2599 Retained Video Capsule Due to Stricturing Crohn's Disease Safely Diagnosed With Use of Magnetic Resonance Imaging (MRI) in a Pregnant Patient

Abstract

INTRODUCTION: Videocapsule endoscopy (VCE) is a noninvasive technology that provides diagnostic imaging of the small intestine. We present a case where MRI was safely utilized to diagnose a retained VCE in a pregnant patient. There is a lack of literature on the use of VCE in pregnancy as well as the use of MRI to diagnose retained VCE. Our case highlights the use of MRI to diagnose a retained VCE during pregnancy without any harmful effects to the patient or fetus. CASE DESCRIPTION/METHODS: A 16-year-old woman with a 4-year history of Crohn's disease presented at 24 weeks gestation with six months of achy, left upper quadrant (LUQ) abdominal pain associated with a 20-pound weight loss. On presentation, the patient was depressed, withdrawn and provided limited history. Exam demonstrated a thin young female with gravid uterus and LUQ tenderness. Labs were notable for ESR >100 mm/h and CRP 4.1 mg/L. An MRI was performed to aid diagnosis and minimize risk of radiation to the fetus. This revealed artifact at the anterolateral aspect of the left mid-abdomen (Figure 1). CT enterography confirmed foreign body in the left mid small bowel, likely jejunum, compatible with retained videocapsule (Figure 2). There was an adjacent segment of small bowel with suspected stricture (Figure 3). Additional history was then revealed by the patient's mother. She had undergone VCE six months prior. Shortly after, pregnancy testing was positive and imaging to confirm passage of the VCE was deferred. Subsequently, her pain worsened. Antegrade double balloon enteroscopy was attempted but could not reach the videocapsule. She underwent exploratory laparotomy revealing an intra-abdominal phlegmon and a loop ileostomy was performed. Patient delivered a healthy infant at 34 weeks. Resection of phlegmon and retrieval of foreign body were performed post-partum. DISCUSSION: Capsule retention is a potential complication of VCE, with a rate of 2.6% in patients with known or suspected Crohn's disease compared to an overall retention rate of 1.4%. Pregnancy is a relative contraindication to VCE due to a lack of safety data on whether the electromagnetic field of the capsule-recorder-system could harm the fetus. There is also feared theoretical complication of performing MRI while a capsule is within the gastrointestinal tract due to migration of the capsule and the potential for bowel injury or perforation. Our case reinforces the theory that 1.5 Tesla MRI can be safely performed in pregnancy with retained VCE without harm to patient or fetus.