Endoscopic video capsules: radiologic findings of spontaneous entrapment in small intestinal diverticula

Retention of endoscopic capsules in diverticula: Literature review of a capsule endoscopy rarity

Background and study aims This review aimed to provide an updated and comprehensive review of capsule retention within diverticula, shedding light on the characteristics and management of this rare event in capsule endoscopy. Methods A systematic literature search was conducted across multiple databases. All observational studies that reported capsule retention in a diverticulum among complication and outcomes, as well as case reports and series, were included. Manual cross-checking of references was also performed. Two extractors performed abstract and full-text reviews, as well as data-extraction. Results We found 167 references from Pubmed, Embase, and Web Of Science. Sixty-five duplicates were removed and another 71 references were excluded. Crosschecking of references found additional two articles. In total, 32 articles were included, resulting in a total of 34 cases of retained capsules in diverticula. The median age was 69 and the majority of the patients were male (76.5%). The most common retention occurred in Meckel's diverticulum (32.4%) followed by Zenker's diverticulum (20.6%). Investigation of capsule retention was done with x-ray (50%) and computed tomography (CT) scan (44.1%). Seventeen cases (50%) were asymptomatic. Resolution of the retention happened with endoscopy (35.3%) and surgical management (32.4%), as well as self-resolution (20.6%). Conclusions Due to the small number of cases, diverticula are not a risk factor for incomplete capsule endoscopy examination. It affects mainly elderly, male, asymptomatic patients, and typically is diagnosed with x-rays and CT scans. The most common type is Meckel's diverticulum, and endoscopy is the primary management. Capsule endoscopy retentions are extremely rare, with only 34 cases reported since the technology's introduction.

Abdominal and pelvic radiographs of medical devices and materials-Part 1: gastrointestinal and vascular devices and materials

When compared with chest radiographs, medical devices of the abdomen and pelvis are less frequently seen. However, with recent advances in technology the interpreting radiologists are seeing more medical objects on these radiographs. The identification of these devices and materials are crucial for not only enabling the radiologist to understand the underlying background pathology but also for evaluating any related complications. An online survey of literature showed our review article to be the most detailed. In this first part of our two-part series, we discuss about the various gastrointestinal and vascular devices and materials seen on abdominal and pelvic radiographs.

Capsule endoscopy device retention and magnetic resonance imaging

A 55-year-old man was hospitalized for a neurologic and infectious workup after having hallucinations and productive cough for 2 days. During hospitalization, he experienced dark stools with an acute drop in hemoglobin. Upper endoscopy and colonoscopy were negative for an identifiable source of bleed. Capsule endoscopy was later done and subsequently an anteroposterior abdominal radiograph confirmed the presence of a retained capsule near the junction of the descending and distal transverse colon, likely contained within a colonic diverticulum. In the interim, the patient developed acute right-sided lumbar radiculopathy prompting emergent lumbar spine magnetic resonance imaging (MRI). During the scanning process, the retained capsule was seen and the test was immediately terminated without harm to the patient. Device retention is a complication unique to capsule endoscopy, occurring at a rate of 1% to 1.7%; retained devices are considered a danger and contraindication to MRI.

Capsule endoscopy – accurate diagnosis method for detection of obscure digestive bleedings and secondary chronic anemia

Background. Capsule endoscopy is a revolutionary new diagnostic method for the detection of digestive diseases, especially localized at the level of small bowel and colorectal tract. This method is the only technique that allows endoscopic examination of the digestive tract without sedation. Obscure gastrointestinal bleeding is the most common indication for capsule endoscopy, which commonly diagnoses arteriovenous malformations, small bowel tumors, ulcers or tumors missed at standard endoscopy or other imaging examinations [1]. Aim. Our study aimed to detect the accuracy of endoscopic videocapsule in detecting the cause of microscopic anemia in patients with supposed digestive pathologies. Material and method. We used PillCam 2 Platform provided by Given Imaging, a system consisting of PillCam 2 videocapsules, a data recorder, a set of sensors and the Rapid 7 Access computer soft capable to receive and transform pictures into films, in order to visualize the entire digestive gastrointestinal tract. We examined 25 patients with chronic anemia, all of them without any known hematologic, renal or digestive disease, investigated by standard imagistic and lab techniques. Results. From the total of 25 investigated patients, 18 (72%) of them presented sources of bleeding discovered with videocapsule endoscopy. The source of bleeding was the small bowel in 10 cases (55%) and the colorectal tract in 8 cases (45%). The accuracy of videocapsule was very good for detecting the digestive tract obscure sources of bleeding (Sn=74%, Sp=87%). Conclusions. The videocapsule endoscopy is an accurate imagistic option to detect digestive sources of bleeding and to identify the cause of many chronic anemia

Multiple giant diverticula of the jejunum causing intestinal obstruction: report of a case and review of the literature

Multiple diverticulosis of jejunum represents an uncommon pathology of the small bowel. The disease is usually asymptomatic and must be taken into consideration in cases of unexplained malabsorption, anemia, chronic abdominal pain or discomfort. Related complications such as diverticulitis, perforation, bleeding or intestinal obstruction appear in 10-30% of the patients increasing morbidity and mortality rates. We herein report a case of a 55 year-old man presented at the emergency department with acute abdominal pain, vomiting and fever. Preoperative radiological examination followed by laparotomy revealed multiple giant jejunal diverticula causing intestinal obstruction. We also review the literature for this uncommon disease.