Subscribe to RSS
DOI: 10.1055/s-2004-826195
Temporary Intestinal Occlusion Induced by a ”Patency Capsule” in a Patient with Crohn’s Disease
Publication History
Submitted 7 August 2004
Accepted after Revision 3 September 2004
Publication Date:
03 February 2005 (online)
A 26-year-old woman was admitted for the investigation of abdominal symptoms related to ileal Crohn’s disease. The patient had been diagnosed 3 years previously with systemic sclerosis, and had been experiencing digestive complaints for 6 months. A first computed tomography (CT) scan showed ileal intestinal mucosal alterations, associated with a sclerolipomatosis and suspicion of ileal stenosis. An ileocolonoscopy was then performed and showed ulcers in the terminal ileum with nonspecific inflammatory changes found on biopsies, both suggesting the diagnosis of Crohn’s disease. The patient was admitted for M2A capsule endoscopy, in order to clarify the respective roles of systemic sclerosis and Crohn’s disease with regard to the symptoms and secondarily to determine the anatomical extent of the Crohn’s lesions. A patency capsule was administered, for detection of intestinal stenosis before capsule endoscopy was done. At 30 hours after capsule ingestion, the patient complained of abdominal pain and nausea and experienced intestinal obstruction due to the blockage of the patency capsule in the ileal stenosis. The capsule dissolved after 76 hours and the patient then improved. After a few days, the patient underwent ileocecal resection. Pathological examination of the surgical specimen confirmed the presence of an ileal stenosis 17 cm in length. In some circumstances a patency capsule may dissolve slowly, leading to transitory intestinal obstruction requiring medical intervention. It should thus be used cautiously under clinical surveillance in patients with Crohn’s disease.
References
- 1 Iddan G, Meron G, Glukhovsky A, Swain P. Wireless capsule endoscopy. Nature. 2000; 405 417
- 2 Ell C, Remke S, May A. et al . The first prospective controlled trial comparing wireless capsule endoscopy with push enteroscopy in chronic gastrointestinal bleeding. Endoscopy. 2002; 34 685-689
- 3 Saurin J C, Delvaux M, Gaudin J L. et al . Diagnostic value of endoscopic capsule in patients with obscure digestive bleeding: blinded comparison with video push-enteroscopy. Endoscopy. 2003; 35 576-584
- 4 Herrerias J M, Caunedo A, Rodriguez-Tellez M. et al . Capsule endoscopy in patients with suspected Crohn’s disease and negative endoscopy. Endoscopy. 2003; 35 1-5
- 5 Eliakim R, Fischer D, Suissa A. et al . Wireless capsule video endoscopy is a superior diagnostic tool in comparison to barium follow-through and computerized tomography in patients with suspected Crohn’s disease. Eur J Gastroenterol Hepatol. 2003; 15 363-367
- 6 Mergener K, Enns R, Brandabur J J. et al . Complications and problems with capsule endoscopy: results from two referral centers [abstract]. Gastrointest Endosc. 2003; 57 AB171
- 7 Barkin J S. Wireless capsule endoscopy requiring surgical intervention: the world’s experience [abstract]. Am J Gastroenterol. 2002; 97 907
- 8 Boivin H L, Vodeholzer W A, Lochs H. Diagnosing small intestinal strictures: first experience with the M2A patency capsule [abstract]. Endoscopy. 2003; 35 A184
- 9 Costamagna G, Spada C, Spera G. et al . Evaluation of the Given patency system in the GI tract: results of a multicenter study [abstract]. Gastrointest Endosc. 2004; 59 AB145
- 10 Pedersen J, Gao C, Egekvist H. et al . Pain and biomechanical responses to distension of the duodenum in patients with systemic sclerosis. Gastroenterology. 2003; 124 1230-1239
- 11 Villadsen G E, Storkholm J H, Hendel L. et al . Impedance planimetric characterization of oesophagus in systemic sclerosis patients with severe involvement of oesophagus. Dig Dis Sci. 1997; 42 2317-2326
- 12 Gay G, Laurent V, Fassler I, Delvaux M. Interest of the video capsule to detect intestinal tumours [abstract]. Third International Conference on Capsule Endoscopy, February-March 2004, Miami, USA. Given Imaging. 135
- 13 de Mascarenhas-Saraiva M N, da Silva A raujo. Small-bowel tumors diagnosed by wireless capsule endoscopy: report of five cases. Endoscopy. 2003; 35 865-868
- 14 Hara A K, Leighton J A, Sharma V K, Fleischer D E. Small bowel: preliminary comparison of capsule endoscopy with barium study and CT. Radiology. 2004; 230 260-265
G. Gay, MD
Department of Internal Medicine and Digestive Pathology, CHU de Brabois · Tour Drouet · 54511 Vandoeuvre les Nancy · France
Fax: + 33-383 15 40 12
Email: g.gay@chu-nancy.fr