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Liu SQ, Li YF, Quan DW, Liu W. Magnetic-assisted detection and extraction of dispersed metallic foreign bodies in the abdominal cavity: A case report. World J Gastrointest Surg 2025; 17:101414. [DOI: 10.4240/wjgs.v17.i5.101414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Revised: 03/09/2025] [Accepted: 04/17/2025] [Indexed: 05/23/2025] Open
Abstract
BACKGROUND Gastrointestinal foreign bodies represent a significant clinical challenge in emergency and surgical settings. While accidental ingestion predominates in healthy adults, intentional ingestion is frequently observed in pediatric, psychiatric, and incarcerated populations. Metallic sewing needles, characterized by their sharp morphology and high mobility, pose particular risks of visceral injury and complications due to their penetrative potential. Although preoperative imaging facilitates initial localization, subsequent migration of multiple needles complicates therapeutic interventions, increasing procedural complexity and patient risk.
CASE SUMMARY We present a novel application of magnetic-assisted localization in managing a complex case of intentional ingestion of 30 metallic sewing needles in a psychiatric patient. The widespread distribution of needles throughout the gastrointestinal tract necessitated an innovative surgical approach. Intraoperative implementation of cylindrical magnetic localization technology enabled precise identification and successful extraction of all foreign bodies while minimizing tissue trauma.
CONCLUSION Magnetic-assisted localization represents an effective and safe technique to manage multiple magnetic gastrointestinal foreign bodies. This approach offers significant advantages in complex cases, particularly for needle-like metallic objects, and warrants consideration as a valuable tool in gastrointestinal surgery.
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Affiliation(s)
- Shi-Qi Liu
- Medical College, Xijing University, Xi’an 710123, Shaanxi Province, China
| | - Yu-Feng Li
- Department of Pediatric Surgery, Guilin Maternal and Child Health Hospital, Guilin 541001, Guangxi Zhuang Autonomous Region, China
| | - Dong-Wen Quan
- The Second Clinical Medical School, Shaanxi University of Chinese Medicine, Xianyang 712000, Shaanxi Province, China
| | - Wei Liu
- Department of Engineering, Western Superconducting Technologies Company, Xi’an 710018, Shaanxi Province, China
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Randall MM, Lee M, Marchosky R, Dales K, Nesper T, Pachon A, Zakhary BL, Minahan T, Mesisca MK. Non-interventional outcomes of adult foreign body ingestions. Am J Emerg Med 2025; 91:88-92. [PMID: 40020391 DOI: 10.1016/j.ajem.2025.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Revised: 02/10/2025] [Accepted: 02/14/2025] [Indexed: 03/03/2025] Open
Abstract
INTRODUCTION Foreign body ingestions are a common problem in the emergency department. Patients often undergo invasive interventions that require significant resources. Current recommendations based on limited studies, are to attempt endoscopic removal of objects that are sharp or greater than 2.5 cm at or above the proximal duodenum. We hypothesized that many small and sharp objects will pass spontaneously without complication. METHODS We performed a retrospective study of all foreign bodies ingested by adults that were not removed initially by endoscopy over five years. We recorded foreign body size, shape and location, radiographic results, interventions performed, and demographic data. Regression analysis was used to determine any significant associations with the outcome of late intervention. RESULTS 117 patients with 171 encounters met inclusion criteria with an average age of 33 years. 74 % of patients had a known psychiatric history. The most common foreign body was a razorblade. Fifteen patients had late intervention with twelve endoscopies and three exploratory laparotomies. 87 % of these late interventions were for failure to progress determined by the treatment team. There were no small bowel obstructions. One patient had a recto-sigmoid perforation from a pencil. Analysis indicates that size and sharpness were not significant risk factors for later intervention. CONCLUSION Our study indicates that small objects, even sharp foreign bodies including razorblades, can pass spontaneously without intervention. If larger, future studies show the same conclusion, there should be a reconsideration of current guidelines.
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Affiliation(s)
- Melanie M Randall
- Department of Emergency Medicine, Riverside University Health System, 26520 Cactus Avenue, Moreno Valley, CA 92555, USA.
| | - Moses Lee
- Department of Emergency Medicine, Riverside University Health System, 26520 Cactus Avenue, Moreno Valley, CA 92555, USA.
| | - Ruben Marchosky
- Department of Emergency Medicine, Riverside University Health System, 26520 Cactus Avenue, Moreno Valley, CA 92555, USA.
| | - Kevin Dales
- Department of Emergency Medicine, Riverside University Health System, 26520 Cactus Avenue, Moreno Valley, CA 92555, USA.
| | - Timothy Nesper
- Department of Emergency Medicine, Riverside University Health System, 26520 Cactus Avenue, Moreno Valley, CA 92555, USA.
| | - Andrew Pachon
- Department of Emergency Medicine, Riverside University Health System, 26520 Cactus Avenue, Moreno Valley, CA 92555, USA.
| | - Bishoy L Zakhary
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, 26520 Cactus Avenue, Moreno Valley, CA 92555, USA.
| | - Thomas Minahan
- Department of Emergency Medicine, Riverside University Health System, 26520 Cactus Avenue, Moreno Valley, CA 92555, USA.
| | - Michael K Mesisca
- Department of Emergency Medicine, Riverside University Health System, 26520 Cactus Avenue, Moreno Valley, CA 92555, USA.
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Singh A, Young E, Singh R. Dual snare endoscopic extraction of a gastric foreign body using a dual-channel endoscope. DEN OPEN 2025; 5:e70065. [PMID: 39866808 PMCID: PMC11757021 DOI: 10.1002/deo2.70065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2024] [Accepted: 01/15/2025] [Indexed: 01/28/2025]
Abstract
Foreign body ingestion, though rare, poses significant health risks, with 10%-20% of cases requiring endoscopic intervention. This article presents a novel case of a 16-year-old female who ingested a cigarette lighter, leading to abdominal pain and radiographic confirmation of a gastric foreign body. Initial attempts at retrieval using grasping forceps and snares were unsuccessful due to the object's size and shape, risking potential complications. We employed a dual-channel endoscope utilizing a push-pull technique with two snares, one capturing the blunt end and the other the sharp edge of the lighter. This method facilitated safe extraction through the gastroesophageal junction without causing trauma. This case highlights the efficacy of dual snares in the endoscopic retrieval of challenging foreign bodies and emphasizes the importance of appropriate techniques in preventing complications during such procedures.
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Affiliation(s)
- Amitjeet Singh
- Department of GastroenterologyLyell McEwin HospitalElizabeth ValeAustralia
| | - Edward Young
- Department of GastroenterologyLyell McEwin HospitalElizabeth ValeAustralia
| | - Rajvinder Singh
- Department of GastroenterologyLyell McEwin HospitalElizabeth ValeAustralia
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Azar L, Tey K. Endoscopic Retrieval of a Migrated Intragastric Balloon Causing Small Bowel Obstruction: A Case Report and Review of Management Strategies. Cureus 2025; 17:e81808. [PMID: 40337570 PMCID: PMC12056879 DOI: 10.7759/cureus.81808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2025] [Indexed: 05/09/2025] Open
Abstract
Intragastric balloons (IGBs) are widely used as a temporary weight-loss measure to induce early satiety and delay gastric emptying. Despite their safety profile, rare complications such as migration and small bowel obstruction (SBO) may occur, particularly when follow-up for timely removal is neglected. We present a case of a 48-year-old female with a history of obesity who arrived at the emergency department complaining of abdominal pain, nausea, vomiting, and obstipation of three days duration. Imaging revealed a dilated stomach and duodenum, with a fluid-filled IGB lodged in the proximal jejunum, causing SBO. Push enteroscopy was performed using a colonoscope, and the IGB was retrieved successfully from the jejunum into the stomach and removed entirely, avoiding the need for surgery. The patient recovered without complications and was discharged the following day. This case demonstrates an innovative approach to managing SBO caused by IGB migration. While surgery is typically the preferred method for small bowel impaction, endoscopic retrieval presents a viable, less invasive option. This article highlights the importance of gastroenterology consultation in managing migrated IGBs and reviews different techniques for endoscopic retrieval. We conclude that endoscopic management of migrated IGB causing SBO should be considered a first-line approach to minimize complications and shorten hospital stays, provided a backup surgical team is available.
