Retraction: The improvement of large High-Density Lipoprotein (HDL) particle levels, and presumably HDL metabolism, depend on effects of low-carbohydrate diet and weight loss.

[This retracts the article DOI: 10.17179/excli2015-642.].

The improvement of large High-Density Lipoprotein (HDL) particle levels, and presumably HDL metabolism, depend on effects of low-carbohydrate diet and weight loss.

Depressed levels of atheroprotective large HDL particles are common in obesity and cardiovascular disease (CVD). Increases in large HDL particles are favourably associated with reduced CVD event risk and coronary plaque burden. The objective of the study is to compare the effectiveness of low-carbohydrate diets and weight loss for increasing blood levels of large HDL particles at 1 year. This study was performed by screening for body mass index (BMI) and metabolic syndrome in 160 consecutive subjects referred to our out-patient Metabolic Unit in South Italy. We administered dietary advice to four small groups rather than individually. A single team comprised of a dietitian and physician administered diet-specific advice to each group. Large HDL particles at baseline and 1 year were measured using two-dimensional gel electrophoresis. Dietary intake was assessed via 3-day diet records. Although 1-year weight loss did not differ between diet groups (mean 4.4 %), increases in large HDL particles paralleled the degree of carbohydrate restriction across the four diets (p<0.001 for trend). Regression analysis indicated that magnitude of carbohydrate restriction (percentage of calories as carbohydrate at 1 year) and weight loss were each independent predictors of 1-year increases in large HDL concentration. Changes in HDL cholesterol concentration were modestly correlated with changes in large HDL particle concentration (r=0.47, p=.001). In conclusion, reduction of excess dietary carbohydrate and body weight improved large HDL levels. Comparison trials with cardiovascular outcomes are needed to more fully evaluate these findings.

Efficacy of mesalazine or beclomethasone dipropionate enema or their combination in patients with distal active ulcerative colitis.

OBJECTIVE: Mesalazine or Beclomethasone dipropionate (BDP) enema have been shown effective in treatment of distal active ulcerative colitis (UC). This study was aimed to determine whether the combination of topical mesalazine and BDP is superior to topical mesalazine or BDP used alone in patients with distal active UC. PATIENTS AND METHODS: One-hundred and twenty patients with clinical, endoscopic and histological diagnosis of distal active UC were randomly assigned to a regimen with mesalazine tablets 2.4 g/day associated to either mesalazine enema 4 g/day (group A, n=40), BDP 3 mg/60 ml every day (group B, n=40) or the combination treatment with the two compounds in a single administration (group C, n=40) for eight weeks. After four weeks of treatment all patients underwent clinical controls but only 109 patients returned back for clinical, endoscopic and histological controls at the end of the treatment period. RESULTS: After eight weeks, complete remission rates were of 52%, 47% and 65% respectively, in group A, B and C. From baseline to 4 and 8 weeks the CAI score decreased significantly in all the three groups (p < 0.0001). CONCLUSIONS: All the three combinations achieved equivalent results in terms of symptoms in inducing symptoms relief and mucosa healing in distally active UC.

Hemoperitoneum: a rare complication of hemorrhoid treatment.

Pile suturing has always been used by surgeons to treat hemorrhoidal disease. We report a case of hemoperitoneum complicating a pile suture. Ultrasonography and computed tomography scan indicated the need for an emergency laparoscopic procedure and conservative management. As other authors have pointed out, we do not know how to prevent this type of complication. This case suggests the possibility of life-threatening complications following treatment procedures for hemorrhoids and underlines the importance of conservative treatment when this is possible.

[Ideation of a new operative anoscope in proctology]. / Ideazione di un nuovo anoscopio operativo in proctologia.

BACKGROUND: Rectocele is defined as an erniation of the anterior rectal and vaginal wall in the vaginal lumen due to the loss of recto-vaginal septum. Rectal mucosal prolapse was characterized by the protrusion of the mucosa alone in the rectal lumen. The Authors, herein, reported the results of a new surgical technique defined Sequential Transfixed Stitch Technique (STST) using a new anoscope. MATERIALS AND METHODS; A total of 30 consecutive patients symptomatic III or IV stage rectocele assessed with clinical and instrumental criteria were submitted to STST using the new anoscope. The new anoscope, consisting of non-toxic metallic material, designed and realized according to surgery needs and tested by the authors, increases the vision of the anal canal can be fixed according to the operator's needs. RESULTS: STST was correctly performed in all the cases without early and late complications. The mean value was of 17 according to the Agachan-Wexner for patients with rectocele, significantly improved score in comparison to pre-operatory condition (p<0.05). Surgical procedure of rectocele repair was judged satisfactory in 80% of the cases. CONCLUSIONS: The new operative anoscope was useful in III and IV stage rectocele repair with STST, ensuring ease of implementation of the binding repair in the absence of side effects for the patient.

