Incomplete Evaluation of Small Bowel by Capsule Endoscopy with Nonvisualization of Cecum Should Require Radiological Evaluation to Rule Out Small Bowel Obstruction

Abstract

Purpose: To present a patient with chronic abdominal pain who underwent small bowel capsule endoscopy. The recording was incomplete with non-visualisation of the cecum secondary to retention of a capsule in the ileum leading to obstruction of the small bowel. 89-year-old Caucasian female presented to our office with chronic recurrent abdominal pain. An upper endoscopy revealed mild gastritis and a colonoscopy showed a small rectal polyp. A CT scan of the abdomen revealed mild thickening of the small bowel but no evidence of small bowel obstruction. In view of her persistent abdominal pain, a small bowel capsule endoscopy was ordered. Examination of the recording showed patchy ileitis with ileal erosions. The small bowel capsule did not reach the cecum at 8 hrs. When the patient was contacted, she reported having mild abdominal pain and abdominal bloating without any nausea or vomiting. Serial abdominal x-rays done for the next few days showed the capsule to be retained in the small bowel without much progression towards the cecum. A surgical consultation was obtained as abdominal x-rays showed dilatation of small bowel suggesting small bowel obstruction. The patient underwent exploratory laparotomy with removal of the small bowel capsule. The patient recovered uneventfully after surgery. There are many factors that can lead to incomplete recording by wireless small bowel capsule endoscopy. Non-visualization of the cecum at the end of 8 hrs of recording should alert us to the possibility of retained capsule secondary to small bowel obstruction. Follow up serial x-rays are helpful for further evaluation.Figure: [1371] Abdominal X-Ray showing retained small bowel capsule causing small bowel obstruction.Figure: [1371] Picture of capsule removed by exploratory laparotomy.