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Affiliation(s)
- Loai Azar
- Internal Medicine, Banner - University Medical Center Tucson, Tucson, USA
| | - Kai Tey
- Gastroenterology and Hepatology, University of Arizona College of Medicine - Tucson, Tucson, USA
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Su W, Jiang Q, Yang X, Wang Y, Hu J, Gao P, Hu H, Zhou P, Lin S. The safety and efficacy of endoscopic submucosal fenestration in the treatment of completely embedded upper gastrointestinal foreign body. Surg Endosc 2024; 38:3819-3827. [PMID: 38811429 DOI: 10.1007/s00464-024-10899-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 05/02/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Upper gastrointestinal foreign body ingestion is a common digestive tract emergency, of which completely embedded ones were challenging for most endoscopists. We aim to evaluate the efficacy and safety of endoscopic submucosal fenestration in the treatment of completely embedded upper gastrointestinal foreign bodies. METHODS From December 2018 to December 2021, 19 patients with completely embedded upper gastrointestinal foreign bodies who underwent endoscopic submucosal fenestration in Zhongshan Hospital, Fudan University were included. The safety, efficacy, and outcome were retrospectively reviewed. RESULTS Among the 19 patients, 15 foreign bodies were embedded in the esophagus, 3 located in the gastric wall, and 1 located in the duodenal bulb. The foreign bodies were successfully managed in 12 cases, and 7 failed after attempts of repeated exploration. Two cases confirmed completely traversing into the mediastinum were successfully removed after transfer to surgery. One case had retrieval of a foreign body in a half-year examination. Till now, 3 failed patients had great relief of symptoms and only one patient claimed occasional thoracodynia. Of note, there were neither serious adverse events, nor long-term complications during the follow-up. CONCLUSION In disposing of foreign bodies completely embedded in the upper gastrointestinal tract, ESF is a safe and effective alternative to surgery.
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Affiliation(s)
- Wei Su
- Zhongshan Hospital Fudan University Endoscopy Center, Shanghai, 200032, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, 200032, China
| | - Qi Jiang
- Zhongshan Hospital Fudan University Endoscopy Center, Shanghai, 200032, China
- Endoscopic Center, Zhongshan Hospital (Xiamen Branch), Fudan University, Xiamen, 361015, China
| | - Xia Yang
- Zhongshan Hospital Fudan University Endoscopy Center, Shanghai, 200032, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, 200032, China
| | - Yun Wang
- Zhongshan Hospital Fudan University Endoscopy Center, Shanghai, 200032, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, 200032, China
| | - Jianwei Hu
- Zhongshan Hospital Fudan University Endoscopy Center, Shanghai, 200032, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, 200032, China
| | - Pingting Gao
- Zhongshan Hospital Fudan University Endoscopy Center, Shanghai, 200032, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, 200032, China
| | - Hao Hu
- Zhongshan Hospital Fudan University Endoscopy Center, Shanghai, 200032, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, 200032, China
| | - Pinghong Zhou
- Zhongshan Hospital Fudan University Endoscopy Center, Shanghai, 200032, China.
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, 200032, China.
| | - Shengli Lin
- Zhongshan Hospital Fudan University Endoscopy Center, Shanghai, 200032, China.
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, 200032, China.
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Topaloglu O, Kılıc KN, Karapolat S, Aydın Y, Turkyilmaz A, Taslak Sengul A, Eroglu A, Basoglu A. Diagnosis, treatment, and management of esophageal foreign bodies in patients with mental retardation: A retrospective study from three centers. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2024; 32:179-184. [PMID: 38933315 PMCID: PMC11197419 DOI: 10.5606/tgkdc.dergisi.2024.25724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/04/2023] [Indexed: 06/28/2024]
Abstract
BACKGROUND This study aims to assess the outcomes and prognosis of surgical interventions aimed at removing esophageal foreign bodies in patients with mental retardation. METHODS Between January 2010 and January 2021, a total of 30 consecutive patients (20 males, 10 females; median age: 29.5 years; range, 2 to 57 years) with mental retardation who were diagnosed with esophageal foreign bodies and underwent surgical treatment were retrospectively analyzed. Age and sex of the patients, symptoms, type of the foreign body, esophageal stricture level, methods used for preoperative diagnosis, type of surgical procedure, postoperative complications, and length of hospital stay were recorded. RESULTS Seventeen (56.6%) patients had a foreign body in the first narrowing, 12 (40%) in the second narrowing, and one (3.3%) in the third narrowing. A rigid esophagoscopy was performed in all cases. However, successful removal was not achieved in two (6.6%) cases, and foreign bodies were removed through cervical esophagotomy in one (3.3%) patient and through esophagotomy with right thoracotomy in one (3.3%) patient. Postoperative complications included esophagitis in seven patients (23.3%) and wound infection and pneumonia in two patients (6.6%). The median length of hospital stay after treatment was 1.09 days in patients without complications and 3.3 days in patients with complications. There was a significant correlation between the occurrence of complications and the length of hospital stay (p=0.002). The foreign body was successfully removed in all patients, and no mortality was observed. CONCLUSION Early diagnosis and emergency intervention can reduce complications, particularly considering the possibility of non-food and sharp-edged foreign bodies that pose a higher risk of damaging the digestive system, in patients with mental retardation than those without such conditions.
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Affiliation(s)
- Omer Topaloglu
- Department of Thoracic Surgery, Karadeniz Technical University Faculty of Medicine, Trabzon, Türkiye
| | - Kubra Nur Kılıc
- Department of Thoracic Surgery, Karadeniz Technical University Faculty of Medicine, Trabzon, Türkiye
| | - Sami Karapolat
- Department of Thoracic Surgery, Karadeniz Technical University Faculty of Medicine, Trabzon, Türkiye
| | - Yener Aydın
- Department of Thoracic Surgery, Atatürk University Faculty of Medicine, Erzurum, Türkiye
| | - Atila Turkyilmaz
- Department of Thoracic Surgery, Karadeniz Technical University Faculty of Medicine, Trabzon, Türkiye
| | - Aysen Taslak Sengul
- Department of Thoracic Surgery, Ondokuz Mayıs University Faculty of Medicine, Samsun, Türkiye
| | - Atilla Eroglu
- Department of Thoracic Surgery, Atatürk University Faculty of Medicine, Erzurum, Türkiye
| | - Ahmet Basoglu
- Department of Thoracic Surgery, Ondokuz Mayıs University Faculty of Medicine, Samsun, Türkiye
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Sbeit W, Basheer M, Shahin A, Makanovitsky D, Khoury T. Predictors of spontaneous passage of ingested foreign bodies in adults: twelve years of experience. Surg Endosc 2024; 38:1533-1540. [PMID: 38272975 DOI: 10.1007/s00464-023-10657-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/22/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Foreign body ingestion in adults is commonly encountered in clinical practice. The therapeutic approach of whether to follow-up or extract is often controversial. AIM We aimed to explore predictors for spontaneous passage of ingested foreign bodies by focusing on foreign body type, length, and location of impaction. METHODS We performed a 12-year retrospective single-center study. Logistic regression analysis was done to identify predictors of spontaneous passage. RESULTS Overall, 365 patients with foreign body ingestion were included. The rate of spontaneous passage was 53.7% in general, while the spontaneous passage rate was 47.9% in food impaction, 44.3% in sharp objects, 88.7% in blunt objects and only 22.2% in long blunt objects (> 6 cm). On regression analysis, esophageal location was associated with a higher impaction rate and lower spontaneous passage vs. stomach and small and large intestine (OR 0.15, 95% CI 0.07-0.31, OR 0.18, 95% CI 0.09-0.37 and OR 0.02, 95% CI 0.003-0.14), respectively. Performing Receiver operating characteristics (ROC) analysis found that the maximal length above which the foreign body will fail to pass spontaneously was 3.5 cm in the stomach and 3 cm in the small intestine, with area under the curve (AUC) of 0.8509 in stomach and 0.8073 in small intestine. CONCLUSION Endoscopic removal was needed for all esophageal foreign bodies, and all foreign bodies more than 3.5 cm above the duodenum. Spontaneous passage of ingested foreign body in a selected cohort of patients depends on foreign body type, location, and length.
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Affiliation(s)
- Wisam Sbeit
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Maamoun Basheer
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Amir Shahin
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Denis Makanovitsky
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Tawfik Khoury
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel.
- Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.
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Ribeiro T, Mascarenhas Saraiva M, Afonso J, Brozzi L, Macedo G. Predicting Factors of Clinical Outcomes in Patients Hospitalized after Esophageal Foreign Body or Caustic Injuries: The Experience of a Tertiary Center. Diagnostics (Basel) 2023; 13:3304. [PMID: 37958198 PMCID: PMC10648504 DOI: 10.3390/diagnostics13213304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 11/15/2023] Open
Abstract
Ingestion of foreign bodies (IFB) and ingestion of caustic agents are frequent non-hemorrhagic causes of endoscopic urgencies, with the potential for severe complications. This study aimed to evaluate the predicting factors of the clinical outcomes of patients hospitalized as a result of IFB or ingestion of caustics (IC). This was a retrospective single-center study of patients admitted for IFB or IC between 2000 and 2019 at a tertiary center. Demographic and clinical data, as well as preliminary exams, were evaluated. Also, variables of the clinical outcomes, including the length of stay (LS) and other inpatient complications, were assessed. Sixty-six patients were included (44 IFB and 22 IC). The median LS was 7 days, with no differences between the groups (p = 0.07). The values of C-reactive protein (CRP) upon admission correlated with the LS in the IFB group (p < 0.01) but not with that of those admitted after IC. In the IFB patients, a diagnosis of perforation on both an endoscopy (p = 0.02) and CT scan (p < 0.01) was correlated with the LS. The Zargar classification was not correlated with the LS in the IC patients (p = 0.36). However, it was correlated with antibiotics, nosocomial pneumonia and an increased need for intensive care treatment. CT assessment of the severity of the caustic lesions did not correlate with the LS. In patients admitted for IFB, CRP values may help stratify the probability of complications. In patients admitted due to IC, the Zargar classification may help to predict inpatient complications, but it does not correlate with the LS.
