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Man Reports PillCam Stuck In His Gut For Over 12 Weeks
A Portland man appears to have a pill-sized camera stuck in his gut. That man is me... Let me explain.
For the average Joe, the following statement might sound a bit peculiar: I have swallowed a pill-sized camera a number of times. You see, I have Crohn's Disease (CD) in the small intestine -- a 20 foot-long portion of the gastrointestinal tract that runs between the stomach and the large intestine (colon). A "PillCam" is the most non-invasive, detailed method to survey this area as it doesn't require a scope up the rectum or down the esophagus, nor does it require any tissue slicing. It's also one of the safest procedures available -- the retention rate is as low as 1%. Unfortunately, this most recent capsule endoscopy resulted in my admission to the 1% club.
On March 27th, 2018, I swallowed the PillCam that is currently lodged in my small intestine. If you do the math, that's more than 82 days ago (over 12 weeks). After hiking Smith Rock and summiting Black Butte a couple weeks later, I thought for sure the pill would have exited. It didn't, as evident by the follow-up X-ray. It can be difficult to find research on such a what-if scenario that happens to so few, but I did manage to find a Motherboard article telling the story of Scott Willis, a CD patient that had a PillCam lodged in his gut for eight weeks. One of the key differences between him and me is that he had a partial block and endured more symptoms, prompting him to schedule a procedure to get it out quicker. I'm relatively symptom free.
We have tried upping the dose of corticosteroids to reduce inflammation and help the pill pass through the strictured areas, but that didn't seem to work. Most recently, I had two double-balloon enteroscopy procedures done within a week apart. They were able to locate the PillCam during the second procedure, but weren't able to retrieve it without risking the scope itself becoming stuck. The next step is to try again via the esophagus. The potential issue/complication here is the location. As my doctors warned, the PillCam is stuck 15 feet down and the scope is only 20 feet in length. There's little wiggle room if the pill is slightly further down the GI tract than estimated.
I am sharing this story with the Slashdot community for two reasons. First, those entrenched in the world of cyborgs and/or modern-day medical procedures may find this experience particularly interesting. Second, the more people who know about the procedures and complications of Crohn's Disease the better. For those interested, I'll update this post after the next procedure. Have you or someone you know experienced a capsule endoscopy? Please share what you feel comfortable with.
UPDATE 7/11/18: Yesterday, I had the procedure to remove the PillCam via the esophagus and it wasn't successful. The doctor said he tried everything he could to retrieve it but the scope wasn't quite long enough to reach the pill. I'll be talking with a surgeon next week and will update this post when a surgery date is confirmed.
For the average Joe, the following statement might sound a bit peculiar: I have swallowed a pill-sized camera a number of times. You see, I have Crohn's Disease (CD) in the small intestine -- a 20 foot-long portion of the gastrointestinal tract that runs between the stomach and the large intestine (colon). A "PillCam" is the most non-invasive, detailed method to survey this area as it doesn't require a scope up the rectum or down the esophagus, nor does it require any tissue slicing. It's also one of the safest procedures available -- the retention rate is as low as 1%. Unfortunately, this most recent capsule endoscopy resulted in my admission to the 1% club.
On March 27th, 2018, I swallowed the PillCam that is currently lodged in my small intestine. If you do the math, that's more than 82 days ago (over 12 weeks). After hiking Smith Rock and summiting Black Butte a couple weeks later, I thought for sure the pill would have exited. It didn't, as evident by the follow-up X-ray. It can be difficult to find research on such a what-if scenario that happens to so few, but I did manage to find a Motherboard article telling the story of Scott Willis, a CD patient that had a PillCam lodged in his gut for eight weeks. One of the key differences between him and me is that he had a partial block and endured more symptoms, prompting him to schedule a procedure to get it out quicker. I'm relatively symptom free.
We have tried upping the dose of corticosteroids to reduce inflammation and help the pill pass through the strictured areas, but that didn't seem to work. Most recently, I had two double-balloon enteroscopy procedures done within a week apart. They were able to locate the PillCam during the second procedure, but weren't able to retrieve it without risking the scope itself becoming stuck. The next step is to try again via the esophagus. The potential issue/complication here is the location. As my doctors warned, the PillCam is stuck 15 feet down and the scope is only 20 feet in length. There's little wiggle room if the pill is slightly further down the GI tract than estimated.
