion, likely contributed to the development of symptomatic hyponatremia and subsequent seizure.
DBE is a relatively safe and therapeutically important procedure, particularly for evaluating and managing small intestinal disease. This case highlights symptomatic hyponatremia as a rare but serious complication in pediatric patients following DBE. It underscores the importance of regulating free water intake during bowel preparation and considering the use of isotonic fluids during procedures, especially in children.
Symptomatic Hyponatremia: A Rare Complication of Double Balloon Enteroscopy; A Case Report.
Background:
Double balloon enteroscopy (DBE) is a novel technique increasingly used for the visualization of the small intestine. It is used to investigate overt gastrointestinal (GI) bleeding or iron deficiency anemia without a clear source and to evaluate for small intestinal polyps, strictures, neoplasms, and inflammatory bowel disease. In particular, it can be highly valuable in patients with Peutz-Jeghers syndrome (PJS) and familial adenomatous polyposis (FAP). Complications such as pancreatitis, perforation, and bleeding have been reported but occur rarely. Here, we report the case of an 11-year-old female who developed symptomatic hyponatremia after DBE, resulting in a tonic-clonic seizure.
Conclusions:
DBE has gained popularity as a valuable tool for the evaluation and treatment of small intestinal pathology. It is typically indicated after other imaging modalities have been exhausted and has largely replaced intraoperative enteroscopy. It is particularly useful in pediatric patients with GI bleeding, polyposis syndromes, inflammatory bowel disease, strictures, Meckel’s diverticulum, and small bowel tumors.
Although less frequently used in pediatrics, DBE complications are rare and have mainly included pancreatitis, perforation, and bleeding in adults. Here, we describe a unique case of symptomatic hyponatremia requiring PICU admission and treatment following DBE. To our knowledge, this is the first reported case of DBE leading to symptomatic hyponatremia and seizure in a pediatric patient.
Overall, DBE is well-tolerated and safe in pediatric populations. In adults, complication rates are approximately 1.7%, with therapeutic DBE associated with increased complications (4.3%). For example, post-polypectomy bleeding is more likely following the removal of larger polyps. Our patient initially had hematemesis, likely a complication of polypectomy. Post-DBE pancreatitis has been reported at a rate of 0.3%–1.8%. Severe complications, such as perforation, are rare, particularly in children. Although our patient’s lipase was elevated, her abdominal ultrasound was unremarkable, and her pain was resolved without intervention. It is likely that the elevated lipase resulted from procedural trauma to the pancreas, a theory previously suggested in the literature.
Other case reports have described symptomatic hyponatremia in adults following substantial free water intake during bowel preparation for colonoscopy. In our case, the patient ingested approximately four liters of water during bowel preparation and received a significant amount of sterile water for intra-procedural irrigation. These factors, in addition to potential increased ADH secretion, likely contributed to the development of symptomatic hyponatremia and subsequent seizure.
DBE is a relatively safe and therapeutically important procedure, particularly for evaluating and managing small intestinal disease. This case highlights symptomatic hyponatremia as a rare but serious complication in pediatric patients following DBE. It underscores the importance of regulating free water intake during bowel preparation and considering the use of isotonic fluids during procedures, especially in children.
Comments
Poster Board Number: 7