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Affiliation(s)
- Tiago Ribeiro
- Department of Gastroenterology, Centro Hospitalar Universitário de São João, 4200-427 Porto, Portugal; (T.R.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
| | - Miguel Mascarenhas Saraiva
- Department of Gastroenterology, Centro Hospitalar Universitário de São João, 4200-427 Porto, Portugal; (T.R.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
- Department of Medicine, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal
| | - João Afonso
- Department of Gastroenterology, Centro Hospitalar Universitário de São João, 4200-427 Porto, Portugal; (T.R.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
| | - Lorenzo Brozzi
- Gastroenterology and Digestive Endoscopy Unit, Pancreas Institute, Department of Medicine, G.B. Rossi University Hospital, 37134 Verona, Italy;
| | - Guilherme Macedo
- Department of Gastroenterology, Centro Hospitalar Universitário de São João, 4200-427 Porto, Portugal; (T.R.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
- Department of Medicine, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal
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Zhang M, Wan J, Zhou Q. Time trends and endoscopic management of foreign body ingestion in the upper GI tract: a retrospective analysis of 1,152 cases in China. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2023; 115:488-495. [PMID: 36896925 DOI: 10.17235/reed.2023.9426/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
OBJECTIVES foreign body ingestions are encountered in the clinical practice and sometimes require endoscopic management. However, time trends and epidemiology of these cases have not been fully clarified. Whether seasons and festivals have an effect on the occurrence has been poorly described. METHOD from 2009 to 2020, 1,152 consecutive foreign body ingestion cases were enrolled in our endoscopic center. Case records were reviewed for demographic data, foreign body type and location, outpatient or hospitalization, adverse events and dates. Annual time trends and seasonal variation were analyzed as well as the influence of Chinese legal festivals on the incidence. The impact of SARS-CoV-2 pandemic on the potential delay for clinical consultation of these cases was preliminarily explored. Clinical features of these cases were demonstrated. RESULTS the overall success rate was 99.7 % and the adverse events rate was 2.4 %. There was an uptrend in the annual frequency of food foreign body ingestion endoscopic extraction from 0.65 in 2009 to 8.86 in 2020 per 1,000 esophagogastroduodenoscopy patients (r = 0.902, p < 0.001). Furthermore, the frequency of endoscopic extraction significantly increased in winter (p < 0.001) and during Chinese New Year celebratory season (p = 0.003). The duration of hospitalization may be longer in the pandemic period (p = 0.0049). CONCLUSION considering the uptrend of the annual frequency of food related foreign body endoscopic extraction, the publicity about the danger of foreign body ingestion should be enhanced. Arrangement of endoscopic physicians and assistants during the high-incidence season should be emphasized.
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Affiliation(s)
- Miaoxin Zhang
- Gastroenterology, Tongji Hospital. Tongji Medical College, Huazhong University of Science and Technology, China
| | - Junchen Wan
- Gastroenterology, Tongji Hospital. Tongji Medical College, Huazhong University of Science and Technology, China
| | - Qi Zhou
- Gastroenterology, Tongji Hospital. Tongji Medical College, Huazhong University of Science and Technology, China
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Calini G, Ortolan N, Battistella C, Marino M, Bresadola V, Terrosu G. Endoscopic failure for foreign body ingestion and food bolus impaction in the upper gastrointestinal tract: an updated analysis in a European tertiary care hospital. Eur J Gastroenterol Hepatol 2023; 35:962-967. [PMID: 37395211 DOI: 10.1097/meg.0000000000002602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
OBJECTIVE Harmfulness of foreign body ingestion and food bolus impaction (FBIs) varies according to geographical area, population, habits, and diet. Therefore, studies may not draw generalizable conclusions. Furthermore, data regarding FBIs management in Europe are limited and outdated. This study aimed to analyze the endoscopic management and outcomes of FBIs in an Italian tertiary care hospital to identify risk factors for endoscopic failure. METHODS We retrospectively reviewed patients who underwent upper gastrointestinal endoscopy for FBIs between 2007 and 2017. Baseline, clinical, FBIs, and endoscopic characteristics and outcomes were collected and reported using descriptive statistics and logistic regression analyses. RESULTS Of the 381 endoscopies for FBIs, 288 (75.5%) were emergent endoscopy and 135 (35,4%) included underlying upper gastrointestinal conditions. The study population included 44 pediatric patients (11.5%), 54 prisoners (15.8%), and 283 adults (74.2%). The most common type and location of FBIs were food boluses (52.9%) and upper esophagus (36.5%), respectively. While eight patients (2.1%) developed major adverse events requiring hospital admission, the remainder (97.9%) were discharged after observation. No mortality occurred. Endoscopic success was achieved in 263 of 286 (91.9%) verified FBIs endoscopies. Endoscopic failure (8.04%) was associated with age, bone, disk battery, intentional ingestion, razor blade, prisoners, and stomach in the univariate analysis. Multivariate logistic regression revealed that intentional ingestion was associated with endoscopic failure (odds ratio: 7.31; 95% confidence interval = 2.06-25.99; P = 0.002). CONCLUSION Endoscopy for FBIs is safe and successful, with low hospital admission rate in children, prisoners, and adults. Intentional ingestion is a risk factor of endoscopic failure.
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Affiliation(s)
- Giacomo Calini
- Department of Surgery, University Hospital 'Santa Maria della Misericordia', University of Udine
| | | | - Claudio Battistella
- Department of Medical and Biological Sciences, Section of Statistics, University of Udine
| | - Marco Marino
- Gastroenterology and GI Endoscopy Unit, University Hospital of Udine, Udine, Italy
| | - Vittorio Bresadola
- Department of Surgery, University Hospital 'Santa Maria della Misericordia', University of Udine
| | - Giovanni Terrosu
- Department of Surgery, University Hospital 'Santa Maria della Misericordia', University of Udine
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Soni A, Roy R, Gupta Y. Esophageal Foreign Bodies in Pediatric Age Group with Different Durations of time from Ingestion to Effective Treatment. Indian J Otolaryngol Head Neck Surg 2023; 75:1421-1428. [PMID: 37636667 PMCID: PMC10447692 DOI: 10.1007/s12070-023-03578-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/07/2023] [Indexed: 08/29/2023] Open
Abstract
A foreign body(FB) is any object in a region it is not meant to be, where it can cause harm by its mere presence if immediate medical attention is not sought. Foreign body is particularly common in the pediatric population especially below 5 years of age and in whom prevalence was reported to vary between 57% and 80%. Endoscopic interventions are indicated when the foreign objects fail to pass spontaneously. The standard methods to remove these foreign bodies include push technique and retrieval methods using various endoscopic instruments. Study of 302 patients admitted with the final diagnosis of esophageal foreign body during January 2017 - April 2018, for sex, age, diagnosis on admission, estimated duration and site of impaction, type and number of foreign body removed. During the study period, 302 patients (169 males and 133 females) of different ages, maximum in the age group of 1-5 years i.e 197 cases were admitted with the diagnosis of esophageal foreign body. 11% of patients were less than 1 year of age & 23% were more than 5 years of age at the time of admission. Most of them presented to hospital within 24 hours of ingestion of foreign body i.e 85%. In this study all the children with suspected foreign body esophagus underwent Xray and FB was found in 300/302 i.e its diagnostic accuracy (sensitivity) is 98%. Rigid esophagoscopy was done in all 302 pts with 100% diagnostic accuracy. Different types of foreign bodies ingested most common being coin i.e in 91% patients followed by FB battery in 17 patients and safety pin in 6 patients. Majority of foreign bodies were located in the cricopharynx (198) followed by upper esophagus (67) and mid-esophagus (25) and only 10 cases involved the lower esophagus and spontaneous passage was found in 2 cases. The most common foreign bodies in children are coins and toys. Sharp foreign bodies are difficult to remove but need to be removed carefully at the earliest to prevent dreaded complications like - retropharyngeal abscess and mediastinitis. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-03578-8.
