its ease of use and patient tolerance has made it popular among gastroenterologists and patients alike . currently , capsule endoscopy is most commonly used to evaluate obscure gastrointestinal bleeding , but its indications are broadening . various reports have described the capsule becoming impacted or retained in the small bowel , requiring retrieval . a 74-year - old female had a history of unidentified gastrointestinal bleeding and underwent a capsule endoscopy . the patient was not able to spontaneously pass the capsule and had intermittent obstructive symptoms . her past medical history was significant for severe copd , and she had undergone hysterectomy and appendectomy in the past . the gastroenterologist performed a colonoscopy , and the capsule was visualized in the terminal ileum . attempts at endoscopic removal of the capsule were not successful . therefore , she was seen in the surgery clinic for removal of the capsule . a decision was made to perform a laparoscopic exploration to evaluate the entire small bowel and colon to identify any associated pathology . just before the procedure , an abdominal x - ray was taken , confirming the presence of the retained capsule in the right lower quadrant ( figure 1 ) . after proper informed consent was obtained , the patient was taken to the operating room . laparoscopic instruments were placed through 4 trocars . the patient was found to have adhesions from her previous hysterectomy , which were divided without difficulty . intraoperative examination of the small bowel revealed a stricture in the terminal ileum just proximal to the ileocecal valve with a bulge consistent with the retained capsule ( figure 2 ) . the mesenteric vessels were controlled with the ligasure device ( us surgical corporation , norwalk , ct ) and 2.0-mm vascular loads of the endo - gia stapler ( us surgical corporation , norwalk , ct ) . the colon was transected distal to the cecum , and then delivered through a 4-cm infraumbilical incision . careful inspection revealed the capsule in the terminal ileum at an area that was significantly strictured . the small bowel was transected proximal to the strictured area , and the specimen was sent to pathology . next , a side - to - side anastomosis was formed between the ileum and the colon with a 3.5-mm endo - gia stapler and the incision was closed . she was advanced to sips of clear liquid on the evening of postoperative day 1 . she was tolerating oral intake , but on postoperative day 4 she developed abdominal distension consistent with an ileus . on postoperative day 5 , she had passage of flatus and was restarted on her clear liquid diet . by postoperative day 7 , she was tolerating her diet well with no nausea or vomiting and was discharged home . she was seen several weeks later in the surgery clinic and was doing well without any complications . final pathology demonstrated no evidence of inflammatory bowel disease or malignancy . despite the fact that no pathologic bleeding site was found , the patient has had no further bleeding or obstructive symptoms at 1-year follow - up . after proper informed consent was obtained , the patient was taken to the operating room . laparoscopic instruments were placed through 4 trocars . the patient was found to have adhesions from her previous hysterectomy , which were divided without difficulty . intraoperative examination of the small bowel revealed a stricture in the terminal ileum just proximal to the ileocecal valve with a bulge consistent with the retained capsule ( figure 2 ) . the bowel was extensively evaluated , and no other abnormalities were found . an ileocectomy was chosen to remove both the stricture and the retained video capsule . the mesenteric vessels were controlled with the ligasure device ( us surgical corporation , norwalk , ct ) and 2.0-mm vascular loads of the endo - gia stapler ( us surgical corporation , norwalk , ct ) . the colon was transected distal to the cecum , and then delivered through a 4-cm infraumbilical incision . careful inspection revealed the capsule in the terminal ileum at an area that was significantly strictured . the small bowel was transected proximal to the strictured area , and the specimen was sent to pathology . next , a side - to - side anastomosis was formed between the ileum and the colon with a 3.5-mm endo - gia stapler and the incision was closed . the patient tolerated the procedure well . she was advanced to sips of clear liquid on the evening of postoperative day 1 . she was tolerating oral intake , but on postoperative day 4 she developed abdominal distension consistent with an ileus . on postoperative day 5 , she had passage of flatus and was restarted on her clear liquid diet . by postoperative day 7 , she was tolerating her diet well with no nausea or vomiting and was discharged home . she was seen several weeks later in the surgery clinic and was doing well without any complications . final pathology demonstrated no evidence of inflammatory bowel disease or malignancy . despite the fact that no pathologic bleeding site was found , the patient has had no further bleeding or obstructive symptoms at 1-year follow - up . since its introduction several years ago , capsule endoscopy has rapidly become an important diagnostic modality in the evaluation of several gastrointestinal conditions . the ease of administration and the ability to visualize the entire small bowel are two of the main advantages of capsule endoscopy . as patients request less invasive approaches to their medical care , primary care physicians and surgeons alike will be increasingly exposed to capsule endoscopy . video capsule endoscopy is most commonly used to detect obscure gastrointestinal bleeding not located by endoscopy . the role of video capsule endoscopy has expanded to inflammatory bowel disease , small - bowel neoplasms , malabsorption disorders , iatrogenic disease ( nsaid strictures ) , radiation enteritis , clarification of previous imaging , and chronic abdominal pain . capsule endoscopy has been contraindicated in patients with known small - bowel obstruction , strictures , extensive crohn 's disease , swallowing disorders , pseudo obstruction , motility disorders , cardiac pacemakers , and defibrillators . relative contraindications include pregnancy , chronic nsaid use , extensive diverticular disease , gastroparesis , and previous pelvic or abdominal surgeries . recently , capsule endoscopy has been reported for use in the evaluation for recurrent small - bowel obstruction and strictures . in one study , 19 patients with suspected small - bowel obstruction underwent capsule endoscopy . a definitive diagnosis was made in 32% of the cases . in 3 cases , the capsule was retained and laparotomy was required , but in no instance was the capsule the cause of an acute small - bowel obstruction . although controversial , this provides an example of the potential for expansion of this new technology . the retention rate appears to be between 0.75% to 3% but may be higher in patients with crohn 's disease . if the capsule has not passed after 7 days , then a plain film is obtained . endoscopic retrieval and extraction by push - and - pull enteros - copy with the double - balloon technique have been used with success . as presented in this case , surgical retrieval in fact , it is widely felt that a retained capsule is diagnostic of a clinically relevant stricture or mass . we describe a safe laparoscopic retrieval of a capsule endoscopy retained in the terminal ileum secondary to scar tissue . a review of capsule endoscopy at 2 referral centers revealed 7 of 197 capsules retained . the surgical findings included nonspecific inflammatory strictures ( twice ) , a radiation stricture , a crohn 's stricture , and an umbilical hernia . two cases of open surgical retrieval of an impacted capsule requiring stricturoplasty and a segmental resection have recently been reported in patients with known crohn 's disease . retention or nonpassage of the capsule endoscopy is an uncommon occurrence that is likely to become a more frequent surgical situation as the indications for the technology broaden . in the meantime , for example , many would recommend small bowel follow through or enteroclysis before capsule endoscopy in patients with known crohn 's disease or suspected strictures . in addition , a standard bowel preparation or even a dose of metoclopramide before capsule administration has been shown to increase the rate of complete small - bowel examinations . in the near future , dissolvable radio - opaque patency capsules may prove beneficial for patients with known small - bowel strictures . as in our case , patients with strictures in the small bowel or intraabdominal scar tissue may make passage of the capsule difficult to predict . using the fundamentals of safe laparoscopy and maintaining the principles of surgical management in specific disease processes