Surgical intervention for capsule endoscope retained at ileal stricture.

examination for the small bowel [1]. We report a case of operation for a capsule endoscope retained at an ileal stricture in a patient with multiple ileal strictures. A 37−year−old man presented with a 3− year history of abdominal pain, gastroin− testinal bleeding, and intermittent in− complete ileus. He underwent compre− hensive investigations including gastros− copy, colonoscopy, and computed tomog− raphy (CT) of the abdomen at a tertiary medical center elsewhere, and the find− ings were unremarkable. Capsule endos− copy was carried out to investigate the small bowel for any potential cause of the symptoms. After ingestion of the cap− sule, the patient was found to have multi− ple small−bowel diverticulosis, and he did not see the capsule pass in the stool. Three weeks later he developed intermit− tent attacks of abdominal pain. Barium examination of the small bowel revealed the capsule endoscope impacted at an ileal stenosis (l" Fig. 1). The patient was referred to our hospital for further evalu− ation. We inserted a double−balloon en− teroscope anally and found the capsule endoscopy trapped on the oral side of a severe ileal stenosis. Owing to the severe stenosis we failed to retrieve the capsule endoscope. Four days later, the patient’s abdominal symptoms worsened and X− ray plain film revealed incomplete ileus and a metallic density within it (l" Fig. 2). After consultation with a se− nior general surgeon, the patient was scheduled to undergo operative interven− tion. The operation went smoothly and a diagnosis of Crohn’s disease was con− firmed (l" Fig. 3). Tanaka et al. reported successful retrieval of a capsule endoscope retained at an ileal stenosis in Crohn’s disease using double−balloon endoscopy [2], confirm− ing that double−balloon endoscopy may be the best method by which to retrieve a retained capsule endoscope because it is able to reach the whole gut. Thus, if a capsule endoscope is impacted, it may be retrieved safely by endoscopy; but be− cause endoscopy is unable to deal with ir− reversible intestinal stenosis, when con− comitant ileus is present, surgery should be considered.