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Affiliation(s)
| | | | - Yamini Gupta
- Department of ENT, Mahatma Gandhi Memorial Medical college, Indore, Madhya Pradesh India
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Stojkovic S, Bjelakovic M, Stojkovic Lalosevic M, Stulic M, Pejic N, Radivojevic N, Stojkovic N, Martinov Nestorov J, Culafic D. Accidental Sewing Pin Ingestion by a Tailor: A Case Report and Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1566. [PMID: 37763686 PMCID: PMC10534428 DOI: 10.3390/medicina59091566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/17/2023] [Accepted: 08/26/2023] [Indexed: 09/29/2023]
Abstract
Foreign body ingestion is a frequently encountered emergency in healthcare institutions. It mostly affects pediatric populations, although it can also affect adults with developmental delays, those with psychiatric diseases, drug abusers, and prisoners. Endoscopy is a diagnostic and treatment method for suspected foreign body ingestion. In this article, we discuss a 45-year-old tailor who swallowed a sewing pin while at work. The abdominal X-ray showed a needle-shaped metal shadow in the stomach region. During an upper endoscopy, it was discovered that a sewing pin with a sharp edge was stuck in the pylorus. The sewing pin was extracted endoscopically, and the patient was discharged the same day in good condition. Since the estimated risk of complications of foreign body ingestion in the adult population is about 35%, and the most common complications include impaction, laceration, bleeding, or perforation of the gastrointestinal wall, endoscopic or surgical removal is necessary. This also emphasizes the importance of a careful endoscopic evaluation of some at-risk occupations for foreign body ingestion with or without gastrointestinal complaints.
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Affiliation(s)
- Stefan Stojkovic
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milica Bjelakovic
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Nis, 18000 Nis, Serbia
| | - Milica Stojkovic Lalosevic
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Milos Stulic
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Nina Pejic
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Nemanja Radivojevic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Nemanja Stojkovic
- Department of Cardiology, University Clinical Hospital Center “Dr. Dragisa Misovic-Dedinje”, 11000 Belgrade, Serbia
| | - Jelena Martinov Nestorov
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Djordje Culafic
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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13
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Han JH, Cha RR, Kwak JY, Jeon H, Lee SS, Jung JJ, Cho JK, Kim HJ. Two Cases of Severe Complications Due to an Esophageal Fish Bone Foreign Body. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1504. [PMID: 37763623 PMCID: PMC10533137 DOI: 10.3390/medicina59091504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/08/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023]
Abstract
Cases of foreign body ingestion are encountered relatively often in clinical settings; however, serious complications are rare. In such cases, mediastinal abscess due to esophageal perforation can become a life-threatening complication. We encountered two cases of severe complications due to an esophageal fish bone foreign body. The first case was a 40-year-old male with an intramural esophageal abscess due to a fish bone after eating fish five days before visiting the hospital. The patient underwent surgical treatment, but the esophageal abscess did not improve; so, the abscess was drained through endoscopic mucosal dissection, and the abscess improved. In the second case, a 64-year-old male, who had eaten fish three days before visiting the hospital, had esophageal perforation by a fish bone, and abscess formation in the mediastinum and the lesser sac in the abdominal cavity were observed. Although surgical treatment was performed, the intra-abdominal abscess formation was not controlled; so, percutaneous drainage (PCD) was inserted, and the abscess improved. Both patients were discharged without any complications. Here, we report two cases that were improved through surgical treatments and additional treatments such as endoscopic dissection and PCD.
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Affiliation(s)
- Ji-Hee Han
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea; (J.-H.H.); (J.-Y.K.); (H.J.); (S.-S.L.); (H.J.K.)
| | - Ra-Ri Cha
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea; (J.-H.H.); (J.-Y.K.); (H.J.); (S.-S.L.); (H.J.K.)
| | - Ji-Yoon Kwak
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea; (J.-H.H.); (J.-Y.K.); (H.J.); (S.-S.L.); (H.J.K.)
| | - Hankyu Jeon
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea; (J.-H.H.); (J.-Y.K.); (H.J.); (S.-S.L.); (H.J.K.)
| | - Sang-Soo Lee
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea; (J.-H.H.); (J.-Y.K.); (H.J.); (S.-S.L.); (H.J.K.)
| | - Jae Jun Jung
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea;
| | - Jin Kyu Cho
- Department of General Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea;
| | - Hyun Jin Kim
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea; (J.-H.H.); (J.-Y.K.); (H.J.); (S.-S.L.); (H.J.K.)
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14
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Schwarzova K, Dabek RJ, Mwinyogle A, Hayward G. Toothpick: An Unusual Cause of Small Bowel Perforation in an Adult. Cureus 2023; 15:e43008. [PMID: 37674964 PMCID: PMC10477459 DOI: 10.7759/cureus.43008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2023] [Indexed: 09/08/2023] Open
Abstract
Foreign body ingestion is a common complaint in the pediatric population; however, in adults, this entity remains quite rare. Most cases are managed conservatively with serial examinations and imaging. Rarely, foreign body ingestion may cause small bowel perforation and peritonitis in adults. Perforation often warrants operative management, and assessment of bowel viability is crucial. Here, we present a case of foreign body ingestion requiring exploration, without the need for bowel resection or repair. Although the need for operative intervention in adults after foreign body ingestion remains rare, it is crucial to recognize those patients who are both at risk for foreign body ingestion and have underlying small bowel narrowing that puts them at risk for perforation. A high index of suspicion in these instances is mandatory as early recognition and appropriate treatment will improve outcomes.
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15
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Zhu YZ, Pu YL, Chen HQ, Li LH. Blister Pack Ingestion in an Elderly Patient With a Communication Barrier: A Case Report. Cureus 2023; 15:e40968. [PMID: 37503480 PMCID: PMC10370282 DOI: 10.7759/cureus.40968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/29/2023] Open
Abstract
Foreign body ingestion is a common problem among elderly patients and can pose a serious health risk, particularly for those with communication barriers, cognitive impairments, or obscure medical histories. This report presents the case of a 67-year-old female inpatient who had a language communication barrier and accidentally ingested a blister pack. Effective communication was facilitated through an interpreter, and prompt endoscopic intervention was conducted to remove the foreign body safely. The patient was discharged with no further symptoms during follow-up. This case highlights the importance of prompt evaluation and intervention for foreign body ingestion in elderly patients, particularly those with communication barriers.
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Affiliation(s)
- Yuan-Zhao Zhu
- Department of Gerontology, The First Affiliated Hospital of Dali University, Dali, CHN
- Department of Internal Medicine, Fugong People's Hospital, Fugong, CHN
| | - Yan-Lin Pu
- Department of Internal Medicine, Fugong People's Hospital, Fugong, CHN
| | - Hui-Qiao Chen
- Department of Internal Medicine, Fugong People's Hospital, Fugong, CHN
| | - Li-Hua Li
- Department of Gerontology, The First Affiliated Hospital of Dali University, Dali, CHN
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16
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V N, Prasad KC, G I, Mohammadi K. Varied Manifestations of Sharp Penetrating Foreign Bodies in the Aerodigestive Tract: Our Experience. Cureus 2023; 15:e39525. [PMID: 37366454 PMCID: PMC10290822 DOI: 10.7759/cureus.39525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Foreign body ingestion or aspiration is an emergency dealt by otorhinolaryngologists. It is most common among children and the geriatric population. It paves the way for critical morbidity when prompt treatment is not initiated. Therefore, in the absence of strong evidence to guide decision-making, all suspicious presentations of the ingested sharp foreign body need to be kept in mind while making a diagnosis. Hence, our study is aimed to document the varied manifestations of sharp penetrating foreign bodies in the aerodigestive tract. Materials and methods The medical records of 40 patients who presented with sharp foreign body ingestion/aspiration in the department of otorhinolaryngology in our centre from September 2012 to September 2022 were reviewed retrospectively. Results In all 40 patients, we were able to retrieve the foreign body as such without crushing or breaking it. In our study, the most common foreign body retrieved among middle-aged and elderly were chicken bone (22.5%) or fish bone (25%), and the most common foreign body following accidental ingestion in children were stapler pins (20%). Conclusion The findings of our study concluded that relevant clinical history, atypical presentation, and radiological imaging of sharp penetrating foreign bodies in the neck should be addressed with the utmost caution, as foreign bodies migrate to deep neck space and bronchus and can result in untoward complications. Hence, we need to be suspicious of the varied manifestation of aerodigestive tract foreign bodies for early diagnosis and prompt treatment.
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Affiliation(s)
- Nisha V
- Otolaryngology, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - K C Prasad
- Otolaryngology, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Induvarsha G
- Otolaryngology, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Kouser Mohammadi
- Otolaryngology/Head and Neck Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
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17
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Rammohan R, Joy M, Natt D, Saggar T, Magam SG, Gomez S, Sayedy N, Desai J, Bunting S, Mustacchia P. Navigating the Esophagus: Effective Strategies for Foreign Body Removal. Cureus 2023; 15:e38593. [PMID: 37284409 PMCID: PMC10239654 DOI: 10.7759/cureus.38593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2023] [Indexed: 06/08/2023] Open
Abstract
Foreign body ingestion is a common medical emergency that can affect individuals of all ages and can be caused by various factors, including accidental ingestion, psychiatric disorders, intellectual disabilities, and substance abuse. The most common site for foreign body lodgment is the upper esophagus, followed by the middle esophagus, stomach, pharynx, lower esophagus, and duodenum. This article provides a case report of a 43-year-old male patient with a history of schizoaffective disorder and an indwelling suprapubic catheter who presented to the hospital due to foreign body ingestion. After examination, a metal clip from his Foley catheter was found lodged in his esophagus. The patient was intubated for the procedure, and an emergent endoscopic removal was performed to remove the metallic Foley component. No postoperative complications were observed, and the patient was successfully discharged. This case highlights the importance of considering foreign body ingestion in patients with chest pain, dysphagia, and vomiting. Prompt diagnosis and treatment are crucial to prevent potential complications such as perforation or gastrointestinal tract obstruction. The article also emphasizes the need for healthcare providers to know the different risk factors, variations, and common sites for foreign body lodgment to optimize patient care. Furthermore, the article highlights the importance of multidisciplinary care involving psychiatry and surgery to provide comprehensive care to patients with psychiatric disorders who may be at higher risk for foreign body ingestion. In conclusion, foreign body ingestion is a typical medical emergency that requires prompt diagnosis and treatment to prevent complications. This case report highlights the successful management of a patient with foreign body ingestion and emphasizes the importance of multidisciplinary care to optimize patient outcomes.
