Acute appendicitis: A potential complication of video capsule endoscopy

A 69-year-old man presented to our emergency room with malena and symptoms suggestive of anaemia. He was on chronic anticoagulation with warfarin for a mechanical aortic valve. He was haemodynamically stable. Laboratory investigations revealed a low haemoglobin level of 7.1 g/dL and a low-ferritin level of 6 ng/dL suggesting chronic gastrointestinal bleeding. Oesophagogastroduodenoscopy and colonoscopy were performed to identify the source of bleeding but were unfruitful. Video capsule endoscopy was performed. Fifteen hours after ingesting the capsule endoscope, the patient started having severe abdominal pain, nausea and vomiting. Abdominal X-ray did not show any bowel perforation. CT of the abdomen revealed impaction of the capsule endoscope at the appendiceal orifice and an inflamed appendix. The patient underwent laparoscopic appendectomy and made a good recovery.