Aims Small bowel video capsule endoscopy (VCE) is currently considered the first diagnostic
method for the study of the small intestine.
Methods A 87-year-old man with heart disease on oral anticoagulation therapy, with previous
left hemicolectomy for colonic adenocarcinoma presented with melena. Since upper and
lower GI endoscopy were unrevealing he underwent to VCE for overt suspected small
bowel bleeding.
Results Our in-depth checklist excluded contraindications to VCE. Ingestion of the capsule
(PillCam SB3), however, appeared difficult and was followed by the onset of cough,
initially more frequent but which regressed after a few seconds. Upon immediate evaluation
of the images provided by the real-time recorder, the capsule did not appear in the
esophagus but inside the airways, perhaps the trachea. Patient parameters were monitored
immediately, O2-saturation remained regular and the patient appeared calm and stable.
Pulmonologists were alerted and, having explained the case, performed a bronchoscopy
for extraction of the foreign body: the inhaled capsule was identified in the intermediate
bronchus of the right lung, and removed with a basket, without any complication. Clinical
parameters were stable during and after the procedure. The patient was subsequently
sent to study of the small intestine by placing the capsule using a gastroscope.
Conclusions Aspiration into the airways of a videocapsule is a very rare occurrence (frequency
˂ 0.003 %). Elderly patients may present pitfalls: although our patient had never
reported dysphagia symptoms, an unrecognized swallowing disorder might be involved.
Older age alone cannot in itself routinely presuppose the positioning of the capsule
by gastroscopy or a preliminary videofluorographic study of swallowing, but it must
be considered a “warning” for the physician and may require an accurate visualization
in real time of the ingestion phase, in order to immediately catch an accidental aspiration
and promptly activate all the appropriate measures.
Citation:
Rizza S, Bruno M, Ciruolo M et al. eP97 A CASE OF BRONCHIAL ASPIRATION OF A SMALL BOWEL CAPSULE
IN AN ELDERLY PATIENT. Endoscopy 2021; 53: S128.