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Affiliation(s)
- Rajmohan Rammohan
- Gastroenterology, Nassau University Medical Center, East Meadow, USA
| | - Melvin Joy
- Internal Medicine, Nassau University Medical Center, East Meadow, USA
| | - Dilman Natt
- Internal Medicine, Nassau University Medical Center, East Meadow, USA
| | - Tulika Saggar
- Internal Medicine, Nassau University Medical Center, East Meadow, USA
| | | | - Sandra Gomez
- Gastroenterology and Hepatology, Nassau University Medical Center, East Meadow, USA
| | - Najia Sayedy
- Pulmonary and Critical Care, Nassau University Medical Center, East Meadow, USA
| | - Jiten Desai
- Internal Medicine, Nassau University Medical Center, East Meadow, USA
| | - Susan Bunting
- Internal Medicine, Nassau University Medical Center, East Meadow, USA
| | - Paul Mustacchia
- Gastroenterology and Hepatology, Nassau University Medical Center, East Meadow, USA
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18
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Impacted esophageal foreign bodies in children. Pediatr Surg Int 2023; 39:73. [PMID: 36617341 DOI: 10.1007/s00383-022-05360-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/26/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE Foreign body (FB) ingestion in children has varied presentation. When unwitnessed, it poses therapeutic and diagnostic challenges especially in the presence of pre-existing anatomical pathology. We aim to analyze the clinical course, management, and outcome of children with impacted esophageal FBs. METHODS Retrospective chart review (Jan 2000-Feb 2018) recruiting children with impacted esophageal FBs. FBs in cricopharynx and those that moved to stomach were excluded. Investigations/management were based on underlying anatomical pathology, duration of impaction, and difficult FBs. Clinical details, management, and outcomes were collated. RESULTS Of 86 children, N1 = 31 had identifiable predisposing anatomic pathology and N2 = 55 had impactions in normal esophagus or difficult FBs. N1 group presented early (42 months), had recurrent impactions (1-6), and needed multiple dilatations (0-8) and longer follow-up (avg 35 months). Food matter was commonest impaction. Many had persistent symptoms. N2 group had commonly coin impactions and strictures developed in long standing or corrosive FBs. Most were asymptomatic. CONCLUSION Abnormal esophageal anatomy predisposes to impaction with organic food bolus. Age of presentation is earlier with recurrent impactions requiring multiple dilatations/surgery and longer follow-up. Metallic FBs commonly impact in normal esophagus and are often innocuous. Atypical/multiple FBs may mirror an underlying psychiatric illness.
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19
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Chauhan A, Bodh V, Sharma R, Sharma B. Intentional Ingestion of a Foreign Body - Why We Need Psychiatrists. Middle East J Dig Dis 2023; 15:57-59. [PMID: 37547154 PMCID: PMC10404070 DOI: 10.34172/mejdd.2023.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 10/11/2022] [Indexed: 08/08/2023] Open
Abstract
Foreign body ingestions are common medical emergencies. In adults, foreign body ingestions occur in patients with psychiatric disorders and prison inmates. A majority (80-90%) of foreign bodies pass spontaneously. Endoscopic and surgical interventions are required in only 10-20% and 1%, respectively. A plain radiograph may be the only diagnostic test required. A computed tomography scan may be needed when a perforation is suspected. Food boluses are the most commonly ingested foreign bodies. Snare and rat tooth forceps are frequently used accessories for the retrieval of foreign bodies. The focus of the emergency team is on the management of an acute case of foreign body ingestion, and the psychiatric aspect of the disease gets often ignored.
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Affiliation(s)
- Ashish Chauhan
- Department of Gastroenterology, Indira Gandhi Medical College, Shimla, India
| | - Vishal Bodh
- Department of Gastroenterology, Indira Gandhi Medical College, Shimla, India
| | - Rajesh Sharma
- Department of Gastroenterology, Indira Gandhi Medical College, Shimla, India
| | - Brij Sharma
- Department of Gastroenterology, Indira Gandhi Medical College, Shimla, India
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20
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Demiroren K. Management of Gastrointestinal Foreign Bodies with Brief Review of the Guidelines. Pediatr Gastroenterol Hepatol Nutr 2023; 26:1-14. [PMID: 36816435 PMCID: PMC9911172 DOI: 10.5223/pghn.2023.26.1.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 07/09/2022] [Accepted: 08/30/2022] [Indexed: 01/15/2023] Open
Abstract
Foreign body (FB) ingestion is a common health problem that affects children more than adults. According to gastroenterologists' guidelines, the management of FB ingestion differs slightly between adult and children. This review aimed to compile adult and children guidelines and establish an understandable association to reveal the requirements and timing of the endoscopic procedure, which is the most effective and least complicated technique for gastrointestinal FBs. Coins, pins, and chicken and fish bones have been the most commonly ingested FBs. However, with their increasing use in recent years, large batteries with lithium-ion conversion, stronger magnets composed of rare earth metals, such as neodymium, and superabsorbent objects have become the most morbid and mortal, necessitating new management strategies. Although the approach to gastrointestinal FBs is controversial, with different treatment options available in different disciplines, many studies have demonstrated the efficacy and safety of endoscopic procedures. Many factors influence the timing of endoscopy, including the nature, size, and location of the ingested object and the patient's clinical condition.
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Affiliation(s)
- Kaan Demiroren
- Department of Pediatric Gastroenterology, University of Health Sciences, Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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21
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Pagano N, Grazia Cirota G, Metelli F. Endoscopic extraction of a gastric foreign body by means of an esophageal self-expanding metal stent. Endoscopy 2022; 54:E1086-E1087. [PMID: 36049766 PMCID: PMC9738041 DOI: 10.1055/a-1901-0957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Nico Pagano
- Gastroenterology Unit, Department of Oncological and Specialty Medicine, University Hospital Maggiore della Carità, Novara, Italy
| | - Giovanna Grazia Cirota
- Department of Gastroenterology and GI Endoscopy, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant’Anna, Cona, Emilia-Romagna, Italy
| | - Flavio Metelli
- ASST Bergamo Est, Gastroenterology Department, Seriate, Lombardia, Italy
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22
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Dixit VK, Sahu MK, Venkatesh V, Bhargav VY, Kumar V, Pateriya MB, Venkataraman J. Gastrointestinal Emergencies and the Role of Endoscopy. JOURNAL OF DIGESTIVE ENDOSCOPY 2022. [DOI: 10.1055/s-0042-1755303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AbstractMany gastrointestinal (GI) disorders present to the emergency room with acute clinical presentations, some even life threatening. Common emergencies encountered that require urgent endoscopic interventions include GI hemorrhage (variceal and nonvariceal), foreign body ingestion, obstructive jaundice, postprocedure-related complications such as postpolypectomy bleed or perforation, etc. A major advantage of emergency endoscopy is that it is cost effective and, on many occasions, can be life-saving. The present review will highlight a practical approach on various endoscopic modalities and their use in the GI emergencies.
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Affiliation(s)
- Vinod Kumar Dixit
- Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Manoj Kumar Sahu
- Department of Gastroenterology and Hepatobiliary Sciences, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan (SOA) University, Bhubaneswar, Odisha, India
| | - Vybhav Venkatesh
- Department of Gastroenterology and Hepatobiliary Sciences, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan (SOA) University, Bhubaneswar, Odisha, India
| | - Varanasi Yugandhar Bhargav
- Department of Hepatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Vinod Kumar
- Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Mayank Bhushan Pateriya
- Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Jayanthi Venkataraman
- Department of Hepatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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23
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Oh GM, Jung K, Kim JH, Kim SE, Moon W, Park MI, Park SJ. Can the patient pinpoint where the ingested fish bone is impacted?: A single-center, retrospective study. Medicine (Baltimore) 2022; 101:e29399. [PMID: 35905236 PMCID: PMC9333482 DOI: 10.1097/md.0000000000029399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/13/2022] [Accepted: 04/14/2022] [Indexed: 01/04/2023] Open
Abstract
Among the plethora of foreign body impactions, fish bones are common examples that patients may struggle to properly disclose in clinical situations. This study investigated whether patients could pinpoint where the ingested fish bone was lodged. In addition, we investigated the differences between fish bone and other foreign bodies, the usefulness of computed tomography (CT), and the related risk factors for hospitalization. The cases of patients who underwent an endoscopic removal of fish bone between April 2008 and April 2020 were retrospectively reviewed. The clinical outcomes, X-ray scan, CT, and complications of each patient were investigated. A total of 96 patients were included in this study. The mean size of the impacted fish bone was 23.78 mm, and most were found in the upper esophagus (n = 38). There was a weak correlation between pain location and the actual lesion location (r = 0.419, P < .001). Compared to those of other foreign bodies, the location of impacted fish bones was different (P < .001), the X-ray detection rate of fish bones was lower (P < .001), and the complication incidence was higher (P = .030). CT (95.89%) showed higher sensitivity than X-ray scanning (11.24%) (P < .001). Foreign body size (P = .004) and door-to-endoscopy time (P = .029) were related to admission. Patients only managed to point out the approximate location of the ingested fish bone. CT detected fish bones well, but scans should include at least the entire esophagus instead of solely the area where pain is felt. Fish bone impaction has different clinical characteristics from other foreign bodies. Endoscopic removal without delay can reduce the admission rates.
