Seeing is Believing … Twice!

A 77-year-old woman with iron-deficiency anemia and no signs of overt bleeding had negative findings on EGD and colonoscopy. A 12-hour video capsule endoscopy study was performed after detailed verbal and written instructions were provided. She reported witnessing capsule elimination 5 hours after ingestion, then retrieved the capsule from her commode, washed it with soap and water, and re-ingested it. Her attestation was confirmed during study interpretation, demonstrating rapid bowel transit on the first pass (A). Subsequent time-stamped capsule views showed the commode (B), the patient’s hand (C), and the patient’s mouth during re-ingestion (D). On the second pass, small bowel transit was also rapid (54 minutes). Neither imaging iteration disclosed a cause of blood loss anemia. At 1 and 7 days after study completion, she reported no oral or digestive adverse effects from her “double duty” effort. In 18 years (>3000 capsule studies), this is the first instance of capsule re-ingestion by a patient at our practice. Although we routinely remind patients to flush the capsule down the commode once it has been eliminated, this innocent, and potentially distasteful, aberrance from protocol prompted us to revise our procedural instructions to emphatically discourage re-ingestion of the device.