[Identification of internal fistolous orifice: evolution of methylene blue technique with a mini-probe]. / Identificazione dell'orifizio fistoloso interno: evoluzione della tecnica di iniezione con blu di metilene tramite mini-catetere.

INTRODUCTION: Often perianal fistulas can be difficult typing and traditional anatomical classifications do not help the surgeon in accurate diagnosis of the fistula as an outpatient procedure and therefore does not allow a timely surgical currettage. The aim of our study was to introduce in the management of anal fistulas performed on an outpatient injection with methylene blue of the fistula through a small polyethylene catheter in order to detect in real time the internal opening of the fistula and drive so the next currettage surgery. MATERIALS AND METHODS: A total of 50 consecutive patients 21 female and 29 male, relating to our clinic with symptoms suggestive of colon proctology perianal fistula, aged between 36 and 69 years were selected for our study. After running the news-gathering medical history, physical examination, digital examination through examination anoscope, using a polyethylene catheter in a small scale, of methylene blue was injected through the external fistula orifice looking inside the spreading of liquid. Subsequently, the patient was started on specillazione currettage and possible surgery. RESULTS: 62 outpatients were treated intramural fistulas, diagnosed with the injection technique with methylene blue running always probing and practiced a wide dish made of the mucosa, submucosa and circular muscle layer of the internal drainage with sphincterotomy. In particular, the technique injection of methylene blue was sufficient to diagnose 42 out of 62 cases examined (67.7%). In the remaining 20 cases it was necessary to integrate diagnosis with MRI-defecates on the complexity of fistulas (10 horseshoe, 6 trans sphincteric and 4 intersphincteric. CONCLUSIONS: Methylene blue injection is a low-cost screening technique, simple to perform on an outpatient basis and in the case of suprasphincteric fistulas also a simple diagnostic technique is sufficient to allow the closure of the fistula.

[Results about the use of a silicone catheter in the stadiation of rectal mucosal prolapse and hemorrhoidal prolapse]. / Risultati sull'uso di un catetere siliconato nella stadiazione del prolasso mucoso del retto o del prolasso emorroidario.

INTRODUCTION: Rectal mucosal prolapse was characterized by the protrusion of the mucosa alone in the rectal lumen. Hemorrhoidal prolapse is an extreme pathological condition oh haemorrhoidal disease. The Authors after an experience conducted in ambulatory patients have performed a technique for the staging of rectal mucosal prolapse and hemorrhoidal prolapse based on the use of an endorectal silicone catheter with a balloon in the extremity. PATIENTS AND METHODS: A total of 40 patients with proctological symptoms during ambulatory visit has been submitted to a less invasive test in comparison to those traditional, using an endorectal silicone catheter with a balloon in the extremity, to insert in rectal lumen and to remove outside through the anus. RESULTS: Only in 18 patients, the method gave the exact size of the prolapse and only 16 patients was able to accurately predict the reducibility or not. Of the 18 patients in 12 patients showed a mucosal prolapse was 50% of the circumference of the anal canal, in 6 patients showed a prolapse was between 50% and 75%. In 22 patients had been diagnosed with the absence of prolapse, then denied by the plug test that showed prolapse below the 50%. CONCLUSIONS: The assessment of mucosal prolapse and hemorrhoidal prolapse through silicone catheter test has not proven better than the traditional plug test.

[Utility of plug test during anoscopy for the ambulatory evaluation of rectal mucosal prolapse]. / Utilità del test della garza durante anoscopia per la stadiazione ambulatoriale del prolasso mucoso del retto.