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Affiliation(s)
- Gyu Man Oh
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Kyoungwon Jung
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Jae Hyun Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Sung Eun Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Won Moon
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Moo In Park
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Seun Ja Park
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
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24
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Pink K. The Case of the Missing Dentures: A Case Report and Review of Esophageal Foreign Body as a Cause of Chest Pain. Cureus 2022; 14:e26898. [PMID: 35978758 PMCID: PMC9376031 DOI: 10.7759/cureus.26898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 11/05/2022] Open
Abstract
Esophageal foreign body ingestion is a cause of non-cardiac chest pain and can be associated with significant mortality. Typically, esophageal foreign body ingestion is managed with endoscopic retrieval to prevent complications. The most commonly ingested foreign bodies in adults are food boluses. However, sometimes we see patients after the ingestion of more atypical and dangerous objects. Here, we present a case of a 66-year-old female who presented to the emergency department with chest pain. Quickly after admission to the emergency department, the patient was noted to have an esophageal foreign body on the chest radiograph. The patient was subsequently taken for endoscopic management of the foreign body and intubated for airway protection. With careful manipulation of the mystery object, the foreign body was removed and the patient was able to be discharged safely from the hospital without complications. This case emphasizes the importance of keeping a broad differential for one of the most commonly seen chief complaints in the emergency department to ensure timely triage of patients.
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25
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Tanaka Y, Sato Y, Ohno S, Endo M, Suetsugu T, Okumura N, Matsuhashi N, Takahashi T, Yoshida K. A possible indicator for removal of a large foreign body from the esophagus via a cervical approach: a case report with literature review. Clin J Gastroenterol 2022; 15:333-338. [PMID: 35001358 DOI: 10.1007/s12328-022-01589-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 01/01/2022] [Indexed: 10/19/2022]
Abstract
Foreign body intake in adults is more common among people with mental illness. Edentulous adults are at increased risk for foreign body ingestion, including of dentures. We experienced a patient who aspirated a large denture that we removed via a cervical surgical approach. A 72-year-old woman presented complaining of chest discomfort. Her medical history revealed that she suffered from schizophrenia and deafness. She had previously visited another hospital for possible loss of her denture. Chest discomfort and pain began the next day. Computed tomography showed the accidentally swallowed denture in her esophagus. Upper gastroendoscopy was attempted to remove the denture via endoscopic forceps, but it was too large to be removed and was strongly stuck. As it was difficult to perform open right thoracotomy due to left pneumonia and there was no perforation or mediastinitis, we decided to remove the denture via a left neck skin incision under general anesthesia. The denture was located in a gap between the aortic arch and vertebral body. The denture was grasped with pean forceps and extracted. The patient was discharged from hospital 18 days postoperatively. This case suggests how high a foreign body in the esophagus can be reached from a cervical incision.
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Affiliation(s)
- Yoshihiro Tanaka
- Department of Gastroenterology, Graduate School of Medicine, Gifu University School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan.
| | - Yuta Sato
- Department of Gastroenterology, Graduate School of Medicine, Gifu University School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Shinya Ohno
- Department of Gastroenterology, Graduate School of Medicine, Gifu University School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Masahide Endo
- Department of Gastroenterology, Graduate School of Medicine, Gifu University School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Tomonari Suetsugu
- Department of Gastroenterology, Graduate School of Medicine, Gifu University School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Naoki Okumura
- Department of Gastroenterology, Graduate School of Medicine, Gifu University School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Nobuhisa Matsuhashi
- Department of Gastroenterology, Graduate School of Medicine, Gifu University School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Takao Takahashi
- Department of Gastroenterology, Graduate School of Medicine, Gifu University School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Kazuhiro Yoshida
- Department of Gastroenterology, Graduate School of Medicine, Gifu University School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
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Koroljov M, Antipova M, Drobjazgin E, Zaharenko A, Meshkov A, Mihin A, Panfilova V, Pinigin A, Sinicyn V, Razumovskij A, Fedorov E, Shavrov A, Shhjogolev A. A foreign body in the digestive tract. Age group: adults and children. The main positions of the national clinical recommendations approved by the Ministry of Health in December 2021. ENDOSKOPICHESKAYA KHIRURGIYA 2022; 28:5. [DOI: 10.17116/endoskop2022280315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Detection and endoscopic treatment of foreign bodies in the upper gastrointestinal system of the geriatric patients. JOURNAL OF CONTEMPORARY MEDICINE 2022. [DOI: 10.16899/jcm.985835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Yu M, Li K, Zhou S, Wang H, Le M, Li C, Liu D, Tan Y. Endoscopic Removal of Sharp-Pointed Foreign Bodies with Both Sides Embedded into the Duodenal Wall in Adults: A Retrospective Cohort Study. Int J Gen Med 2021; 14:9361-9369. [PMID: 34908865 PMCID: PMC8664340 DOI: 10.2147/ijgm.s338643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/04/2021] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Sharp-pointed FBs with both sides embedded in the duodenal wall are rare. Compared with smooth edged FBs, sharp objects are more likely to be associated with significant adverse events, when penetrating the wall of the digestive tract. The clinical features of patients who experienced sharp-pointed FBs embedded in both sides of the duodenum were retrospectively analyzed, as were the efficacy and safety of endoscopic removal of these FBs. PATIENTS AND METHODS This retrospective study included 21 adults with both sides of sharp-pointed FBs embedded into the duodenal wall who were admitted to the Second Xiangya Hospital in China between January 1, 1996, and May 31, 2021. Data associated with the endoscopic removal of these FBs were collected from the electronic medical record system (EMRS) of the hospital. RESULTS The incidence rate of duodenal total FBs and FBs embedded in both sides was 8.87% and 1.03%, respectively. The success rate of endoscopic treatment was 100.00% in 124 patients without embedded duodenal FBs and 97.14% in 35 patients with one side embedded duodenal FBs. Of the 21 patients with FBs embedded in both sides of the duodenal wall, endoscopic removal was successful in 85.71% of patients, whereas 14.29% required surgery. FBs removed from these patients included toothpicks in 12; needles in 3; jujube pits in 2; and a chopstick, dentures, fish bones, and chicken bones in one each. Most of these 21 FBs were located in the bulb and descending duodenum, followed by the third part of duodenum. CONCLUSION Sharp-edged FBs with both sides embedded in the duodenal wall are rare. Endoscopic removal may be considered as a feasible, safe, and effective method of removing sharp-pointed FBs with both sides embedded in the duodenal wall. And if endoscopic removal is unsuccessful, surgical management can be a secondary option.
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Affiliation(s)
- Meihong Yu
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China
- Research Center of Digestive Disease, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Kaixuan Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People’s Republic of China
| | - Shishuang Zhou
- Department of Nursing Administration, Army Military Medical University, Chongqing, 400038, People’s Republic of China
| | - Hanyu Wang
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China
- Research Center of Digestive Disease, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Meixian Le
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China
- Research Center of Digestive Disease, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Chen Li
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China
- Research Center of Digestive Disease, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Deliang Liu
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China
- Research Center of Digestive Disease, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Yuyong Tan
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China
- Research Center of Digestive Disease, Central South University, Changsha, Hunan, 410011, People’s Republic of China
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Ibrahim AH, Andijani A, Abdulshakour M, Algain S, Thamrah AA, Ali MM, Marwah H, Aldaher A, Bashir S, Alsaleem B, Asery A, Al-Hussaini A. What Do Saudi Children Ingest?: A 10-Year Retrospective Analysis of Ingested Foreign Bodies From a Tertiary Care Center. Pediatr Emerg Care 2021; 37:e1044-e1050. [PMID: 31348207 PMCID: PMC8667801 DOI: 10.1097/pec.0000000000001894] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Few studies investigated the correlation between foreign body (FB) ingestion and occurrence of complications. The local literature is limited to case reports and small case series on esophageal FBs. We conducted this study to identify the high-risk factors predisposing to complications among Saudi children ingesting FBs. METHODS The medical records of 436 children (boys, 59.6%; mean age, 4.4 ± 2.7 years) presenting to the emergency department (ED) between 2007 and 2016 were retrospectively reviewed. Relative risk analysis of clinical variables was performed between 2 groups: The first group constituted children without FB-related complications (n = 389), and the second group included those with major complications (n = 14). Major complication was defined as any event associated with significant morbidity such as esophageal stricture, esophageal perforation, esophageal fistula, and intestinal perforation or fistula formation. RESULTS Most of the 436 cases presented between ages 2 and 4 years (35.1%). Coin was the most commonly ingested FB (22.9%) followed by button battery (19.5%). Most of the ingested FBs passed spontaneously without intervention (69%). Upper endoscopy was performed in 121 cases (27.7%). By multivariate analysis, the variables that were significantly associated with major complications included the following: very young age group (0-2 years; odds ratio [OR], 11.5), button battery (OR, 4), FB impacted at upper esophagus (OR, 8.7), and longer time duration to visit the ED (OR, 14.7). CONCLUSION Button battery impaction at upper esophagus in very young children and delayed presentation to the ED were the most significant risk factors of FB-related complications.
