Natural Elimination of a Video Capsule After Retention for 1 Year in a Patient With Small Bowel Crohn Disease: A Case Report

Abstract

Introduction: Video capsule endoscopy (VCE) is a useful tool to differentiate small intestinal bleeding, inflammatory bowel disease, and other small bowel disease. The most common adverse effect of VCE is capsule retention; the incidence varies greatly depending on the underlying disease, which is known to increase from 1.5% in healthy individuals to 21% in patients with small bowel Crohn disease. We report this case on a patient who had asymptomatic capsule retention for 12 months and experienced natural elimination with medication.

Patient concerns: A 21-year-old woman presented to the hospital with chronic abdominal pain and persistent diarrhea for 2 years.

Diagnoses: The patient was diagnosed with small bowel Crohn disease using VCE, and radiography revealed capsule retention.

Intervention: Symptoms of obstruction were not distinctive, it was decided to increase the dosages of azathioprine and infliximab to 50 and 500 mg (10 mg/kg), at 5 months after VCE. And at month 11 of capsule retention, she was admitted and started on a regimen of hydrocortisol 300 mg for 4 days and hydrocortisol injection 200 mg for 10 days.

Outcomes: At month 12, abdominal radiography in the clinic confirmed that the capsule had been naturally retrieved.

Lessons: Capsule retention could be initially treated conservatively with medication and if the treatment fails, it is recommended to remove the capsule surgically. But in the case of the clinical condition of the patient is favorable without symptoms of bowel obstruction, the medication should be continued and the patient followed up.