INTRODUCTION: Rectal mucosal prolapse was characterized by the protrusion of the mucosa alone in the anal lumen. The Authors, to correctly establish the intraoperatory stage of rectal mucosal prolapse have performed a test based on the intrarectal introduction of a plug of great dimension, to successively pull-through the anal canal during anoscopy. PATIENTS AND METHODS: A total of 30 patients with proctological symptoms and with diagnosis of rectal mucosal prolapse has been submitted, in ambulatory setting, to a less invasive test with a small plug and in second time, using a plug entirely inserted in rectal lumen and to remove outside through the anus during anoscopy. RESULTS: In all cases the plug test used during anoscopy permitted the perfect evaluation of the prolapse extension. In 12 patients the plug test evidenced a mucosal prolapse occupying the 25% of anal canal, in 10 patients the 50% of anal canal and in 8 patients a mucosal prolapse occupying up to the 50% of the anal circumference. The first 22 patients were treated transfixed stitch technique (TST) while for the other patients Longo surgical technique was preferred. CONCLUSIONS: The plug test during anoscopy is efficacious to achieve differential diagnosis between rectal mucosal prolapse and haemorrhoidal prolapse. Indeed. it is useful to choice more precisely the type of surgical intervention.

[Chronic pelvic pain treatment with posterior tibial nerve stimulation]. / Trattamento del dolore pelvico cronico mediante stimolazione del nervo tibiale.

INTRODUCTION: Chronic pelvic pain is a common problem that has a high impact on quality of life of patients who are affected. The technique of percutaneous neuromodulation by electrical stimulation of the tibial nerve (Percutaneous Tibial Nerve Stimulation PTNS) is described by Stoller for the treatment of overactive bladder syndrome in the 90s is currently being tested in the treatment of chronic pelvic pain. MATERIALS AND METHODS: The study included 35 patients with chronic pelvic pain: 17 were treated with a protocol based on 12 PTNS stimulation sessions performed weekly (Group A), 18 were treated with a protocol based on 12 sessions PTNS stimulation performed 3 times a week (group B). All patients were evaluated before and after treatment, by means of diary quality of life score (I-QoL, SF36) and proctologic examination. RESULTS: At the end of treatment 11/17 patients (63%) in group A and 12/18 patients (67%) in group B were considered a successes. Overall 4/11 (36%) patients in group A and 5/11 (45%) patients in group B recovered completely after treatment. In both groups, patients reported a subjective improvement after 6-8 stimulation sessions. At follow-up 36/8 months there were more complications. CONCLUSIONS: In conclusion, the use of PTNS in the treatment of chronic pelvic pain shows encouraging results in patients not responding to standard analgesic therapy.

[Treatment of rectocele and rectal mucosal prolapse with mucosal flaps excision and with manual reconstruction]. / Trattamento del rettocele e del prolasso mucoso del retto con escissione a lembi della mucosa con sutura manuale (Tecnica di "Delorme interna" modificata).

BACKGROUND: Rectocele is defined as an erniation of the anterior rectal and vaginal wall in the vaginal lumen due to the loss of rectovaginal septum. Rectal mucosal prolapse was characterized by the protrusion of the mucosa alone in the rectal lumen. The Authors, herein, reported the results of a new surgical technique with the excision of one or more mucosal or muco-muscolar flaps and reconstruction with Sequential Transfixed Stitch Technique (STST) using a anal retractor designed by them. MATERIALS AND METHODS: The new surgical technique was applied to 40 consecutive patients with rectal mucosal prolapse and 20 with symptomatic rectocele of III degree assessed with proctological evaluation, digital examination of the anal canal, sphere test, defecography and total colonoscopy were submitted to STST. Patients with previous colorectal or pelvic surgery were excluded from the study. The quality of life was defined using a questionnaire before surgery, at 3 and 6 months of follow-up. Data were evaluated according to the Agachan-Wexner score. RESULTS: The new technique was correctly performed in all the cases without early and late complications. The mean value was of 18.2 according to the Agachan-Wexner for patients with rectocele and 17.6 for rectal mucosal prolapse, both significantly improved score in comparison to pre-operatory condition (p<0.05). Surgical procedure with flaps excision and manual procedure of STST was judged satisfactory in 89% of the cases. CONCLUSIONS: The treatment of symptomatic rectocele and rectal mucosal prolapse with multiple excision of exceeding tissue flaps and the reconstruction with STST manually conducted showed optimal results for the surgical treatment of in our experience with a significant improvement of quality of life referred by the patients and absence of significant post-operative side effects.

Microscopic colitis: a concise review.

