Melinda Nguyen, Toufic El-Khoury and David Van der Poorten
Background: Long term Capsule Endoscopy (CE) retention is an uncommon, but potentially serious complication of CE. It is most frequently due to Crohn’s related small bowel strictures or neoplastic lesions but can be caused by post-surgical stenosis and non-steroidal anti-inflammatory drug (NSAID) enteropathy. We present a case of retained CE in the distal ileum due to NSAID enteropathy with striking photographs of the small bowel stricture and the moment of laparoscopic device retrieval.
Case report: An 83-year-old female on amlodipine and esomeprazole presented with a month-long history of melaena and was found to have iron deficiency anaemia. She had been investigated two years prior for a similar episode with gastroscopy, colonoscopy and CE without finding an underlying cause. Gastroscopy and colonoscopy were repeated, revealing gastritis and diverticular disease but no bleeding source. CE showed an inflamed distal ileal stricture, which prevented capsule passage. The patient was asymptomatic and X-ray and computed tomography (CT) confirmed retention of the capsule with no bowel obstruction. On directed questioning she admitted to infrequent use of a COX-II inhibitor for arthritis over the previous 3 years. She underwent double balloon enteroscopy with dilatation, which identified the stricture and the retained capsule, but it could not be safely retrieved at that time or one week later. She developed abdominal pain and ultimately proceeded to laparoscopic removal of the capsule and resection of the stricture. Histology was consistent with an NSAID etiology.
Conclusion: CE retention is a serious complication and can be caused by strictures related to occult NSAID use. Directed history taking and use of patency capsules could reduce the incidence of this problem.
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