Colon cancer detection by a „rendezvous colonoscopy“; successful removal of stuck colon capsule by conventional colonoscopy

Background: Although capsule retention is a known complication of small bowel capsule endoscopy initial studies with colon capsule endoscopy (CCE) have not reported any capsule retention or stucking neither in the small bowel nor in the colon. We report a complication of CCE when the stuck colon capsule was passed through the malignant colon stricture and removed by the aid of flexible colonoscope.

Case report: A 76 year old woman with a history of percutaneous coronary stent implantation was admitted because of worsening dyspnea and cardiac chest pain. Medications included 75mg clopidogrel and 100mg aspirin daily. At admission the Hb was 4.8g/dL. There was no hematochezia or melaena however the FOBT was positive. The patient received 6 units of packed red cells transfusion. EGD was negative for a source of bleeding. With the suspicion of large bowel bleeding origin the PillCam Colon capsule endoscopy (Given Imaging Ltd.) was chosen initially because of its noninvasive nature.

During the CCE procedure a real-time viewing was performed with Rapid Access Real Time Tablet PC to determine the location of the capsule. By this method an actively bleeding obstructive tumor mass was detected in the ascending colon which blocked the capsule passage for 2.5 hours. To avoid capsule retention and to complete the diagnosis colonoscopy was performed with a standard colonoscope. Colonoscopy revealed a 10cm long ascending colon tumor leaving only a 10–12mm lumen in diameter. The stuck capsule was caught by a polypectomy snare, passed through the tumorous stricture and finally removed from the colon without further complications.

Conclusion: The current case describes the usefulness of the real-time viewer system. Similar situations may occur during the forthcoming spread of CCE and the present case is an example how to manage the potentially risky stuck colon capsule condition.