Retained capsule in covert strictures at the stoma closure site of an ileal pouch, retrieved following endoscopic strictureplasty via retrograde enteroscopy: a case report

Abstract

Video capsule endoscopy (VCE) is an important tool to evaluate small-bowel involvement in inflammatory bowel disease. However, the risk of capsule retention increases in the presence of strictures or obstruction. In patients with total proctocolectomy and ileal pouch-anal anastomosis (IPAA), the use of VCE is challenging because of the surgically altered anatomy and the common presence of strictures. A 46-year-old man with a history of ulcerative colitis and total proctocolectomy with IPAA underwent VCE to assess persistent, unexplained anemia, which impaired his training for a marathon. The capsule was retained at a high stoma closure site with 2 severe strictures undetected on magnetic resonance imaging and previous routine pouchoscopy. Endoscopic balloon dilation and endoscopic strictureplasty were performed with eventual retrieval of the capsule via retrograde enteroscopy. A thorough endoscopic evaluation of the ileal pouch, including the stoma closure site, is crucial prior to VCE.