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Affiliation(s)
- Ahmed H. Ibrahim
- From the Children’s Specialized Hospital, King Fahad Medical City
| | | | | | - Sulwan Algain
- From the Children’s Specialized Hospital, King Fahad Medical City
| | - Asma Abu Thamrah
- From the Children’s Specialized Hospital, King Fahad Medical City
| | - Mariam M. Ali
- From the Children’s Specialized Hospital, King Fahad Medical City
| | - Haifa Marwah
- From the Children’s Specialized Hospital, King Fahad Medical City
| | - Anwaar Aldaher
- From the Children’s Specialized Hospital, King Fahad Medical City
| | - Salman Bashir
- Department of Biostatistics, Research Services Administration, Research Center, King Fahad Medical City
| | - Badr Alsaleem
- Division of Pediatric Gastroenterology, Children’s Specialized Hospital, King Fahad Medical City
| | - Ali Asery
- Division of Pediatric Gastroenterology, Children’s Specialized Hospital, King Fahad Medical City
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Wei X, Wang J, Xu W. Emergency management of jujube pit esophageal impactions using rigid esophagoscopy in the aged. Laryngoscope Investig Otolaryngol 2021; 6:1332-1338. [PMID: 34938871 PMCID: PMC8665464 DOI: 10.1002/lio2.677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/27/2021] [Accepted: 09/27/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To study the emergency management of esophageal jujube pit ingestion. STUDY DESIGN Retrospective case series. METHODS A retrospective study of 114 consecutive cases of jujube pits esophageal impaction during 3 months was performed. RESULTS One hundred and fourteen cases were confirmed as jujube pit esophageal impaction using contrast-enhanced radiography. All jujube pits were retrieved using rigid esophagoscopy under general anesthesia as outpatients, except one case where a direct laryngoscope was used. In four cases, esophageal perforation was found, the patients were treated with conservative measures, and none died. CONCLUSION Jujube pit esophageal impaction is characterized by a high incidence of perforation. The conservative management of cervical perforation is effective in this study. Rigid esophagoscopy under general anesthesia is safe for jujube pit esophageal impaction. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Xingmei Wei
- Department of Otorhinolaryngology Head and Neck SurgeryBeijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of EducationBeijingChina
| | - Jie Wang
- Department of Otorhinolaryngology Head and Neck SurgeryBeijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of EducationBeijingChina
- Beijing Engineering Research Center of Audiology TechnologyBeijingChina
| | - Wen Xu
- Department of Otorhinolaryngology Head and Neck SurgeryBeijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of EducationBeijingChina
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Hayashi H, Abe A, Ota M, Momokita M, Ishihama T, Furuta H, Taniguchi T, Takeuchi K. Endoscopic removal of accidental aspirated and ingested dental foreign bodies: A cross-sectional study. Medicine (Baltimore) 2021; 100:e27602. [PMID: 34797284 PMCID: PMC8601339 DOI: 10.1097/md.0000000000027602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 10/07/2021] [Indexed: 01/05/2023] Open
Abstract
The incidence of accidental ingestion and aspiration of foreign body (FB) is likely to occur. Many FBs are discharged spontaneously, but many dental FBs are often sharp and may remain in the pharynx, esophagus, and stomach, causing serious complications such as hemorrhage, asphyxia, perforation of the digestive tract, mediastinal emphysema, peritonitis, and ileus. We aimed to examine which type of dental foreign bodies can be removed by endoscope.In this study, we enrolled 32 patients who were evaluated at the Emergency and Critical Center between January 2014 and December 2019 and who accidentally ingested or aspirated dental FBs. Medical records were reviewed to determine the patients' sex, age, medical history, time from accidental ingestion of a FB to consultation, cause, location, occurrence status, nature of the FB, location of retained FB, treatment, complications, and outcome.We enrolled 32 patients (14 men, 18 women), with a mean age of 74.5 ± 12.8 years. Accidental ingestion at treatment was common. The most frequent site where the FB was retained was upper gastrointestinal tract (26 cases, 81.3%). In this study, endoscopic removal was indicated for dentures under the size of 43.3 mm, for dental FB (except dentures) more than 13.6 mm. In dentures, between the number of missing teeth, clasp, type, and endoscopic removal was not statistically significant.Dentures under the size of 43.3 mm was likely to be removed by endoscope. Dental FB (except dentures) more than the size of 13.6 mm was likely to be removed by endoscope. There were no indications for endoscopic removal except for size.
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Affiliation(s)
- Hiroki Hayashi
- Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Atsushi Abe
- Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Mitsuhiko Ota
- Oral and Maxillofacial Surgery, Sakura General Hospital, Japan
| | - Moeko Momokita
- Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Takanori Ishihama
- Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Hiroshi Furuta
- Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Toru Taniguchi
- Oral and Maxillofacial Surgery, Sakura General Hospital, Japan
| | - Kazuo Takeuchi
- Department of Gerodontology and Home Care Dentistry, Aichi Gakuin University, Japan
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Sude NS, Karanam VPK. Endoscopic Retrieval of Ingested Foreign Bodies: A Single Surgeon Experience. Cureus 2021; 13:e19293. [PMID: 34754707 PMCID: PMC8570916 DOI: 10.7759/cureus.19293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Foreign body (FB) ingestion either accidental or intentional is a common clinical scenario encountered by general surgeons. This article reports a single surgeon's experience of endoscopic retrieval of foreign bodies from the upper gastrointestinal (UGI) tract. Methods A retrospective analysis of data of all the patients who underwent endoscopic management for foreign body removal by a single surgeon in a tertiary care hospital in southern India between 2015 and 2020 was conducted. Patient variables in terms of age, sex, type of foreign body, its location in the gastrointestinal (GI) tract, the time between ingestion and presentation, the time between presentation and endoscopy, treatment outcomes were reviewed. Results A total of 97 patients were studied. The age range of the patients studied was one month to 71 years. Males were predominant (n=64, 65.97%). The most common retrieved foreign body were coins (n=31, 31.9%). The most common site of foreign body lodgment was the esophagus (n=75, 77.31%), with the upper third esophagus (n=38; 39.37%) being the predominant site. The success rate of endoscopic retrieval in our study was 97%. No procedure-related complications were encountered in any patient. Endoscopic management failed in two patients who ultimately required surgical intervention. Conclusion Endoscopic retrieval of foreign bodies in the UGI tract is a safe and effective modality. Early endoscopy in such patients avoids surgical intervention and reduces morbidity.
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Affiliation(s)
- Nandkishor Sopanrao Sude
- General Surgery, Employees State Insurance Corporation Medical College and Hospital, Hyderabad, IND
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Wang X, Zhao J, Jiao Y, Wang X, Jiang D. Upper gastrointestinal foreign bodies in adults: A systematic review. Am J Emerg Med 2021; 50:136-141. [PMID: 34365062 DOI: 10.1016/j.ajem.2021.07.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/04/2021] [Accepted: 07/24/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Foreign body(FB) ingestion in the upper digestive tract is a common emergency that lacks sufficient attention in adult population. Improper management may bring additional injuries and financial burdens to patients. This review was performed to determine the clinical characteristics of upper gastrointestinal FBs, including the demographic of adult patients, the type and location of FBs, underlying diseases of patients and other risk factors, and outcomes. METHODS We searched PubMed, MEDLINE, EMBASE and Cochrane databases with the terms "foreign body AND upper gastrointestinal NOT child". Finally, we got 7 articles between 2001 and 2020 and extracted the information. RESULTS A total of 1391 patients were included. 736 (52.9%) patients were males and 655 (47.1%) were females. Fish bone was the most common type of FBs. Esophagus accounts for the most location in the upper digestive tract. 18.2% (235/1291) patients had the underlying diseases, and 11.7% (58/494) had other risk factors. The overall complication rate was 4.5% (63/1391).
