Introduction: Capsule retention at the level of an ileostomy takedown anastomosis is a rare complication. Retrieval of such a proximally retained capsule endoscopically is even rarer. We report a case of capsule endoscopy retention and an adhesive small bowel obstruction.
Case Description/Methods: A 53-year-old man with a history of ulcerative colitis underwent a subtotal colectomy with ileorectal anastomosis and ileostomy takedown. He presented with abdominal pain, nausea, and vomiting after a capsule endoscopy six days prior. A computed tomography scan showed pill cam retention and partial small bowel obstruction, with the pill cam located in a dilated loop of small bowel, but not causing the obstruction.<br>Admitted to the surgical service, he was managed with nasogastric tube decompression and bowel rest. A water-soluble contrast small bowel follow-through was performed on hospital day one, which revealed partial obstruction. Contrast passed throughout the entirety of the small bowel within four hours, but the capsule remained retained at the previous ileostomy takedown site.<br><br>Surgical intervention posed high risks due to his extensive surgical history, so endoscopic retrieval was attempted. During retrograde small bowel enteroscopy, the scope was advanced to the ileum but encountered looping and redundancy due to adhesions. With positioning adjustments, the scope reached the ileo-ileal anastomosis, where the capsule was visible but blocked by a stricture. The stricture was dilated using a 12 to 15mm through-the-scope balloon, allowing the scope to advance and retrieve the capsule with a Roth net.<br><br>Post-procedure, the patient’s symptoms improved dramatically. His abdominal pain resolved, bowel function returned, and he was discharged the same day.
Discussion: While many patients can be managed medically with eventual capsule passage, this approach carries risks, especially in patients with concurrent small bowel obstructions. This case demonstrates the feasibility of endoscopic management of capsule retention in a patient with a history of subtotal colectomy and an anastomotic stricture at his previous diverting loop ileostomy.
Figure: A composite figure of the CT scan showing the dilated bowel loops along with a retained capsule, Ileo-Ileal constriction, ballon dilatation of ileo-ileal anastomosis, and a successful capsule retrieval using a Roth net
Disclosures:
Mohamad Hijazi indicated no relevant financial relationships.
Katherine Markesbery indicated no relevant financial relationships.
Mhd Kutaiba Albuni indicated no relevant financial relationships.
Venkata Muddana indicated no relevant financial relationships.
Mohamad Hijazi, MD1, Katherine Markesbery, DO2, Mhd Kutaiba Albuni, MD3, Venkata Muddana, MD2. P2173 - The Feasibility of Retrograde Small Bowel Endoscopy for Video Capsule Retrieval, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
