Intestinal obstruction by capsule endoscopy in a patient with radiation enteritis

Video capsule endoscopy is in widespread use as a diagnostic modality. Although capsule endoscopy is generally considered safe, several prior reports have documented capsules' failure to progress through narrowed areas of intestine. Symptomatic retention and obstruction by capsule endoscopy have not yet been reported in the setting of radiation enteritis.

We report a case of a patient with a history of pelvic radiation who underwent capsule endoscopy to identify an occult intestinal bleeding source after conventional modalities were not diagnostic.

The patient was noted to have capsule retention several days longer than was expected, and video images of the distal bowel showed edema, narrowing, and ulceration consistent with radiation enteritis. The patient developed a symptomatic bowel obstruction requiring resection of this segment of bowel, including the impacted capsule.

A history of abdominal or pelvic irradiation in patients with occult gastrointestinal bleeding should serve as a relative contraindication to video capsule endoscopy. The risk of obstruction and possible need for surgical intervention should be clearly outlined for such patients if they are to undergo this diagnostic maneuver.