Improvising in Endoscopy: Endoscopic Removal of Sharp Foreign Bodies in the Upper GI Tract, Using a Handmade Protective Device
K MiltiadouZisimangelos SolomosD LygkosAlexandros ChatzidakisEvripidis RizosIoannis S. PapanikolaouKonstantinos Triantafyllou
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Abstract:
Introduction. Foreign body ingestion is a common problem in large-volume endoscopic departments. Several techniques and devices have been described for the safe endoscopic removal of these objects. However, these devices may not be suitable in every clinical setting or—as in our case—they may not even be available. Case Presentation. We report the case of a 34-year-old patient, presenting with sharp foreign body ingestion. The foreign bodies were safely removed using a handmade protective hood due to lack of a commercial device. In our case, improvisation proved to be of great benefit for the patient as well as for the endoscopist. Discussion. Improvised interventions can be of special interest in the setting of insufficiently funded or equipped endoscopic departments.Keywords:
Foreign Body Ingestion
Improvisation
Presentation (obstetrics)
Case presentation
Foreign body ingestion is a common problem among children especially under psychological stress. More than 110.000 ingested foreign bodies were reported in the United States, of which more than 85% occurred in the pediatric population. Ingested foreign bodies usually pass through the alimentary tract without any problem. However, they can occasionally be trapped and require endoscopic or surgical management. In the asymptomatic patient, a series of abdominal X-rays are recommended to follow up on the progress of the foreign body. When a foreign body becomes immobile in the distal bowels a high suspicion that the foreign body has become trapped must be considered and surgical management is recommended with or without signs of inflammation. Here we describe the cases scenarios of foreign bodies trapped in the gastrointestinal tract and the management options.
Foreign Body Ingestion
Alimentary tract
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Foreign body ingestion is one of the commonest presenting complaints in emergency department throughout the world. Majority of foreign bodies will be expelled spontaneously or can be removed endoscopically but only a few require emergency surgical removal.Majority of foreign body ingestions are encountered in pediatric age group elderly and individuals with psychiatric illness being the next common group. We present here three cases of foreign body ingestion in unusual circumstances.
Foreign Body Ingestion
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Foreign bodies are a common problem seen in otolaryngological practice. Of the reported foreign bodies, metallic foreign bodies are a rare entity. One of the least common complications of foreign body ingestion is penetration and migration. We describe a case of a migrating metallic foreign body in a 50-year-old woman with a history of accidental ingestion causing odynophagia. In the present case, the foreign body migrated extraluminally into the carotid sheath. Our review of literature revealed that few such cases have been reported.
Odynophagia
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We report a rare case of ingestion of a large stone in a male patient with a known psychiatric disorder. Failure of endoscopic removal necessitated retrieval of the impacted stone by an open oesophagotomy. This case highlights an important yet unusual presentation and management of an oesophageal foreign body.
Impaction
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Presentation (obstetrics)
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Ingestion of a foreign body is a problem seen in nearly all otolaryngologic practices. One of the least common complications of foreign-body ingestion is penetration and migration, which may lead to serious morbidity or even death. We report the findings of a retrospective review of a series of 5 patients who had presented with a complete foreign-body penetration. All of them had radiologic evidence of a foreign body, but findings on rigid endoscopy were negative. Computed tomography is the radiologic study of choice to identify penetrating foreign bodies. The foreign bodies in all 5 patients were extracted via an external approach.
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Foreign body ingestion is a common condition, es-pecially among children who represent 80% of these emergencies. The most frequently ingested foreign bodies in children are coins, toys, magnets and batter-ies. Most foreign body ingestions in adults occur while eating, leading to either bone or meat bolus impaction. Flexible endoscopy is the therapeutic method of choice for relieving food impaction and removing true foreign bodies with a success rate of over 95% and with mini-mal complications. This review describes a comprehen-sive approach towards patients presenting with foreign body ingestion. Recommendations are based on a review of the literature and extensive personal experi-ence.
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