A 74 year old male patient was seen in our clinic for chronic diarrhoea. Duodenal biopsies revealed the presence of coeliac disease; upper and lower endoscopies were otherwise unremarkable. As he also presented with marked anaemia and weight loss, he underwent wireless capsule endoscopy (M2A capsule; Given Imaging) in order to exclude additional small bowel pathology.
On the second day after application of the capsule (and before analysis of the pictures), he complained of mild respiratory distress while walking, which had started “right after swallowing the capsule”. Physical examination revealed quiet inspiratory and expiratory wheezing, most audible over the central part of the right lung. A chest x ray was obtained (fig 1 ▶) which showed aspiration of the video capsule into the right main bronchus. Because of the smooth surface of the capsule, its removal by flexible bronchoscopy proved to be rather difficult, but eventually it was successfully recovered from the bronchial tree. The patient made an uneventful recovery.
Figure 1.
Chest x ray showing aspiration of the video capsule into the right main bronchus (Courtesy of Professor G Kauffmann, Heidelberg, Germany).
He had a history of ankylosing spondylitis with involvement of the cervical spine. Although he reported no symptoms of dysphagia and recalled swallowing the capsule as uneventful, it may be possible that the cervical spine disease contributed to aspiration of the capsule.1
To the best of our knowledge, this is the first published case of aspiration of an M2A capsule since this diagnostic method has become available to general clinical practice. It underlines the recommendations of the manufacturer for cautious use in patients with known or possible swallowing disorders (http://www.givenimaging.com).
Reference
- 1.Di Vito J. Cervical osteophytic dysphagia: Single and combined mechanisms. Dysphagia 1998;13:58–61. [DOI] [PubMed] [Google Scholar]