I am sharing this story with the Slashdot community for two reasons. First, those entrenched in the world of cyborgs and/or modern-day medical procedures may find this experience particularly interesting. Second, the more people who know about the procedures and complications of Crohn's Disease the better. For those interested, I'll update this post after the next procedure. Have you or someone you know experienced a capsule endoscopy? Please share what you feel comfortable with.
UPDATE 7/11/18: Yesterday, I had the procedure to remove the PillCam via the esophagus and it wasn't successful. The doctor said he tried everything he could to retrieve it but the scope wasn't quite long enough to reach the pill. I'll be talking with a surgeon next week and will update this post when a surgery date is confirmed.
Have you tried eating only meat? http://meatheals.com/category/... Other, lower tech approaches: The Core Strategy | Crohn's Dad http://bit.ly/15S3dWL
"Tempers are wearing thin. Let's just hope some robot doesn't kill everybody." --Bender
When I saw the title of the post I knew this would be about someone with Crohn's. I have it too, and my doctor wanted to do a PillCam, but luckily he decided to do an abdominal MRI first to make sure there weren't any strictures narrow enough to prevent the pill from passing through. After the MRI the doc decided it was too risky, and went for a traditional colonoscopy instead.
I hope they find a way to get yours out without resorting to major surgery. :)
Good luck! Crohn's sucks enough without problems like this to deal with.
Hopefully the Crohn's MAP vaccine will be approved soon and we can all put this behind us.
Plain and simple: thanks for taking about this, both for the interest and the education.
I'm typically jokey here, but really: thanks, and good luck losing that thing.
It sounds as though despite active disease, stricture, and these technical headaches, that you are active (hiking tall rocks) and thus not acutely complicated by your palsied pill. If you are not sick, then no urgent risk. The big concern of course is that the thing will lodge in the stricture and you will get acutely obstructed.
I assume that your doctors have already tried various things, but on hearing the story anew, several things come to mind. They might have all been done already, but it doesn't hurt to get fresh ideas:
- Steroid boost. I see that that has been tried, but all too often when I hear that steroids were raised, it is often just trivial amounts. If reduction of inflammation and edema will loosen the stricture and de-narrow the lumen, one to two weeks of sizeable doses might be needed, e.g. the kinds of doses used for severe life threatening flares of autoimmune disorders such as lupus or pemphigus.
- Lubrication. Mineral oil is a classic stool softener and lubricant. It is less in favor today because (1) concerns about hydrocarbon aspiration and pneumonitis if you are obstructed and vomiting, and (2) high priced pharmaceutical pills are more in the minds of most physicians these days. If you are not obstructed (sounds like you are not), then a good swig or two of the stuff might help.
- Bulk flow. The concentrated osmotic agents that are used for bowel preps might create a wave of peristalsis and flow that might carry the flotsam forward. This could be a concern if you are obstructed, but evidently you are not. But if you were . . .
- Gastrograffin swallow. This is intestinal x-ray dye. It is very hygroscopic and can induce bulk fluid flows as well as dehydrating the mucosa (lining tissue) of the bowel surface. It is often used as a first line intervention to alleviate an early bowel obstruction before resorting to surgery. A gastrograffin swallow would partly combine the effects of steroids and osmotic agents, which if primed with mineral oil might get the thing to sneak by.
- Technical. If they could see it with the 2-balloon enteroscope, then they might have snagged it except that they either could not reach it or else not grab it with a biopsy forceps. Instead, they could use a stone basket. If the stone baskets are on too short a wire, then weld-solder-splice an extension. Big companies such as Olympus that make the equipment will often make custom modified hardware for special circumstances, and making a 20 or 25 foot long stone basket might be easy if you ask your local rep for help.
None of these are guaranteed to work, but they have a fair chance of doing so, and they are safe. Perhaps one or some of these have not been tried yet, in which case it is worth discussing them with your doctors.
Good luck.
I am sorry you have this problem.
I am a Trauma, General surgeon.
This is what I would do:
1) removing the pill does not fix the stricture problem. It simply kicks the proverbial can down the road. The next time something gets stuck there, (and there will be a next time) it will be possibly worse. It may lead to a perforation and an emergency surgery with possible ostomy (stool bag) as the outcome.
