Srikanth Parsi, MD, Noone Robert, MD. Lankenau Medial Center
INTRODUCTION: Capsule endoscopy has been increasingly used in recent times for evaluating small bowel disease and obscure gastrointestinal bleeding. Although capsule endoscopy is non-invasive and relatively safe procedure, retention of capsule is a major concern, necessitating endoscopic or surgical retrieval. Retrieval by laparotomy is the most common surgical approach for retained capsule. We describe a case of successful laparoscopic retrieval of impacted capsule from an underlying small bowel stricture.
CASE REPORT: 69-year-old female with history of chronic abdominal pain, nausea and weight loss was referred for surgical removal of retained endoscopic capsule. She previously underwnent upper endoscopy and colonoscopy, which were unremarkable. CT revealed small bowel thickening and gallstones. Capsule endoscopy identified a focal small bowel stricture in the mid to distal jejunum with ulceration. Interestingly, the capsule did not pass beyond the stricture for several days. Contrast CT revealed capsule within the small bowel in left lower quadrant with mild proximal small bowel dilatation (fig 1).
We utilized 5 mm camera port and 2 additional 5mm ports, one in the epigastrium and the other in right mid abdomen. Intra operatively, a focal area of hyper vascularity on the serosa of mid jejunum was identified as the site of impacted capsule (fig 2&3). The abnormal segment of small bowel with impacted capsule was exteriorized and resected. The rest of the small bowel appeared normal. She was discharged on second post operative day. Her pathology came back as benign small bowel stricture.
DISCUSSION: Capsule retention defined as presence of capsule in the digestive tract for at least 2 weeks. The reported retention rates range from 1.4 to 3%. Although majority of patients are asymptomatic, retained capsule indirectly indicates significant underlying pathology that warrants surgical exploration. Majority cases of surgical retrieval of retained capsule published in the literature were performed by laparotomy. In fact, there are only two reported cases of laparoscopic retrieval of retained capsule in the literature. Our case further support laparoscopic approach for retrieval of retained capsule endoscope over laparotomy.
CONCLUSION: Capsule retention following capsule endoscopy is rare and is suggestive of underlying small bowel pathology. Surgical approach preferably by laparoscopic retrieval is recommended for diagnosis and treatment of associated small bowel disease.
Fig 1: CT revealing impacted capsule in mid small bowel
Fig 2: Demostrating hypervascualar serosa of the small bowel at site of impacted capsule
Fig 3: Small bowel specimen with stricture and capsule
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80903
Program Number: P165
Presentation Session: Poster (Non CME)
Presentation Type: Poster
