Endoscopic capsule retention in an intestinal anastomosis

Wireless capsule endoscopy (CE) was introduced for human clinical diagnostic utilization in 2001. CE has become a first line method of evaluating the small intestine for suspected abnormalities and disease. Contraindications to CE include the presence of intestinal obstruction, fistulas, or structures. Capsule retention has been reported in patients with a strictured or stenotic area of intestine caused by occult neoplasm, nonsteroidal anti-inflammatory drugs, Crohn's disease, radiation enteritis, or previous abdominal surgery. Safe and effective use of CE has been reported in the evaluation of patients who have previously undergone surgical resection of the small intestine for benign or malignant disease. This case report reviews the utilization and subsequent retention of an endoscopic capsule in a symptomatic patient who had a previous small bowel resection caused by the sequelae of radiation therapy to the abdomen and pelvis for endometrial cancer. The retained endoscopic capsule required surgical removal after the patient developed an iron deficiency anemia. The resected segment of small intestine contained the endoscopic capsule, previous intestinal anastomosis, recurrent bowel strictures secondary to radiation enteritis, and a chronic ulcerated intestinal lumen caused by the retained endoscopic capsule. This case report shows that use of CE cannot always be considered safe in patients who have had a previous surgical intestinal anastomosis. CE should not be used in patients who have had a previous small bowel resection and anastomosis for symptomatic intestinal structures that developed because of radiation enteritis.