Neha Kantawala and JS Rajkumar

Chennai, Tamil Nadu

Abstract

Wireless capsule endoscopy is a relatively new diagnostic technique for the detection of small bowel disease. Currently, it represents an increasingly used method for diagnostic evaluation of the small intestine. It is important for surgeons to be familiar with its uses and complications that may arise. We report an interesting case of spontaneous video capsule entrapment in small bowel Crohn’s disease in which diagnosis was made radiologically.

Introduction

Wireless capsule endoscopy is a relatively new diagnostic technique for the detection of small bowel disease. This minimally invasive procedure generally poses few risks to the patients and reported complications typically are related to capsule retention. The retrospective analysis of some series indicates that the incidence of capsule retention depends on the indication for the capsule examination 0% in healthy controls, 1.4% in obscure gastrointestinal bleeding, 1.48% in suspected Crohn’s disease, 5-13% in known Crohn’s disease and 21% in suspected small bowel obstruction. We report an interesting case of spontaneous video capsule entrapment in small bowel Crohn’s disease in which diagnosis was made radiologically.

Case Report

A 35-year-old woman was evaluated for persistent fever and weight loss in a known case of Crohn’s disease. She had no gastrointestinal symptoms. CT scan of abdomen was normaland colonoscopy revealed terminal ileal Crohn’s disease. Small intestine evaluation was thus pursued and wireless capsule endoscopy was performed. Unfortunately, as the endoscopic images revealed, the capsule became lodged in small intestine segment containing stagnant contents and eventually lost battery power. As patient had no symptoms of obstruction, he was called for review after 15 days. An abdominal radiograph showed video capsule in the right lower quadrant. CT of the abdomen revealed that the video capsule was caught in the ileum. As patient had persistent weight loss and persistent fever with capsule retention, itwas planned to proceed with diagnostic laparoscopy, which revealed multiple strictures in terminal ileum with capsule retained in proximal stricture. There were five completestrictures in terminal ileum so we decided to proceed with resection with ileotransverse anastomosis. Postoperatively, the patient recovered well.

Discussion

Wireless capsule endoscopy was approved for clinical use in United States in 2001 and currently represents an increasingly used method for diagnostic evaluation of the small intestine. It is important for surgeons to be familiar with its uses and complication that may arise. In our case, CT scan of the abdomen was done to rule out strictures. The endoscopiccapsule examination begins when the patient swallows the 1.1 × 2.6 cm, 4 g capsule, which contains a camera, light source, batteries and transmitter. As the capsule transverses the small intestine, it relays images to a recorder worn on a belt around the patient’s waist. The capsule battery has a life span of about 8 hours, typically enough time for it to image the entire small bowel as it passes through. Recorded images are downloaded and analyzed later. Most capsules are naturally expelled within 72 hours of ingestion. Current imaging techniques can show long or medium stenosis, with great reduction of lumen size; however, short stenosis usually cannot be detected by standard methods. This fact explains that in most of the reported cases of capsule retention, the previous performance of the usual radiological studies was not capable of diagnosing the intestinal strictures which the capsule clearly showed. It is therefore, proven that the lack of findings in radiological techniques does not rule out theexistence of bowel stenosis. 

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