1146 Laparoscopic Retrieval of a Retained Video Endoscopy Capsule: Case Report and Review of Literature

Abstract

Abstract Video-Capsule-Endoscopy (VCE) is a non-invasive method and a useful tool in determining the aetiology of obscure gastrointestinal bleeding and in the diagnosis of Crohn’s disease. Despite its proven utility, VCE carries risks, primarily capsule retention (CR). This refers to the failure of the capsule passing by day 14. CR may suggest underlying pathology, but in the process can lead to several sequelae including obstruction. We report the case of a 28-year-old patient with suspected Crohn’s disease requiring laparoscopic bowel-resection and retrieval of the capsule. The patient presented in 2019 with bloating, crampy abdominal pain and altered bowel habits. Initial endoscopic and blood investigations were unremarkable, however subsequent tests revealed raised calprotectin and anaemia. OGD and colonoscopy remained negative. In April 2021, he underwent VCE, demonstrating an inflamed distal ileum with structuring. However, the capsule failed to pass. After a period of watchful waiting and multidisciplinary discussion resulting in a trial of infliximab and steroid therapy, the capsule remained in-situ as confirmed by sequential X-rays and CTs. In March 2022, he underwent uncomplicated 3-port laparoscopic small bowel resection and retrieval of the retained capsule and was discharged 2 days later. Our case demonstrates an optimal approach in the management of CR. An initial conservative trial with medical therapy was attempted. MDT discussion ensured both gastroenterologists and surgeons were involved in the decision-making. Finally, our literature review demonstrated a lack of concise guidelines. Thus, based on the latest evidence we developed an algorithmic flow chart for the management of retained VCE.