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142 MECHANICAL SMALL BOWEL OBSTRUCTION AND DEATH CAUSED BY RETAINED WIRELESS CAPSULE ENDOSCOPE G Chami, CN Bernstein Capsule endoscopy (CE) is becoming a common and useful procedure for diagnosing pathology of the small bowel. While it is relatively safe, certain complications have been identified. Retention of the capsule is well-documented, even with a normal small bowel follow through study prior to ingestion. However, capsule retention causing mechanical small bowel obstruction (SBO) is extremely rare, and there has never been a report of prolonged CE retention (2 years) leading to delayed mechanical SBO and death.
Department of Medicine, Section of Gastroenterology, University of Manitoba, Winnipeg, Manitoba
We present a case of a 70-year-old woman who underwent capsule endoscopy for the investigation of chronic abdominal pain, weight-loss and diarrhea, in which the capsule was retained for over two years. She had previous abdominal irradiation for endometrial cancer. A small bowel follow through pre-capsule study did not reveal any strictures or delayed transit, and it was assumed that the capsule retention was secondary to a post radiation neuropathic motility disorder. She was managed conservatively as she was asymptomatic. However, two years later while in hospital recovering from a stroke, she presented with a mechanical small bowel obstruction secondary to the retained capsule. At laporotomy, the capsule was identified to be caught in an area of stricture from a previous surgical site. The capsule was milked into the cecum, and a stricturoplasty was performed. The patient's obstruction seemed to resolve, however she died 1 month later in the intensive care unit from a nosocomial pneumonia and cardiogenic shock. This is believed to be the only case in the literature describing prolonged retention of a capsule endoscope (greater than two years) causing a delayed occurrence of mechanical small bowel obstruction and possibly death in a previously asymptomatic patient.