Abstract
IntroductionPerforation caused by capsule endoscopy impaction is extremely rare and, at present, only five cases of perforation from capsule endoscopy impaction are reported in the literature.Case presentationWe report here two cases of patients with undiagnosed small bowel stenosis presenting with acute perforation after capsule endoscopy. Strictures in the small bowel were likely the inciting mechanism leading to acute small bowel obstruction and subsequent distension and perforation above the capsule in the area of maximal serosal tension.Case 1 was a 55-year-old Italian woman who underwent capsule endoscopy because of recurrent postprandial cramping pain and iron deficiency anemia, in the setting of negative imaging studies including an abdominal ultrasound, upper endoscopy, colonoscopy and small bowel follow-through radiograph. She developed a symptomatic bowel obstruction approximately 36 hours after ingestion of the capsule. Emergent surgery was performed to remove the capsule, which was impacted at a stenosis due to a previously undiagnosed ileal adenocarcinoma, leading to perforation.Case 2 was a 60-year-old Italian man with recurrent episodes of abdominal pain and diarrhea who underwent capsule endoscopy after conventional modalities, including comprehensive blood and stool studies, computed tomography, an abdominal ultrasound, upper endoscopy, colonoscopy, barium enema and small bowel follow-through, were not diagnostic. Our patient developed abdominal distension, acute periumbilical pain, fever and leukocytosis 20 hours after capsule ingestion. Emergent surgery was performed to remove the capsule, which was impacted at a previously undiagnosed ileal Crohn’s stricture, leading to perforation.ConclusionsThe present report shows that, although the risk of acute complication is very low, the patient should be informed of the risks involved in capsule endoscopy, including the need for emergency surgical exploration.
Highlights
Perforation caused by capsule endoscopy impaction is extremely rare and, at present, only five cases of perforation from capsule endoscopy impaction are reported in the literature.Case presentation: We report here two cases of patients with undiagnosed small bowel stenosis presenting with acute perforation after capsule endoscopy
The present report shows that, the risk of acute complication is very low, the patient should be informed of the risks involved in capsule endoscopy, including the need for emergency surgical exploration
Small bowel capsule endoscopy (CE) has become a commonly performed diagnostic test in patients affected by various small bowel diseases
Summary
Small bowel capsule endoscopy (CE) has become a commonly performed diagnostic test in patients affected by various small bowel diseases. A computed tomography (CT) scan was performed showing that the capsule was trapped in her proximal ileum, and that there was extensive small bowel dilatation along with free peritoneal air (Figure 2). Our patient underwent an urgent laparotomy during which an ileal perforation was found (Figure 3) proximal to a neoplastic-like stricture in the mid-ileum. Over the two preceding years, our patient had undergone an extensive negative workup performed for recurrent episodes of abdominal pain and diarrhea, including comprehensive blood and stool studies, CT, abdominal ultrasound, esophogastroduodenoscopy, colonoscopy, barium enema and small bowel follow-through. A CT scan of his abdomen was performed and showed the presence of the capsule endoscope located in his distal ileum and a stricture along with extensive small bowel distension, a thickened bowel wall and loculated free air (Figure 4). His postsurgical course was uneventful, and our patient was discharged 10 days later and treated subsequently with medications for Crohn’s disease with good results
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
