A Case Of Bronchial Aspiration of a Small Bowel Capsule in an Elderly Patient

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.

Publication History

Article published online:
19 March 2021