2) I would do laparoscopy using three 5mm ports. Identify the stricture, and do the correct surgery which is a stricturaplasty And removal of the Pill Cam. If stricturoplasty is inadequate then you may need a resection.
Thatâ(TM)s it.
The real problem is that you can not avoid the inevitable which is you have a relatively asymptotic stricture which is symptomatic by virtue of the Pill Cam not passing through. Consider it a warning and deal with it in semi-elective manner. Better now then as an emergency which given enough time it will become.
Of course, it could also be dangerous, but it might be worth talking to the doctor about. {...} Rare earth magnets that are SWALLOWED can do damage,
The danger of swallowing rare earth magnets comes from the plural -s at the end of the word.
If you swallow just one, nothing of significance happens, you'll eventually just shit it out.
The risks rise dramatically if there's more than one magnet, specially if swallowed on separate instance (not stuck together as 1 block, but separately).
They'll travel with a distance apart from each other along the 20feet of gut tract.
If they come (from the outside perspective) close to each other, while they are in 2 distinct part of the gut (from the perspective of the length of the gut).
(Say, each magnet is in a turn, and both turn happens to be close to each other. Basically think a long labyrinth and the magnets only having a couple of walls inbetween), then there's a high risk that the magnets will attract each other and get stuck.
They'll be stick magnetically to each other, which might prevent from moving further along the gut.
They'll also be very strongly pinching whatever (mostly gut wall of the different loops) is in between them, which could damage the tissue, and/or block the blood flow due to the pinching.
These can lead to the the gut wall dying.
Regarding the camera, as you say it might be an idea worth talking but could be dangerous.
The poor guy isn't healthy, he has a gut disease (chronic inflammation).
His gut doesn't behave like a simple 20feet long hose. But instead due to the inflammation, the gut's wall is partly damaged, and in some points is stuck together (that's the "strictures" he's talking about). The hypothesis is that the pill is stuck in one such stricture.
Pulling it with magnets could potential help it go further along the gut.
But pulling it with magnets could also pull the pill against damaged wall, burrowing it further into the walls, or risking to rupture a peculiarly damaged wall.
For the double-balloon procedure, which end did they enter? If via the colon, I'll have to reference this in the future when BeuHD makes very silly posts a about solar-electric and such.
Given that he mentions that the eosophagus would be the next entry to try, I think we can guess that the colon was the entry used in the first 2 attempts.
"Sufficiently advanced satire is indistinguishable from reality." - [Tips: 1DrYakQDKCQ6y52z6QbnkxHXAocMZJE61o ]
This is not a joke. Try smoking (or vaping, or eating) some marijuana. It tends to relax internal muscles and may help you pass it. At worst, it's a cheap, harmless, fun thing to try before going in for a more complicated, potentially needless procedure.
This is not a joke, this is some of the worst advice. Please stop posting uninformed advice that is more harmful than helpful.
Muscle relaxants (of which marijuana is a poor one) are not useful here and are actually contraindicated. This capsule is not hung up on a sphincter, it is likely caught in a stricture and inhibition of peristalsis is not going to help and may make matters worse.
In addition, by consuming marijuana and getting "high" he or she may miss changes in their condition that indicate that they need to get to the hospital emergently (e.g. abdominal pain indicative of intestinal rupture). If they decide to take themselves to the ED, driving while impaired is illegal in all states not to mention just plain dangerous. Once there, again, being under the influence of a psychoactive drugs they may not give a thorough medical history, or it may alter the physical exam findings, possibly leading to a misdiagnosis (even with EMRs - I have seen this happen). Marijuana may also interact with other more useful medications that need to be given leading to further complications. In addition, diagnostic tests may be delayed as they won't be able to properly consent after consuming an substance that alters cognition. In addition, buying drug on the street is very dangerous because you do not know exactly what you are buying (a pharmacology professor of mine proved this in the 80s) - even marijuana can be laced with even more dangerous substances
In short, please don't self-medicate. This is especially true when you have a complex medical condition. Leave the medical advice to someone who is trained and qualified.
And stop claiming that marijuana is harmless. I see too many people land in our ED as a result of this type of self-medication.