Lin Otto S, Brandabur John J, Schembre Drew B, Soon Maw-Soan, Kozarek Richard A
Gastroenterology Section, Virginia Mason Medical Center, Seattle, WA 98101, USA.
Gastrointest Endosc. 2007 Apr;65(4):725-8. doi: 10.1016/j.gie.2006.11.033.
Capsule impaction is a well-recognized complication of capsule endoscopy, with an incidence rate of 0.75% to 21%, depending on indication. There have been only 2 reported cases of capsule impaction causing symptomatic obstruction.
We present 3 cases of capsule impaction causing acute symptomatic obstruction and/or perforation.
Case series.
Teaching hospital.
A 71-year-old woman had iron deficiency anemia in the setting of negative upper endoscopy, colonoscopy, enteroclysis, and enteroscopy. She developed severe abdominal pain, vomiting, and leukocytosis 20 hours after capsule ingestion. Emergent surgery was performed to remove the capsule, which was impacted at a previously undiagnosed ileal Crohn's stricture leading to perforation. A 64-year-old woman with Gardner's syndrome and a history of colectomy and subsequent episodes of small bowel obstruction underwent capsule endoscopy to define the site of obstruction. She experienced severe abdominal pain 24 hours after capsule ingestion, and emergent enteroscopy was done to retrieve the capsule, which was impacted at a previously undiagnosed annular mass in the distal duodenum. An 85-year-old man with episodic small bowel obstruction due to radiation enteritis underwent capsule endoscopy to localize the site of obstruction in anticipation of surgery. He returned with severe abdominal pain and vomiting 3 days later. At surgery, the capsule was found to be impacted at an ileal radiation stricture.
Acute symptomatic bowel obstruction.
These cases show that bowel obstruction and even possibly perforation can occur as a result of capsule impaction.
The possibility of acute symptomatic small bowel obstruction should be included in the informed consent for capsule endoscopy.
胶囊滞留是胶囊内镜检查中一种公认的并发症，根据适应证不同，其发生率为0.75%至21%。仅有2例关于胶囊滞留导致症状性梗阻的报道。
我们报告3例胶囊滞留导致急性症状性梗阻和/或穿孔的病例。
病例系列。
教学医院。
一名71岁女性，在胃镜、结肠镜、小肠造影和小肠镜检查均为阴性的情况下患有缺铁性贫血。她在吞服胶囊20小时后出现严重腹痛、呕吐和白细胞增多。紧急手术取出胶囊，胶囊嵌顿在先前未诊断出的回肠克罗恩狭窄处导致穿孔。一名64岁患有加德纳综合征的女性，有结肠切除史及随后的小肠梗阻发作史，接受胶囊内镜检查以确定梗阻部位。她在吞服胶囊24小时后出现严重腹痛，紧急进行小肠镜检查取出胶囊，胶囊嵌顿在先前未诊断出的十二指肠远端环形肿物处。一名85岁男性因放射性肠炎反复出现小肠梗阻，接受胶囊内镜检查以定位梗阻部位，为手术做准备。3天后他因严重腹痛和呕吐返回。手术中发现胶囊嵌顿在回肠放射性狭窄处。
急性症状性肠梗阻。
这些病例表明，胶囊滞留可导致肠梗阻甚至可能穿孔。
胶囊内镜检查的知情同意书中应包括急性症状性小肠梗阻的可能性。
