Acute symptomatic small bowel obstruction due to capsule impaction

Capsule impaction is a well-recognized complication of capsule endoscopy, with an incidence rate of 0.75% to 21%, depending on indication. There have been only 2 reported cases of capsule impaction causing symptomatic obstruction.

We present 3 cases of capsule impaction causing acute symptomatic obstruction and/or perforation.

Case series.

Teaching hospital.

A 71-year-old woman had iron deficiency anemia in the setting of negative upper endoscopy, colonoscopy, enteroclysis, and enteroscopy. She developed severe abdominal pain, vomiting, and leukocytosis 20 hours after capsule ingestion. Emergent surgery was performed to remove the capsule, which was impacted at a previously undiagnosed ileal Crohn's stricture leading to perforation. A 64-year-old woman with Gardner's syndrome and a history of colectomy and subsequent episodes of small bowel obstruction underwent capsule endoscopy to define the site of obstruction. She experienced severe abdominal pain 24 hours after capsule ingestion, and emergent enteroscopy was done to retrieve the capsule, which was impacted at a previously undiagnosed annular mass in the distal duodenum. An 85-year-old man with episodic small bowel obstruction due to radiation enteritis underwent capsule endoscopy to localize the site of obstruction in anticipation of surgery. He returned with severe abdominal pain and vomiting 3 days later. At surgery, the capsule was found to be impacted at an ileal radiation stricture.

Acute symptomatic bowel obstruction.

These cases show that bowel obstruction and even possibly perforation can occur as a result of capsule impaction.

The possibility of acute symptomatic small bowel obstruction should be included in the informed consent for capsule endoscopy.