The most important complication of capsule endoscopy is retention of the capsule.
Among patients with obscure gastrointestinal bleeding, capsule retention was reported
in 1.5 %; in patients with suspected Crohn’s disease or suspected stenosis of the
small bowel the risk of capsule retention seems to be considerably higher (5 % and
21 % respectively) [1]
[2]. To our best knowledge this is the first case of capsule retention in a duodenal
diverticulum.
A 74-year-old woman was admitted to hospital for evaluation of microcytic anemia.
Gastroscopy and colonoscopy were normal. Capsule endoscopy, using the M2A capsule
(Given Imaging Ltd., Yoqneam, Israel [3]), demonstrated some diverticula shortly after passage of the pylorus. Further images
were not evaluable.
Three weeks afterwards the patient was asymptomatic but had still not excreted the
capsule. A plain film of the abdomen demonstrated the capsule superimposed on the
epigastrium and was otherwise normal ([Fig. 1]). A small-bowel radiograph with water-soluble contrast medium showed the capsule
in a duodenal diverticulum and ruled out obstruction of the small bowel ([Fig. 2]). Gastroscopy was performed and the capsule successfully extracted from a large
juxtapapillary diverticulum using the Roth retrieval net ([Fig. 3]).
Fig. 1 Plain film anteroposterior abdominal radiograph: the capsule is superimposed on the
epigastrium.
Fig. 2 Small-bowel radiograph with water-soluble contrast medium: the capsule is retained
in a large duodenal diverticulum.
Fig. 3 The capsule was captured in a Roth retrieval net (white arrow). The yellow arrow marks
the Teflon-coated tube of the net.
Most patients with capsule retention are asymptomatic. However, a very few cases of
symptomatic bowel obstruction requiring surgical or endoscopic removal of the impacted
capsule have been reported [4]
[5]. This is the first case of capsule retention in a duodenal diverticulum and successful
endoscopic removal of the impacted capsule. We suggest that, even in asymptomatic
patients, capsules that are retained in intestinal diverticula and are not excreted
within a period of about 3 weeks should be removed by gastroscopy or enteroscopy in
order to prevent complications such as diverticulitis, perforation, or pancreatitis.
We conclude that capsule retention in a duodenal diverticulum is a rare complication
of capsule endoscopy. In our patient endoscopic removal of the impacted capsule using
a retrieval net was successful.
Endoscopy_UCTN_Code_CPL_1AI_2AB
