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Undiagnosed Endoscopy Capsule Retention Causing Delayed Intestinal Obstruction in a Patient with a Small Bowel Neuroendocrine Tumor

Unusual clinical course, Challenging differential diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents

Nikolaos G. Symeonidis, Kalliopi E. Stavrati, Efstathios T. Pavlidis, Kyriakos K. Psarras, Eirini C. Martzivanou, Christina C. Nikolaidou, Maria C. Meitanidou, Sofia N. Tsiftsi, Theodoros E. Pavlidis ORCID logo

Greece 2nd Propaedeutic Department of Surgery, Aristotle University School of Medicine, Hippokration General Hospital, Thessaloniki, Greece

Am J Case Rep 2021; 22:e932419

DOI: 10.12659/AJCR.932419

Available online: 2021-06-17

Published: 2021-07-24


#932419

BACKGROUND: Capsule endoscopy has played a significant role in small bowel investigation, providing the opportunity of detecting neoplastic lesions to a greater degree and at an earlier stage than other diagnostic procedures. Failure to excrete the capsule with the feces within 48 h can lead to capsule retention with increased risk of further complications such as bowel obstruction and perforation. Capsule retention can remain undetected in case of incomplete follow-up and poor patient compliance. Acute small bowel obstruction as late as many months following capsule endoscopy investigation is very rare, with only a few cases reported in the published literature. We herein report a rare case of prolonged capsule retention which remained undiagnosed, resulting in small bowel obstruction 6 months after the initial investigation.
CASE REPORT: An 82-year-old woman presented with abdominal pain and symptoms suggestive of intestinal obstruction. The patient history included a capsule endoscopy investigation because of episodes of abdominal pain 6 months prior to admission. Both the outcome of the investigation and the excretion of the capsule remained undetermined due to her history of dementia and follow-up failure. Radiologic investigations identified the capsule causing small bowel obstruction. Upon surgery, the capsule was found to be impacted in a stenotic small bowel lesion, and a segmental small bowel resection was performed. Histologic examination revealed the presence of a stenotic small bowel neuroendocrine tumor.
CONCLUSIONS: Appropriate follow-up is necessary to diagnose the complication of capsule retention which, if it remains unrecognized, can cause life-threatening complications as late as many months after capsule endoscopy.

Keywords: capsule endoscopy, Carcinoma, Neuroendocrine, Intestinal Obstruction



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