Small bowel capsule endoscopy is a valuable diagnostic tool for visualizing parts of the small intestine that are difficult to access through traditional endoscopic methods. Although generally safe, this technique can rarely lead to complications, such as aspiration into the respiratory tract.
In an intriguing case report, a 91-year-old man with a history of atrial fibrillation and anticoagulant therapy faced a rare and unexpected complication. After a significant episode of upper GI bleeding, a jejunal diverticulum was identified and treated with a hemoclip. Despite this intervention, the patient experienced recurrent bleeding, prompting further investigation with small bowel capsule endoscopy.
During the procedure, the patient ingested the PillCam Small Bowel 3 Capsule while seated upright.HOwever, the capsule was inadvertently aspirated into the proximal trachea. The video from the endoscopy revealed the capsule lodged in the trachea. Remarkably, the patient did not exhibit any signs of respiratory distress or compromise. About 10 hours after the aspiration, the patient spontaneously coughed up the capsule.
Follow-up upper device-assisted enteroscopy failed to identify a new source of bleeding, and the patient’s GI bleeding subsided. His anticoagulant, rivaroxaban, was appropriately withheld, and he was scheduled for follow-up with his primary care physician and cardiologist.
This case is particularly striking because it is the first documented instance of asymptomatic tracheal aspiration of a capsule endoscope with successful self-expulsion after a significant delay. This rare event underscores the importance of patient positioning during capsule ingestion and highlights the potential for unexpected outcomes even in routine procedures.
Travers, Jared MD, PhD1,2; Isenberg, Gerard MD, MBA1,2. Prolonged Asymptomatic Tracheal Aspiration of a Small Bowel Capsule Endoscope. ACG Case Reports Journal 11(7):p e01425, July 2024. | DOI: 10.14309/crj.0000000000001425