Unexpected Capsule Endoscopy Findings: A Case Of How An Initial Evaluation For Polyposis Syndrome Led To The Discovery Of Multiple Foreign Bodies

Introduction This is a case of a 42 year old female who was unexpectedly found to have multiple foreign bodies visible on capsule endoscopy. This case is important and unique as it demonstrates the utility and value of capsule endoscopy in regards to small bowel pathology. For our case, we were able to visualize and identify the objects of question. This case also shows the unpredictable nature of foreign body ingestions. Case A 42 year old female presented to the ED for abdominal pain and constipation. Four days prior to her ED visit, she had an EUS and capsule endoscopy performed for re-evaluation of recently removed duodenal nodule and concerns for polyposis syndrome. Since her endoscopic evaluations, she had been dealing with abdominal distention, pain, and constipation. Patient's labs and vitals were within normal limits. Abdominal exam was notable for distention with diffuse tenderness along the epigastrium. Bowel sounds were hypoactive. No guarding, rebound, or rigidity was noted. Abdominal CT scan was consistent with ileus and possible Meckel's diverticulitis. In the ED, patient was given 12mg of Relistor. She was started on IV fluids and an NG tube was placed. Further imaging studies showed multiple foreign bodies on serial abdominal X-rays. During her admission, a Meckel's scan was performed and normal. It was believed that her ileus was caused by polypharmacy from her psychiatric medications. Capsule images were reviewed and concerning for foreign bodies in her intestinal lumen. Small bowel enteroscopy was unable to retrieve objects. Surgery was consulted for surgical intervention. They recommended monitoring the patient as, through serial imagining, the objects had been moving within the bowel and were relatively small in size (<1cm). Diet was advanced and bowel function returned, without foreign body expulsion, before discharge. Two months later, patient returned with severe abdominal pain. She was found to have a small bowel perforation and required immediate surgical repair and removal of all four foreign bodies. Discussion This case teaches us the utility of capsule endoscopy for visual evaluation of the small bowel. We were fortunate that the capsule study, performed four days prior for concern of polyposis syndrome, identified the objects of question. The initial decision to observe without surgical intervention was warranted but ultimately she required surgical repair and removal of foreign bodies after discharge.1873_A Figure 1 No Caption available.1873_B Figure 2 No Caption available.1873_C Figure 3 No Caption available.