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Small bowel capsule impaction and successful endoscopic retrieval

2005; Elsevier BV; Volume: 3; Issue: 1 Linguagem: Inglês

10.1016/s1542-3565(04)00464-1

1542-7714

Razi M. Arifuddin, Matthew M. Baichi, Parvez Mantry,

Esophageal and GI Pathology

A 28-year-old white man with a total proctocolectomy with ileoanal anastomosis for familial adenomatous polyposis presented with recurrent right lower quadrant pain, constipation, and vomiting. The abdomen was slightly distended with high-pitched and hyperactive bowel sounds. A computed tomography scan showed focal intermittent areas of small bowel wall distention and minimal wall thickening without a transition point. A small bowel follow-through, enteroscopy, and ileoscopy were unrevealing. Because of recurrent symptoms, a capsule endoscopic study was pursued and showed a prolonged small bowel transit time, and radiographs confirmed a retained capsule in the right lower quadrant. Ileoscopy revealed a tight ileal stricture at 80 cm from the anal canal. The capsule was visualized through the stricture, but the adult gastroscope could not be passed (Figure 1). The stricture was dilated with a through-the-scope 5-cm “pyloric” balloon, the stricture was passed, and the capsule was retrieved with a retrieval basket. The patient remains well and has not experienced any further episodes of obstruction in 18 months of follow-up.The most common reported complication of capsule endoscopy is impaction of the capsule in either strictures or diverticula1Swain C.P. Wireless capsule endoscopy.Gut. 2003; 52: 48-53Crossref Scopus (179) Google Scholar including a Meckel’s diverticulum.2Gortzak Y. Lantsberg L. Odes H.S. Video capsule entrapped in a Meckel’s diverticulum.J Clin Gastroenterol. 2003; 37: 270-271Crossref PubMed Scopus (16) Google Scholar In all patients with a suspicion of obstructive symptoms, radiographic examination of the upper gastrointestinal tract is necessary before performing a capsule study. Barium examination of the small intestine might miss strictures in patients with intermittent symptoms of small bowel obstruction.The patient should be informed of the risks involved in capsule endoscopy, including the need for surgical exploration if the capsule does not pass. This patient’s need for surgery was circumvented by diagnosis of ileal stricture and successful endoscopic retrieval of the capsule. A 28-year-old white man with a total proctocolectomy with ileoanal anastomosis for familial adenomatous polyposis presented with recurrent right lower quadrant pain, constipation, and vomiting. The abdomen was slightly distended with high-pitched and hyperactive bowel sounds. A computed tomography scan showed focal intermittent areas of small bowel wall distention and minimal wall thickening without a transition point. A small bowel follow-through, enteroscopy, and ileoscopy were unrevealing. Because of recurrent symptoms, a capsule endoscopic study was pursued and showed a prolonged small bowel transit time, and radiographs confirmed a retained capsule in the right lower quadrant. Ileoscopy revealed a tight ileal stricture at 80 cm from the anal canal. The capsule was visualized through the stricture, but the adult gastroscope could not be passed (Figure 1). The stricture was dilated with a through-the-scope 5-cm “pyloric” balloon, the stricture was passed, and the capsule was retrieved with a retrieval basket. The patient remains well and has not experienced any further episodes of obstruction in 18 months of follow-up. The most common reported complication of capsule endoscopy is impaction of the capsule in either strictures or diverticula1Swain C.P. Wireless capsule endoscopy.Gut. 2003; 52: 48-53Crossref Scopus (179) Google Scholar including a Meckel’s diverticulum.2Gortzak Y. Lantsberg L. Odes H.S. Video capsule entrapped in a Meckel’s diverticulum.J Clin Gastroenterol. 2003; 37: 270-271Crossref PubMed Scopus (16) Google Scholar In all patients with a suspicion of obstructive symptoms, radiographic examination of the upper gastrointestinal tract is necessary before performing a capsule study. Barium examination of the small intestine might miss strictures in patients with intermittent symptoms of small bowel obstruction. The patient should be informed of the risks involved in capsule endoscopy, including the need for surgical exploration if the capsule does not pass. This patient’s need for surgery was circumvented by diagnosis of ileal stricture and successful endoscopic retrieval of the capsule.