Microscopic colitis is an increasingly common cause of chronic watery diarrhoea, and often a causes of abdominal pain of unknown origins. The increase of interest for this clinical entity is due to a misdiagnosis of any symptoms that have been frequently attributed to diarrhea-predominant irritable bowel syndrome, often for many years before diagnosis. Presumably, most estimates of incidence and prevalence understate the true frequency of microscopic colitis for this reason. The aim of this paper is to evaluate the importance of microscopic colitis as cause of chronic non bloody diarrhoea, on the basis of literature review. These kind of colitis are characterized by normal colonic mucosa at endoscopy or barium enema but with increased inflammation in colonic biopsies. Microscopic colitis consists of two main subtypes, collagenous colitis and lymphocytic colitis, distinguished by the presence of absence of a thickened subepithelial collagen band. Several models of pathogenesis has been proposed but no convincing mechanism has been identified, although is difficult to characterize this clinical entity as an independent phenomenon or a simple manifestation or related factors active to induce microscopic changing in the colonic mucosa. A rational approach to therapy does not exist and was conduct with several types of drugs after the exclusion of other causes, commonly characterized by this symptoms and the definitive histological assessment in the biopsies specimens. In the majority of cases this condition tends to follow a self-limited course but potentially can assume the characteristics of relapsing course with the necessity to a chronic therapy. Several long-term follow-up studies excluded a possible progression to neoplastic malignancies of microscopic colitis.

[Proctological surgery: advantages derived from the use of an innovative detergent in the post-operative period]. / Chirurgia proctologica: vantaggi derivanti dall'uso di un detergente innovativo nel post-operatorio.

BACKGROUND: This study was aimed to verify the efficacy, in terms of healing, reepithelization and discomfort, of a detergent cream to be locally used after surgery for the most frequent pathologies of anal canal and perineal region. MATERIALS AND METHODS: The study was carried out on a "presentation sample" of 40 patients, 30 with clinico-instrumental diagnosis of III-IV degree haemorrhoids, 10 with diagnosis of chronic anal fissures, provided by 5 Colonproctological Centers, who entered a clinical follow-up after colonproctological surgery for their respective pathologies. The tested detergent cream (Anonet liquid) is composed by natural substances, such as Aloe vera, Hamamelis, Calendule e Hippocastane, as the lenitive and antiinflammatory principles, and Elastine, as a stimulatory agent of dermal elastic fibers, plus zincus oxide that has a protective, reparative and lenitive action, rice's starch with an anti-inflammatory action, liver fish oil and potassium glicirizzinate with high lenitive and anti-inflammatory action. The product does not contain strong tensioactive substances as well as preservants. The patients were asked to apply the cream on the perianal and perineal region twice a day for at least 12 days after surgery. RESULTS: The study demonstrated that in 84% of tested patients the prescribed cream has favoured the prevention of infective complications by stimulating a normal reepithelization, and diminished the anal discomfort related to burning and pruritus. The cream did not cause irritative and allergic manifestations, skin damage as well as pharmacological toxicity. CONCLUSIONS: The post-surgical use of the tested detergent cream, composed by the above-cited active principles, is recommended for locally preventing the infections, promoting the reepithelization, minimizing the perineal discomfort in patients operated of haemorrhoids and anal fissures.

[Overnight surgery in proctology and anesthesia type: our experience on 320 patients]. / Overnight surgery in proctologia e tipo di anestesia: nostra esperienza su 320 pazienti.

BACKGROUND: Several evidences demonstrated that general anaesthetics associated with local anaesthesia show more advantages in comparison to spinal anaesthesia in proctological surgery. Aim of this study was to verify the efficacy of deep general anaesthesia associated with a loco-regional anesthesiological technique, in a grade population of 320 patients affected by haemorrhoidal disease and anal fissure. PATIENTS AND METHODS: Patients with III-IV grade haemorrhoids and chronic posterior anal fissures has been eligible for this study while were excluded patients with history of allergic reaction or pharmacological hypersensibility to naropine, propofol o similar drugs. All patients (group A) were submitted to general anaesthesia associated with loco-regional anaesthesia, Control patients (group B) underwent spinal anaesthesia. At the end of all surgery procedure, it has been evaluated the presence of early and late complications according to our classification recently proposed. RESULTS: A total of 320 patients were included, 240 submitted to haemorrhoidectomy for prolapse and 80 surgically treated for anal fissures. Anesthesia obtained has been satisfactory in the all treated patients and has not been observed permanent side-effects. Among the early post-operative complications it has been observed urinary retention in 9% of patients and pain in 30%. Among late post-operative complications it has been observed pain in 8% and urinary retention in 1% of patients. In two patients has been observed the development of abscess in correspondence of anaesthetic infiltration area. The local anaesthetical effect was present for a mean period of 4-8 hours. CONCLUSIONS: Loco-regional anesthesiological technique with posterior block, associated to general anaesthesia, has been demonstrated efficacious for the treatment of the most frequent proctological pathologies. This method allowed a low incidence of early and late complications and a more fast resolution of clinical sequelae of the surgery.

