Retrieval of a Retained Capsule Guided by Intraoperative Enteroscopy After Failed DBE in a Patient With Multiple Enteroliths

Abstract

Introduction: Small bowel obstruction (SBO) can rarely cause enterolith formation. Capsule retention (CR) occurs in up to 3-5% of patients. Retrieval of retained capsules can be accomplished with deep enteroscopy such as double balloon enteroscopy (DBE) or at exploratory laparotomy when DBE is not successful. We present a unique case of retrieving a retained capsule within an adhesion related pouch of enteroliths during exploratory laparotomy after failed DBE. A 49-yearold female status post hysterectomy with no prior history of bowel obstruction or weight loss underwent an upper GI series to evaluate abdominal pain, and was found to have a possible mass lesion in the mid ileum. She was referred to an outside facility and underwent capsule endoscopy, which failed to pass beyond the mid small bowel (SB) in an area of a possible dilation and debris. She was subsequently referred to our institution for DBE, which did not reach the retained capsule. Subsequent CT scan of the abdomen revealed dilatation of SB proximal to a retained capsule, with collapsed bowel loops distally. She then underwent intraoperative enteroscopy, which revealed a collection of enteroliths and a retained capsule in a dilated segment of ileum just proximal to a partial obstruction. SPOT ink from the attempted DBE was seen 50 cm proximally. She then had a resection of the abnormal segment of SB and recovered uneventfully. Deep enteroscopy alone may not always be successful in SB foreign body retrieval, necessitating surgical management. This case illustrates the value of intraoperative enteroscopy in localizing a retained capsule during laparotomy to guide bowel resection. Unexpectedly, the patient had developed multiple enteroliths from long-standing partial obstruction, which were not appreciated with either radiologic imaging or capsule endoscopy.