Report of video-capsule endoscopy disruption producing episodic small bowel obstruction after prolonged retention

• We report a case of a patient who developed intermittent small bowel obstruction secondary to a retained video-capsule endoscopy with capsule disruption.
• Wireless video-capsule endoscopy is associated with elevated risk for capsule retention and intestinal obstruction in the setting of Crohn's disease.
• Prolonged video-capsule endoscopy retention may predispose to capsule fragmentation and intestinal perforation.
• Early intervention is indicated for retained video-capsule endoscopy without excellent patient compliance and follow-up.

INTRODUCTIONWireless video-capsule endoscopy is a procedure which provides direct visualization of the gastrointestinal tract, particularly the jejunum and ileum. Capsule retention is the main risk associated with capsule endoscopy, occurring at a significantly elevated incidence in patients with known or suspected Crohn's disease.PRESENTATION OF CASEA case of a prolonged retained capsule with subsequent fragmentation producing a multicentric complete small bowel obstruction in a 39 year old male patient who had undergone wireless video capsule-endoscopy approximately three years prior. Management required surgical resection of the strictured jejunum and removal of retained capsule fragments under fluoroscopic guidance.DISCUSSIONAlthough capsule endoscopy is capable of diagnosis, evaluation, and monitoring inflammatory bowel disease, understanding the elevated risk for capsule retention is important in this population. Specifically, prolonged capsule retention appears to increase the risk of capsule disruption, and likely the potential for intestinal perforation.CONCLUSIONPatients should therefore be carefully selected for monitoring based upon treatment compliance and offered early endoscopic or surgical intervention in the setting of questionable compliance due to the risk for capsule disruption and subsequent intestinal perforation.