Temporary Intestinal Occlusion Induced by a ”Patency Capsule” in a Patient with Crohn’s Disease

Abstract

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.

Patency© and agile© capsules

“…However, at least four cases of occlusion did not respond adequately to conservative treatment and needed surgery. According to Gay et al [30] , the problem could be that when the PC entrapped in a very tight stenosis it might not have been in contact with fluids and, therefore, only started to dissolve 48 h later, after moving back to the enlarged intestinal loop where it encountered fluids. Another possible factor is proposed by Gay et al [30] ; PC is mainly made of lactose and the presence of lactase, an enzyme produced by intestinal mucosal cells, may be of importance in initiating the dissolution process.…”

“…According to Gay et al [30] , the problem could be that when the PC entrapped in a very tight stenosis it might not have been in contact with fluids and, therefore, only started to dissolve 48 h later, after moving back to the enlarged intestinal loop where it encountered fluids. Another possible factor is proposed by Gay et al [30] ; PC is mainly made of lactose and the presence of lactase, an enzyme produced by intestinal mucosal cells, may be of importance in initiating the dissolution process. As lactase is mainly produced in the jejunum, one may also assume the enzyme is massively destroyed before the intestinal content reaches the ileum and that in the cases of occlusion, the enzyme could not have interacted with the capsule material.…”

Small Bowel Capsule Endoscopy

“…Informed consent should be undertaken, with the patient informed of the very rare risk of temporary intestinal occlusion caused by the disintegrating capsule and the potential need for surgery [401]. Any drugs that affect gut motility, including narcotics should be reviewed and, if possible, withheld for at least 48 h before the procedure.…”

Wireless Capsule Endoscopy in Pediatric Gastrointestinal Diseases

“…If passage of the patency capsule is blocked, the capsule dissolves in 40-100h. The safety and efficacy of the initial model has been questioned (Gay, 2005), but recently, a new patency capsule model with a biodegradable body has been developed. The new patency capsule is a reliable indicator of functional patency in suspected or even known cases of intestinal stricture, and it can be used prior to conventional CE to predict and minimize the risk of retention and impaction (Banerjee, 2007).…”