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Bowel obstruction due to video capsule endoscopy in a patient with Crohn's disease
Guillermo R Guevara-Morales1, Juan C Castellanos-Juárez2
1Servicio de Cirugía General. Hospital Regional de Veracruz, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Veracruz, Veracruz, México.
Background:
The retention of the endoscopic capsule (EC) is a serious complication and exceptionally, acute intestinal obstruction is conditioned.
Clinical Case:
64 years-old man, previously treated by gastroenterology for Crohn's disease. With good initial response to pharmacological treatment for 6 weeks, subsequently with the onset of pain and symptoms not explained by colonoscopy. EC was performed, presenting at 48 hours bowel obstruction symptoms with data of systemic inflammatory response and peritoneal irritation. Exploratory laparotomy with bowel resection and side-to-side stapled anastomosis was performed, histopathology report confirmed obstruction of the bowel lumen due to impacted EC in ileal stenosis area. In the immediate postoperative period with good evolution. At 8 weeks of the procedure, he went for an enterocutaneous fistula, which had a good response to conservative treatment.
Conclusion:
The rate of retention of CE in Crohn's disease is 5-6%, prior to its use, it is recommended to perform imaging studies to evaluate the bowel permeability, however negative studies do not exclude the presence of stenosis. In cases where intestinal resection is indicated, it is recommended to be wide with side-to-side stapled anastomosis to reduce the risk of recurrence of the disease.