Capsule impaction presenting as acute small bowel perforation: a cases series. (Journal of Medical Case Reports)

IntroductionPerforation caused by CE impaction is extremely rare and, at present, only 5 cases of perforation from CE impaction are reported in the literature.Case presentationWe report here 2 cases of patients with undiagnosed small bowel stenosis presenting acute perforation after CE. Strictures in the small bowel were likely the inciting mechanism leading to acute SB obstruction and subsequent distension and perforation above the capsule in the area of maximal serosal tension.Case 1 was a 55-years-old Italian woman who underwent CE because of recurrent postprandial cramping pain and iron deficiency anemia, in the setting of negative abdominal US, upper endoscopy, colonoscopy, and small bowel follow-through radiograph. She developed a symptomatic bowel obstruction approximately 36 hours after ingestion of CE. Emergent surgery was performed to remove the capsule, which was impacted at a previously undiagnosed structuring ileal adenocarcinoma leading to perforation.Case 2 was a 60-year-old Italian male with recurrent episodes of abdominal pain and diarrhea who underwent CE after conventional modalities, including comprehensive blood and stool studies, CT, abdominal ultrasound, upper endoscopy, colonoscopy, barium enema, and small bowel follow-through, were not diagnostic. The patient developed abdominal distension, acute periumbilical pain, fever and leukocytosis 20 hours after capsule ingestion. Emergent surgery was performed to remove the capsule, which was impacted at a previously undiagnosed ileal Crohn`s stricture leading to perforation. Conclusions: The present report shows that although the risk of acute complication is very low, the patient should be informed of the risks involved in capsule endoscopy, including the need for emergency surgical exploration