A 24 y.o. social worker with a hx of crohn's since 2010 comes in with RLQ pain

What is the metallic object in her pelvis?

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Our patient had an endoscopy capsule camera lodged in the terminal ileum.  Capsules are traditionally used to detect sites of GI bleeding, diagnose cancer in the small bowel, diagnose celiac disease and screening for polyps.  In the case of our patient she had a stricture of the terminal ileum and the camera lodged there.

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The camera captures two pictures per second which are sent by a radio transmitter to a recorder that the patient wears on a belt. A number of electrodes are attached to the patients abdomen similar to an EKG.  After 8 hours the batteries are depleted  and the 55,000 images  are “glued" into a video which is then downloaded on to a computer. The first capsule, for the small bowel, was FDA approved in 2001. There are two other type of capsules; esophageal and colonic. The indications for the esophageal capsules are Barrett’s esophagus and esophageal varices. These capsules have not become popular because of the prevalence of UGI endoscopy so 90% of the capsules are small bowel type.

Capsule endoscopy of the small bowel  is more sensitive than small-bowel follow through xrays which is still the only way to image the small bowel.   In patients with possible strictures a dissolvable “patency capsule” can be ingested first to see if it will pass. The pill camera contains metallic batteries and can cause a perforation so removal is recommended. It can also interfere with pacemakers.

1-4% of crohn's patients retain the endoscopy capsule

1-4% of crohn's patients retain the endoscopy capsule

Our patient underwent ileocolic resection with removal of the capsule camera because of recurrent pain,  She has done well post op

Capsule endoscopy costs  $919-$2,379. This is compared to $1,500 to $10,000 for upper GI endoscopy.

Mergener K, Update on the use of capsule endoscopy. 2008 Gastroenterol Hepatol. Feb;4(2): 107-110.

Marmo R, Rotondano G, Rondonotti C, et al. Casule endoscopy vs other diagnostic procedures in diagnosing obscure gastrointestinal bleeding: a cost-effectiveness study. Eur J Gastroenterol Hepatol. 2007;19:535-542.

Flemming J, Cameron S. Small bowel capsule endoscopy: indications, results, and clinical benefit in a university environment.  2018. Medicine Vol 97(14). P e0148.