title: Report of video-capsule endoscopy disruption producing episodic small bowel obstruction after prolonged retention.
abstract: BACKGROUND
  Wireless video-capsule endoscopy is a procedure which provides direct visualization of the gastrointestinal tract, particularly the jejunum and ileum. Capsule retention is the main risk associated with capsule endoscopy, occurring at a significantly elevated incidence in patients with known or suspected Crohn's disease.
  
  
  METHODS
  A case of a prolonged retained capsule with subsequent fragmentation producing a multicentric complete small bowel obstruction in a 39 year old male patient who had undergone wireless video capsule-endoscopy approximately three years prior. Management required surgical resection of the strictured jejunum and removal of retained capsule fragments under fluoroscopic guidance.
  
  
  CONCLUSIONS
  Although capsule endoscopy is capable of diagnosis, evaluation, and monitoring inflammatory bowel disease, understanding the elevated risk for capsule retention is important in this population. Specifically, prolonged capsule retention appears to increase the risk of capsule disruption, and likely the potential for intestinal perforation.
  
  
  CONCLUSIONS
  Patients should therefore be carefully selected for monitoring based upon treatment compliance and offered early endoscopic or surgical intervention in the setting of questionable compliance due to the risk for capsule disruption and subsequent intestinal perforation.
authors.affiliation: Department of Surgery, Orlando Health, 1414 Kuhl Avenue, Orlando, FL 32806, USA. Electronic address: nelson.royall@orlandohealth.com.
authors.forename: Nelson A
authors.initials: NA
authors.lastname: Royall
authors.affiliation: Advanced Surgical Care Specialists, Florida Hospital Medical Group, 4106 West Lake Mary Boulevard, Suite 330, Lake Mary, FL 32746, USA.
authors.forename: Creighton D
authors.initials: CD
authors.lastname: Fiscina
keywords: Capsule endoscopy; Crohn's disease; Foreign body; Inflammatory bowel diseases; Intestinal obstruction