[Proctological surgery: use of a salsobromoiodic gel solution in the post-operative period]. / Chirurgia proctologica: uso di una soluzione salsobromoiodica in gel nel post-operatorio.

BACKGROUND: This study was aimed to demonstrate the advantages and the efficacy of a salsobromoiodic gel solution sponge to use in coloproctology after surgery for the most frequent pathologies of anal canal and of perineal region. MATERIALS AND METHODS: The Authors have tested the salsobromoiodic gel solution (Fertomcidina U) in a consecutive series of patients referred to 5 coloproctological centers where they have been submitted to surgery for pathologies of anal canal and of perineal region. A total of 30 patients, 15 with clinico-instrumental diagnosis of III-IV degree haemorrhoids and 15 with diagnosis of chronic anal fissure entered in a clinical follow-up after an out-patient setting or surgery for the respective pathologies. The gel formulation is realized as a salsobromoiodic solution containing salicylic acid and magnesium biphosphate making a strong bactericide and fungicide action applicable on human skin for tissues reparation and their re-epithelization. The experimental treatment was performed on the duration of at least 10 days, with two topic applications. RESULT: In 100% of the treated patients, the used gel has determined the prevention of infective complications, favouring a normal re-epithelization of tissue submitted to surgery or affected by previous anal mucosal lesions. The use of gel has not caused irritation and skin damage. No symptom and sign of toxicity were observed. CONCLUSIONS: The use of salsobromoiodic gel solution has been useful to prevent infections and to contribute to the cicatrisation, healing and re-epithelization of anal mucosal lesions after surgery on a normal outpatients setting. The use of gel formulation resulted easy and satisfactory for the patients affected by the most frequent proctological pathologies which require a surgical treatment.

Evolution of the transfixed stitches technique hemorrhoidectomy.

AIM: To date, the types of surgical hemorrhoidal treatments available for a surgeon are manifold. The authors, beginning from an original interpretation of the indications for a surgical treatment of hemorrhoids, based on the new disease classification defined PATE 2006, hereby present the results related to the evolution in performing hemorrhoidectomy with the transfixed stitches technique (TPT). METHODS: A total of 50 patients, 30 males and 20 females, with diagnosis of hemorrhoids of grade III-IV underwent hemorrhoidectomy with the TPT, which consisted in using two suture threads (Monofil) for each nodule. Patients' follow-up was prolonged for six months after the surgical intervention. RESULTS: The mean score, according to the PATE 2006 classification, after the intervention was significantly lower in all patients in comparison to the initial mean score (23.7 versus 7.2, P<0.01). The mean score value of the early stage complications was 4.8 while that of the late stage complications was 2.2. We found a reduction in the score related to the recorded pain after 24 and 96 hours from the intervention (3 versus 1.4, P=0.05). Only 26% of the patients who underwent hemorrhoidectomy with the new TPT were administered non-steroidal anti-inflammatory drugs. The relapse rate was only of 2%. CONCLUSIONS: The TPT, performed with the new technique, allows to reach best results in comparison to the previous surgical options, by reducing the incidence of disease relapse and the infectious events during the postoperative period, thus reducing the needed time for return to working activity.

The evolution of transfixed sequential suturing technique (TSST) in the treatment of rectocele: advantages and efficacy in 10 cases.

