CASE 6046 Published on 23.10.2007

Intestinal obstruction secondary to capsule enteroscope

Section

Abdominal imaging

Case Type

Clinical Cases

Authors

Dr Vishnu Banumukala Foundation year 1 House officer, Dr Adarsh Babu Foundation year 1 House Officer Dr Stephen Moss Consultant Physician and Gastroenterologist. Diana Princess of Wales Hospital, Northern Lincolnshire and Goole Hospitals NHS Foundation Trust, Scartho Road, Grimsby, DN33 2BA.

Patient

57 years, male

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Clinical History

Patient with a strong family history of Crohn's disease presented for the first time with abdominal pain and weight loss. Underwent capsule enteroscopy for suspected small bowel disease. The day after having the capsule the patient presented with acute abdomen. CT imaging then showed capsule impacted in the distal ileum causing mechanical small bowel obstruction.

Imaging Findings

57-year-old gentleman, with strong family history of Crohn's disease, presented for the first time with abdominal pain and diarrhoea for 3 weeks duration. He had accompanying loss of weight and appetite. Examination revealed tenderness in lower quadrants of abdomen and blood investigations showed raised inflammatory markers. He was initially treated with steroids and IV antibiotics. CT scan at that stage revealed lots of fluid in small and large bowel, colonoscopy showed erythema of caecum. In view of erythema of caecum, urgent small bowel capsule study was ordered. Next day after he had the capsule, started spiking temparature, abdominal pain became more intense and had vomiting. He was septic and CT scan then showed dilated small bowel loops, small bowel obstruction. Capsule was struck in the terminal ileal loops and was the cause of intestinal obstruction. Subsequently he was operated, distal ileum was resected and ileostomy placed.

Discussion

Its been nearly 5 years since capsule endoscopy was introduced. This disposable 27mm*11mm video capsule containing its own optical dome, light source, batteries, transmitters, antenna is swallowed with water after 12 hrs fast. Capsule is propelled via peristalisis through the gastro intestinal tract, capturing aboutr 60,000 digital images and excreted naturally. [3] Capsule has been approved for use in children as young as 10 years of age. [4] Indications-Occult gastro intestinal bleeding, suspected small bowel tumour, suspected Crohn's, survellance of inherited polyposis syndrome, drug induced small bowel injury or any abnormal small bowel imaging. [3] Contraindications- Intestinal Obsruction/Pseudoobstruction, suspected small bowel strictures and pregnancy. Lesions can be missed due to poor bowel preparation or rapid or delayed small bowel transit or orientation of the camera away from the lesion. The development of similar competitor devices and devices whose movement can be controlled is in progress. [4]

Differential Diagnosis List

Intestinal obstruction following capsule enteroscopy.

Final Diagnosis

Intestinal obstruction following capsule enteroscopy.

References

[1] Rays. 2002 Jan-Mar;27(1):67-72.
Small bowel exploration with video capsule endoscopy.
Riccioni ME, Foschia F, Mutignani M, Perri V, Tringali A, Costamagna G. (PMID: 12696275)

[2] Gastrointest Endosc Clin N Am. 2006 Apr;16(2):299-306.
Use of capsule endoscopy for established Crohn\'s disease.
Legnani P, Abreu MT. (PMID: 16644458)

[3] Curr Opin Gastroenterol. 2006 Mar;22(2):124-7. Links
Video capsule endoscopy of the small bowel (PillCam SB).
Eliakim AR. (PMID: 16462167)

[4] Ileus secondary to wireless capsule enteroscopy
International Journal of Colorectal Disease
Volume 21, Number 6 / September, 2006
R. Magdeburg1 , T. Riester1, F. Hummel2, M. L怀hr2, S. Post1 and J. Sturm1. (PMID: 16411112)

[5] Gastrointest Endosc Clin N Am. 2006 Apr;16(2):287-97, ix.
The role of PillCam endoscopy in Crohn\'s disease: the European experience.
Voderholzer WA. (PMID: 16644457)

[6] Dig Dis Sci. 2006 May;51(5):900-5. Epub 2006 Jun 14.
Results of videocapsule endoscopy in 250 patients with suspected small bowel pathology.
Van Tuyl SA, Van Noorden JT, Kuipers EJ, Stolk MF. (PMID: 16773429)

Case information