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What does normal capsule endoscopy post ingestion of crown teeth?

Answered by
Dr.
Dr. Klerida Shehu

Gastroenterologist

Practicing since :2006

Answered : 2265 Questions

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Posted on Wed, 29 Jul 2015 in Digestion and Bowels
Question: I am female. 44 years old. 114 lbs. 5 ft 2.


5/28/15

Swallowed a DOUBLE temporary crown made of acrylic. 1inch long x 1/4 inch wide.

Had x ray which did not show anything since acrylic is radioluscent

Bloodwork
Cbc with diff
Basic metabolic panel
(All normal)

6/02/15

Requested a capsule ( camera) endoscopy
Only showed mild small intestinal inflamation.
GI dr did not seem concerned and feels I likely passed the crown.

7/9/15

Routine bloodwork for anual physical.

Creatine. .47 ( .50 - .90 )

Bun/creatine ratio. 29 (10 - 20 )

Rbc. 4.41 ( 4.8 - 10.8 )


What could this be?

Could this indicate any intestinal bleeding?

Please advise. I'm not getting answers and I am told that you can not see radioluscent objects on scans.

Thank you.
doctor
Answered by Dr. Klerida Shehu 13 hours later
Brief Answer:
You have passed it out, following coments to your analysis...

Detailed Answer:
Hi and thank you for asking!
I read your query and understood your concerns.

You have done one month ago capsule endoscopy that didn’t find any foreign body. This is a sign that you have passed it out. Please keep in mind that the capsule endoscopy look throughout all gastrointestinal tract (including small and large intestine) and this is why it’s not necessary another examination.

However in order to help you to deal with your doubts I would recommend to do an abdominal CT with oral contrast. This will definitely help you to clear your doubts.

After reviewing your analysis I would like to say that:
-     You have an increased BUN/creatinine ratio with a normal creatinine. This is typical for dehydration and I would like to recommend drinking plenty of water.
-     You have a slightly lower RBC that is suggestible for possible anemia. Keep in mind that other data (especially hematocrit and hemoglobin levels) are essential for confirming anemia and to find out what is causing anemia. If the hemoglobin and hematocrit levels are normal, than this is a common finding in fertile women (age 15-50) due to monthly periods lost.

Hope this was of help!
Wish you health!
Dr. Shehu
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Klerida Shehu 4 hours later
Thank you for your reply.

If I would take the abdominal ct scan, what would this show?
Could ct scan see plastic ( radioluscent)?

I am allergic to ct scan XXXXXXX ( the injectable XXXXXXX through the vein) Is the oral contrast drinkable because I have no allergy to that.

With your experience, if one if your patients swallowed a double temporary crown 1inch long x 1/4 inch wide, what would be your advice? Is it concerned for the size?

You mention dehydration as the cause for the elevated bun/ creatine ratio.

I forgot to include the urea nitrogen

Urea nitrogen 14 (6 - 20 mg / dl)
Creatine .47 ( .50 - .90)
Bun/ creatine ratio 29 ( 10-20 )

After viewing my urea nitrogen, is the elevated ratio still due to dehydration?

I thought the urea nitrogen had to be elevated.

I have read that high bun/creatine ratio can indicate a gastrointestinal bleed.

Many thanks to you

doctor
Answered by Dr. Klerida Shehu 8 hours later
Brief Answer:
Following advice...

Detailed Answer:
Hi back,

Yes oral contrast is drinkable however you should discuss with your doctor to exclude allergies from oral contrast. The oral contrast will help to make visible any foreign body inside the intestine.

Although your BUN and creatinine levels are normal you have an raised BUN/creatinine ratio that is typical for dehydration.

You shouldn't worry about gastrointestinal bleeding as long as capsule endoscopy didn't find anything wrong with your intestines.

Wish you health!
Dr. Klerida
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. Klerida Shehu 19 hours later
Thank you.

If I could just ask you a few more questions to clarify.

1) Is not my creatine low? Is this representation of dehydration?

2) Does capsule endoscopy see objects that are plastic ( radioluscent)?

3) Could it miss an object?

( my concern is it will be stuck for many years and cause future complications ( erosion, bleeding, perforation). I want to be certain, it has passed.

4) Could it miss the swallowed object?

My RBC is slightly low but please know that I have not menstruated for 5 years since I have a Mirena IUD.

I have supplemented with one tablet 65 mg iron 1x daily since 7 years. Reason was for iron deficiency anemia ( heavy menstruation) BEFORE IUD was placed.
Iud has stopped all menstruation since 5 years when I had it inserted but I still supplement with the one iron pill daily.

5) Is it possible that I have gadtrointestinal bleeding but since I take the iron pill, perhaps it has made the hemoglobin and hemocrat appear normal?

Thank you kindly,
All the best

doctor
Answered by Dr. Klerida Shehu 6 hours later
Brief Answer:
Following answer to your queries...

Detailed Answer:
Hi back,
Let me answer your queries.

1. Your creatinine levels are low and your BUN levels are normal. This produces an elevated BUN/Creatinine ratio, which is typical for dehydration.

2-4. Capsule endoscopy can look inside your intestine and identify everything inside them, including plastic objects. It can't miss any swallowed object. The capsule endoscopy has evidenced even the minimal mucosal inflammation (that is microscopic) and it will probably evidenced any foreign body inside you.

5. As long as your hemoglobin and hematocrit values are normal and your RBC is 4.4 million/mm3 than you don't have anemia and there's no evidence to support any blood lost. More over capsule endoscopy would have shown any mucosal bleeding site 9it show only inflammation no ulcer or mucosal erosions).

Keep in mind that RBC count is only one parameter and to confirm the diagnosis of anemia is essential to have altered also the other parameters (especially hemoglobin and hematocrit levels). Based on this data you shouldn't worry about anemia and internal bleeding.

Wish you health!
Dr. Klerida
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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