Asymptomatic bronchial aspiration and prolonged retention of a capsule endoscope: a case report

An 82-year-old Caucasian man was referred to our unit from another local hospital to undergo capsule endoscopy. He swallowed the capsule without any apparent difficulties and did not show any overt symptoms. The following day, when we reviewed the capsule endoscopy images, we realized that the capsule was in the bronchial system and remained there for the duration of the study. An urgent X-ray of the chest confirmed the presence of the capsule in the left side of the bronchopulmonary tree. Two days later a repeat chest X-ray showed the capsule in the right bronchus. After two days the capsule was retrieved in the feces. Our patient remained asymptomatic during the entire admission period.Aspiration of a capsule endoscope is a rare complication; to the best of our knowledge this is the first reported case in which a capsule endoscope remained for six days in the bronchial system of a patient without causing airway compromise or pneumonitis and spontaneously returned to the gastrointestinal tract.Capsule endoscopy is rapidly becoming a widespread tool used for small bowel exploration; the advantages of capsule endoscopy include the absence of discomfort for patients, good diagnostic yield and good safety profile. The main complication is capsule retention, reported in about 1% to 2% of cases [1,2]. Sometimes patients present difficulty in swallowing the capsule but bronchial aspiration of a capsule endoscope is a very rare complication, and only eight cases of bronchial aspiration have been reported in the literature [2-9]. We describe the case of a patient who experienced prolonged bronchial aspiration of a capsule endoscope without relevant symptoms, resolved with spontaneous return of the capsule to the gastrointestinal (GI) tract.An 82-year-old Caucasian man was referred to our unit from another local hospital in order to undergo capsule endoscopy. He presented with unexplained anemia, and previous upper and lower endoscopic examinations had failed to reveal any p