Spontaneous disintegration of a retained video capsule in a patient with cryptogenic multifocal ulcerous stenosing enteritis: a rare complication.

pain, diarrhea, and weight loss under− went capsule endoscopy after a normal enteroclysis. The capsule study revealed small−bowel ulcers and erosions and a di− agnosis of cryptogenic multifocal ulcer− ous stenosing enteritis was made [1,2] (l" Fig. 1, l" 2). Enteropathy due to non− steroidal anti−inflammatory use, Crohn’s disease, and celiac disease were all ruled out. Asymptomatic capsule retention in the ileum was diagnosed subsequently (l" Fig. 3). The patient was not fit for sur− gery. She died after 7 months as a result of bilateral bronchopneumonia complicated by sepsis. At autopsy, six short stenosing strictures and a video capsule disintegrat− ed into three parts were discovered in the distal ileum (l" Fig. 4). Histological exam− ination revealed superficial erosions and reparative changes with granulation tis− sue and scar formation in the mucosa and submucosa (l" Fig. 5). The longest reported duration of video capsule retention is 2.5 years and the In− ternational Conference on Capsule En− doscopy (ICCE) consensus for capsule re− tention stated no time limit for removing a retained capsule [3]. Only one case of capsule disintegration (after retention in the ileum for 6 months) has been report− ed so far [4]. To the best of our knowledge, this is only the second reported case of video capsule retention (caused by multiple ileal steno− ses) resulting in disintegration of the cap− sule. The mechanism of capsule disinte− gration is not clear but the combination of chronic exposure to digestive and bac− terial enzyme activity and peristalsis on the joint between the optical dome and the capsule body is the most probable ex− planation. There are some potential prob− lems in this situation. The smaller com− ponents of the disintegrated video cap− sule could be caught within the stricture and induce ileus, and the sharp parts could injure the intestinal wall. On the other hand, the capsule’s batteries are only minimally toxic, containing silver oxide. In reporting this case we want to draw at− tention to the possible risk of capsule dis− integration after a long period of reten− tion. The length of time which an asymp− tomatic retained capsule can be safely left in the small bowel should therefore be determined.