Temporary intestinal occlusion induced by a "patency capsule" in a patient with Crohn's disease.
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.
Gay
G
G
Department of Internal Medicine and Digestive Pathology, Centre Hospitalier Universitaire, Nancy, France. g.gay@chu-nancy.fr
Delvaux
M
M
Laurent
V
V
Reibel
N
N
Regent
D
D
Grosdidier
G
G
Roche
J-F
JF
D000328:Adult; D002214:Capsules / Q000009:adverse effects; D003424:Crohn Disease / Q000150:complications*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007077:Ileal Diseases / Q000175:diagnosis / Q000209:etiology*; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000209:etiology*; D012595:Scleroderma, Systemic / Q000150:complications*
D002214:Capsules