P1331 - Retrieval of a Capsule Endoscope Retained in a Hernial Sac at an Anastomosis in the Distal Jejunum by Colonoscopy

Harini Rathinamanickam, MD, Ying Ying Hu, MD
SIU School of Medicine, Springfield, IL

Introduction: A capsule endoscope (CE) used in small bowel evaluation may cause complications such as capsule retention (CR). Balloon enteroscopy (BE) is used for CR in the jejunum while colonoscopy could be used for CR in the ileum. We report a patient with CR in a hernial sac at anastomosis in the distal jejunum. CE was retrieved using a colonoscope.

Case Description/Methods: 82 y/o Caucasian woman with HTN, DM, CAD, and pulmonary fibrosis presents with rectal bleeding. Hb dropped from 12.8 to 9.6. Colonoscopy revealed diverticulosis, blood throughout the colon, and no active bleeding source. EGD and CE were negative. The patient didn’t pass the CE for > 2 days. CTA did not reveal a bleeding source but noted CR in a hernial sac at an anastomosis in the small bowel. The radiologist suggested that the CE is located at the distal jejunum to the proximal ileum area based on distance from the ileocecal valve. The patient underwent a repeat colonoscopy 1 week from admission due to persistent bleeding. No source of active bleeding was noted. After ileal intubation, the scope was traversed through the anastomosis, dilating the orifice. The scope was traversed beyond the anastomosis and CE was retrieved. She was thought to have a diverticular bleed. During observation, her bleeding stopped. She is doing well at 4 months f/u.

Discussion: CR occurs at a rate of 0.75-3%. A patency capsule (PC) prevents CR. We didn’t do PC since the patient didn’t provide h/o bowel surgery. Ventral hernia could not be appreciated due to obesity. The bowel surgery was due to adhesions and no evidence of IBD was noted. CR is defined as CE retention for >2 weeks. We opted to retrieve CE sooner since our patient developed signs of bowel obstruction.
Traditionally surgery was required for CR. BE is now used for CR in the mid-small bowel with a success rate of 56 to 91.7%. The endoscopic approach depends on the location of CR. Push enteroscopy can reach up to mid jejunum or 70 cm of the small bowel. BE is used in CR distal to the mid-jejunum or in the mid-small bowel. The standard colonoscope has been utilized for CR in the distal small bowel. Key to a successful retrieval of CE using a colonoscope is intubation of the ileum and advancement of scope to the required site. Factors aiding ileal intubation are young age, good bowel prep, and technique. Our case demonstrates that with good technique, a standard colonoscope could be attempted first in CR in the distal jejunum, particularly in poor surgical candidates and resource-limited settings.



Disclosures:


Harini Rathinamanickam, MD, Ying Ying Hu, MD. P1331 - Retrieval of a Capsule Endoscope Retained in a Hernial Sac at an Anastomosis in the Distal Jejunum by Colonoscopy, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.