A Case of Small Intestine Cancer Presented with Retention of Capsule Endoscopy Camera

Abstract

A 48-year-old man who presented with epigastric pain was pointed out to have severe anemia and was referred to our hospital for the purpose of further examination. Abdominal contrast-enhanced computed tomography and upper and lower endoscopy showed no obvious abnormalities. Small intestinal lesions were thus suspected, and a capsule endoscopy (CE) without giving an oral patency capsule (PC) was performed. The CE camera was not excreted even 24 hours after the oral administration, and abdominal CT performed thereafter suggested that the CE camera might remain on the oral side of the stenotic lesion in the upper small intestine near the Treitz ligament. Balloon endoscopy (BAE) detected a stenotic lesion in the upper small intestine and the CE camera had been incarcerated in the center of the lesion. The CE camera was endoscopically removed and the lesion was biopsied. The definitive diagnosis of primary small intestine cancer was made by obtained specimens at the biopsy, and subsequently operation was performed. The operation proceeded under laparotomy, and partial small intestinal resection and radical lymph node dissection were performed with a sufficient surgical margin centered on the lesion approximately 40 cm from the Treitz ligament on the anal side. The histopathological diagnosis was stage IIIA small intestine cancer, and CapeOX (capecitabine+L-OHP) therapy was performed for half a year according to adjuvant chemotherapy for colorectal cancer. One year has passed since the operation, but it has not recurred. By using BAE to recover the retained CE camera at an early stage to avoid intestinal obstruction and to make the preoperative diagnosis, it became possible to provide sufficient surgical treatment for primary small intestine cancer, which generally carries a poor prognosis. It is important to follow the guidelines for the use of CE to avoid retention of the CE camera.