Inflammatory Bowel Disease (IBD) is characterized by chronic inflammation in the gastrointestinal (GI) tract. Video capsule endoscopy (VCE) is widely used to investigate the small bowel, and capsule retention is the most serious potential complication. Endoscopic and surgical management has been reported, but in the absence of bowel obstruction, there is little consensus as to which should be employed. In this case report, we describe a patient who was investigated with VCE for weight loss and anaemia. He had previously undergone colectomy with ileoanal pouch formation for ulcerative colitis (UC). Capsule retention occurred at an ileal stricture and he was subsequently diagnosed with Crohn's disease (CD). We describe his medical management and successful capsule retrieval using endoscopic methods. This case also highlights the importance of screening for intestinal strictures in an atypical presentation of UC following colectomy. 1. Introduction IBD is a chronic inflammatory condition comprising UC and CD. The incidence of UC varies greatly between 0.5 and 24.5/100,000 persons, while that of CD varies between 0.1 and 16/100,000 persons worldwide [1]. The precise aetiology remains unknown but is thought to be a combination of genetic, immunologic, and environmental factors. The diagnosis is made on the clinical history, laboratory investigations, and endoscopic and histologic appearances. UC is characterized by confluent mucosal inflammation which is confined to the colon. In contrast, CD is characterized by patchy transmural inflammation which can affect any part of the GI tract, though it commonly involves the ileocaecal region. Enteric fistulas and stricturing are pathological features unique to CD which distinguish it from UC. Video capsule endoscopy (VCE) is used for the investigation of small bowel lesions. Its main indication is for investigation of anaemia due to occult GI bleeding. Following fasting, the patient swallows a small capsule (consisting of a camera, a light source, and a wireless circuit for the transmission of signals). As the capsule moves through the GI tract, images are transmitted to an external data recorder. These data are transferred to a computer for interpretation. The capsule is then passed in the patient’s stool [2]. We report a case of VCE retention and recovery in a patient with IBD without resorting to surgical intervention. 2. Case Report A 36-year-old man presented to the Gastroenterology Outpatients Department with a four-month history of weight loss and iron-deficiency anaemia. He denied abdominal pain and
References
[1]
P. L. Lakatos, “Recent trends in the epidemiology of inflammatory bowel diseases: up or down?” World Journal of Gastroenterology, vol. 12, no. 38, pp. 6102–6108, 2006.
[2]
National Institute for Health and Clinical Excellence, Wireless Capsule Endoscopy For Investigation of the Small Bowel, 2004.
[3]
S. D. Ladas, K. Triantafyllou, C. Spada et al., “European Society of Gastrointestinal Endoscopy (ESGE): recommendations (2009) on clinical use of video capsule endoscopy to investigate small-bowel, esophageal and colonic diseases,” Endoscopy, vol. 42, no. 3, pp. 220–227, 2010.
[4]
J. S. Barkin and S. Friedman, “Wireless capsule endoscopy requiring surgical intervention. The world's experience,” The American Journal of Gastroenterology, vol. 97, pp. A-83–A-89, 2002.
[5]
A. S. Cheifetz, A. A. Kornbluth, P. Legnani et al., “The risk of retention of the capsule endoscope in patients with known or suspected Crohn's disease,” American Journal of Gastroenterology, vol. 101, no. 10, pp. 2218–2222, 2006.
[6]
D. M. Sears, A. Avots-Avotins, K. Culp, and M. W. Gavin, “Frequency and clinical outcome of capsule retention during capsule endoscopy for GI bleeding of obscure origin,” Gastrointestinal Endoscopy, vol. 60, no. 5, pp. 822–827, 2004.
[7]
R. Sidhu, D. S. Sanders, A. J. Morris, and M. E. McAlindon, “Guidelines on small bowel enteroscopy and capsule endoscopy in adults,” Gut, vol. 57, no. 1, pp. 125–136, 2008.
[8]
E. Rondonotti, J. M. Herrerias, M. Pennazio, A. Caunedo, M. Mascarenhas-Saraiva, and R. de Franchis, “Complications, limitations, and failures of capsule endoscopy: a review of 733 cases,” Gastrointestinal Endoscopy, vol. 62, no. 5, pp. 712–716, 2005.
[9]
J. M. Herrerias, J. A. Leighton, G. Costamagna et al., “Agile patency system eliminates risk of capsule retention in patients with known intestinal strictures who undergo capsule endoscopy,” Gastrointestinal Endoscopy, vol. 67, no. 6, pp. 902–909, 2008.
[10]
M. Boysen and M. Ritter, “Obstruction from capsule endoscopy,” Western Journal of Emergency Medicine, vol. 11, pp. 71–73, 2010.
[11]
M. Delvaux, B. Soussan, V. Laurent, E. Lerebours, and G. Gay, “Clinical evaluation of the use of the M2A patency capsule system before a capsule endoscopy procedure, in patients with known or suspected intestinal stenosis,” Endoscopy, vol. 37, no. 9, pp. 801–807, 2005.
[12]
F. T. Fork, N. Karlsson, S. Kadhem, and B. Ohlsson, “Small bowel enteroclysis with magnetic resonance imaging and computed tomography in patients with failed and uncertain passage of a patency capsule,” BMC Medical Imaging, vol. 12, no. 1, article 3, 2012.
[13]
D. Cave, P. Legnani, R. de Franchis, and B. S. Lewis, “ICCE consensus for capsule retention,” Endoscopy, vol. 37, no. 10, pp. 1065–1067, 2005.
[14]
J. H. Cheon, Y. S. Kim, I. S. Lee et al., “Can we predict spontaneous capsule passage after retention? A nationwide study to evaluate the incidence and clinical outcomes of capsule retention,” Endoscopy, vol. 39, no. 12, pp. 1046–1052, 2007.
[15]
G. Hauser, D. Stimac, V. Giljaca, and B. M. Sincic, “Video capsule retention—endoscopic or surgical problem?” Clinics and Research in Hepatology and Gastroenterology, vol. 36, no. 6, pp. e135–e136, 2012.