AIM: Rectocele, or posterior vaginal prolapse, is considered a herniation of the anterior rectal and posterior vaginal wall into the lumen of the vagina, which arises from either a tear or an attenuation of the rectovaginal (Denonvilliers') fascia. To date, all the surgical techniques proposed both through the anus and through the vagina have not demonstrated a real clinical efficacy in terms of a complete solution of this anatomic disorder. The authors of the present study have improved the surgical treatment outcome of rectocele introducing a new technique called transfix sequential suturing technique (TSST). Hereby its evolution is described, using a new suture called Monofil (Assut Europe s.p.a., Magliano dei Marsi, L'Aquila, Italy) and a new single-use operating kit. METHODS: Ten consecutive female outpatients were treated surgically, after diagnosis of rectocele has been made both clinically and by imaging. Seven patients were found at stage 2 and three at stage 3 rectocele. The surgical technique performed was the same in all patients, and consisted in fixing sutures sequentially into the rectum until a complete closure of the rectocele pouch was obtained. All patients underwent a gloved finger examination of the rectum, anoscopy with the sphere-test, a defecagram and a total colonoscopy. Each patient was asked to fill a Quality of Life questionnaire (Agachan-Wexner Score) before surgery, and after three and six months of follow-up. RESULTS: In our series, no serious postoperative complication was registered. The Quality of Life average score before treatment was 25, after three months of follow-up it decreased to 14, and to 12 after six months. The difference was found statistically significant (P<0.05). CONCLUSIONS: The introduction of Monofil and that of a single-use operating kit demonstrated to be more efficacious in treating rectocele compared to TSST performed with an interrupted running suture and compared to other surgical techniques. Patients' quality of life improved significantly and a lower incidence of postoperative discomfort was found.

[A new disposable isostatic anal retractor for proctology]. / Un nuovo divaricatore anale isostatico monouso in proctologia.

The Authors present the characteristics and the advantages derived by the use of a new disposable isostatic retractor resulted of the positive operative experience of several years. The aim of this experimentation was to test a new instrument helpful and simple to use in coloproctology. The efficiency of the new kit constitued by plastic material has been tested on 30 patients with haemorrhoidal disease, rectocele and anal fissures. The therapeutical results obtained, demonstrated that the new isostatic anal retractor have ameliorate the surgical procedures in all treated patients. The use of kit is indicated for the praticity, the manoeuvrability, a more visibility of operative space and in case of sphincterial hypotonia.

[Haemorrhoid disease during pregnancy: focus on delivery unit]. / La malattia emorroidaria durante la gestazione: focus sulle sale parto.

OBJECTIVE: Hemorrhoidal disease (HD) is most frequent during and after the pregnancy, always resulting disabling and not without the occurrence of complications that make necessary a surgical therapy. In these cases the HD could be underestimated by obstetricians, precluding the patient's access to possible medical and surgical or rehabilitative treatments to correct eventual dysfunction related to the delivery. MATERIALS AND METHODS: For this purpose the Authors have administered a questionnaire at 165 obstetricians regarding the occurrence of HD symptoms according to our experience, the prevalence and the modalities of treatment of HD and the knowledge of specialists and methods to cure HD. RESULTS: The interviewed obstetricians in a proportion of 95% referred the presence of HD symptoms during pregnancy in particular in three-fourths of patients who have a natural (57%) or a vaginal operative delivery (41%). It was resulted that only the 42% of obstetricians refer to the specialist for HD and approximatively the half of them not known the role of perineologist or the pelvic rehabilitative methods. CONCLUSIONS: Our study seems to confirm that the management of HD during pregnancy is inadequate due to the lack of collaboration between obstetrician, gynaecologist and the specialist of anal and pelvic pathologies.

[Incidental diagnosis of caecum adenocarcinoma due to retention of endoscopic videocapsule: a clinical case]. / Diagnosi incidentale di adenocarcinoma del cieco dovuto a ritenzione della videocapsula endoscopica: un caso clinico.

Capsule endoscopy is a new technique for the study of small intestine particularly in cases of obscure gastro-intestinal bleeding or chronic iron-deficiency anemia. In our study we present a case of 62 years-old man with a chronic iron-deficiency anaemia developed at least six months before and refractory to iron therapy. The patient was submitted to upper gastro-intestinal endoscopy and to partial colonscopy due to abdominal adhesions for previous abdominal surgery. A capsule endoscopy was indicated to achieve a definitive diagnosis. Wich discosed an intestinal obstruction. So far a surgical resolution was indicated. The surgery revealed a stricturing neoplasia of the cecum in which the capsule endoscopy was retained.