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Affiliation(s)
- Xinyue Wang
- Department of Burns and Plastic Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250033, PR China
| | - Jie Zhao
- Department of Emergency Medical Center, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250033, PR China
| | - Ya Jiao
- Department of Emergency Medical Center, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250033, PR China
| | - Xinglei Wang
- Department of Emergency Medical Center, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250033, PR China
| | - Duyin Jiang
- Department of Emergency Medical Center, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250033, PR China; Department of Burns and Plastic Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250033, PR China.
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Ghazanfar H, Shehi E, Makker J, Patel H. The Role of Imaging Modalities in Diagnosing Dysphagia: A Clinical Review. Cureus 2021; 13:e16786. [PMID: 34513393 PMCID: PMC8405125 DOI: 10.7759/cureus.16786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 12/13/2022] Open
Abstract
Dysphagia, which is characterized by difficulty in oro-gastric bolus transit, is a common condition. It is broadly classified into oropharyngeal or esophageal pathology. A wide array of differentials for dysphagia and initial clinical suspicion of oropharyngeal or esophagus etiology can assist in further evaluation. Fiberoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopic swallow study (VFSS) are the preferred modalities for assessing oropharyngeal bolus transit, residual, as well as determining the risk of laryngeal aspiration. High-resolution pharyngeal manometry (HRPM) is an emerging modality for optimal topographical and pressure assessment of pharyngeal anatomy. HRPM provides improved assistance in evaluating the strength of the pharyngeal muscular contraction. Esophagogastroduodenoscopy (EGD) is the preferred exam for patients with suspected esophageal etiology of dysphagia. Barium swallow provides luminal assessment and assists in evaluating esophageal motility; it is non-invasive, but therapeutic interventions like biopsy cannot be performed. High-resolution esophageal manometry (HREM) has added another dimension in the diagnosis of esophageal motility disorders. The purpose of this review article is to help internists and primary care providers get a better understanding of the role of various imaging modalities in diagnosing dysphagia in the elderly population. This article also provides a comprehensive review and detailed comparison of these imaging modalities based on the latest evidence.
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Affiliation(s)
| | - Elona Shehi
- Medicine/Gastroenterology, Bronxcare Health System, Bronx, USA
| | - Jasbir Makker
- Gastroenterology, Bronxcare Hospital Center, Bronx, USA
| | - Harish Patel
- Internal Medicine, Bronxcare Hospital Center, Bronx, USA
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Yadollahi S, Buchannan R, Tehami N, Stacey B, Rahman I, Boger P, Wright M. Endoscopic management of intentional foreign body ingestion: experience from a UK centre. Frontline Gastroenterol 2021; 13:98-103. [PMID: 35300468 PMCID: PMC8862457 DOI: 10.1136/flgastro-2021-101776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE We report on the increasing incidence and outcomes from intentional foreign body ingestion (iFoBI) presenting to our hospital over a 5-year period. The aim was to assess the impact on services and to identify ways to safely mitigate against this clinical challenge. DESIGN/METHOD We performed a retrospective observational study of all patients presenting to a university hospital between January 2015 and April 2020 with iFoBI with a focus on objects swallowed, timing of endoscopy and clinical outcomes. RESULTS 239 episodes of iFoBI in 51 individuals were recorded with a significant increase in incidence throughout the study period (Welch (5, 17.3)=15.1, p<0.001), imposing a high burden on staff and resources. Items lodged in the oesophagus were more likely to lead to mucosal injury (p=0.009) compared with elsewhere. Ingested item type and timing of endoscopy were not related to complications (p=0.78) or length of stay (p=0.8). In 12% of cases, no objects were seen at endoscopy. CONCLUSION In all except those patients with oesophageal impaction of the object on radiograph, there is no need to perform endoscopic extraction out of hours. A subset of cases can avoid endoscopy with an X-ray immediately prior to the procedure as a significant proportion have passed already. We discuss more holistic approaches to deal with recurrent attendances.
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Affiliation(s)
- Sina Yadollahi
- Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ryan Buchannan
- Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK,Faculty of Medicine, University of Southampton, Southampton, UK
| | - Nadeem Tehami
- Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Bernard Stacey
- Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Imbadhur Rahman
- Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Philip Boger
- Gastroenterology, Southampton General Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mark Wright
- Hepatology, University Hospital Southampton, Southampton, Hampshire, UK
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Qiu Y, Xu S, Wang Y, Chen E. Migration of ingested sharp foreign body into the bronchus: a case report and review of the literature. BMC Pulm Med 2021; 21:90. [PMID: 33731031 PMCID: PMC7968162 DOI: 10.1186/s12890-021-01458-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 03/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background Foreign body ingestion is a common emergence in gastroenterology. Foreign bodies are most likely to be embedded in the esophagus. The sharp ones may penetrate the esophageal wall and lead to serious complications. Case presentation A 72-year-old Chinese female was admitted to our hospital with a 4-day history of retrosternal pain and a growing cough after eating fish. Chest computed tomography scan indicated that a high-density foreign body (a fish bone) penetrated through the esophageal wall and inserted into the left main bronchus. First, we used a rigid esophagoscope to explore the esophagus under general anesthesia. However, the foreign body was invisible in the side of the esophagus. Then, the fiberoptic bronchoscopy was performed. We divided the fish bone, which traversed the left main bronchus, into two segments under holmium laser and removed the foreign body successfully. The operation time was short and there were no complications. The patient was discharged 1 week postoperatively and was symptom free even under a liquid diet. Conclusions There are several challenges in the management of this rare condition. We applied the technique of interventional bronchoscopy to the management of esophageal foreign body flexibly in an emergency. A surgery was avoided, which was more invasive and costly.
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Affiliation(s)
- Yuanhua Qiu
- Department of Respiratory and Critical Care Medicine, Regional Medical Center for National Institute of Respiratory Disease, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Shan Xu
- Department of Respiratory and Critical Care Medicine, Regional Medical Center for National Institute of Respiratory Disease, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Yafang Wang
- Department of Respiratory and Critical Care Medicine, Regional Medical Center for National Institute of Respiratory Disease, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Enguo Chen
- Department of Respiratory and Critical Care Medicine, Regional Medical Center for National Institute of Respiratory Disease, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
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Wang X, Su S, Chen Y, Wang Z, Li Y, Hou J, Zhong W, Wang Y, Wang B. The removal of foreign body ingestion in the upper gastrointestinal tract: a retrospective study of 1,182 adult cases. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:502. [PMID: 33850899 PMCID: PMC8039707 DOI: 10.21037/atm-21-829] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Foreign body (FB) ingestion in the gastrointestinal tract is a common and urgent problem observed in children and adults. However, there may be difficulty locating FBs and complications associated with their removal. This study aimed to identify risk factors and complications correlated to the presence and removal of FBs. Methods This 5-year retrospective study enrolled 1,311 patients between June 2014 and April 2019. Demographic and endoscopic data were collected, containing age, gender, types and location of FBs, duration of FB ingestion, accessory devices, endoscopic methods, and complications. Logistic regression analysis was applied to evaluate the predictive risk factors. Results Among 1,131 patients, FBs were found in 90.16% of cases. A major predictor for the presence of FB was a presentation of less than 24 hours (h). The types of FBs were jujube pits (36.72%) and fish bones (22.00%), and over 80% of the FBs were discovered in the esophagus. Complications were found in 239 cases (20.22%), of which hemorrhage (162/239, 67.78%) was the most frequent. Age ≥60, duration ≥24 h, and FBs ingested in the esophagus were considered as risk factors for developing complications. Conclusions In conclusion, the longer duration, age ≥60, and impaction in the esophagus were risk factors for developing complications following the ingestion of FBs. These factors should be considered when developing assessment and treatment plans in the management of FB ingestion.
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Affiliation(s)
- Xin Wang
- Department of Gastroenterology and Hepatology, General Hospital of Tianjin Medical University, Tianjin, China
| | - Shuai Su
- Department of Gastroenterology and Hepatology, General Hospital of Tianjin Medical University, Tianjin, China
| | - Yiming Chen
- Department of Gastroenterology and Hepatology, General Hospital of Tianjin Medical University, Tianjin, China
| | - Zelan Wang
- Department of Gastroenterology and Hepatology, General Hospital of Tianjin Medical University, Tianjin, China
| | - Ying Li
- Department of Gastroenterology and Hepatology, General Hospital of Tianjin Medical University, Tianjin, China
| | - Junjie Hou
- Department of Gastroenterology and Hepatology, General Hospital of Tianjin Medical University, Tianjin, China
| | - Weilong Zhong
- Department of Gastroenterology and Hepatology, General Hospital of Tianjin Medical University, Tianjin, China
| | - Yuming Wang
- Department of Gastroenterology and Hepatology, General Hospital of Tianjin Medical University, Tianjin, China
| | - Bangmao Wang
- Department of Gastroenterology and Hepatology, General Hospital of Tianjin Medical University, Tianjin, China
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Abstract
Ingestion of foreign bodies is common within the pediatric population; in adults, it occurs more commonly in those with a psychiatric background. Diagnosis of such cases can be readily made based on plain abdominal X-rays. As reported, many foreign bodies pass through the gastrointestinal tract without complications, obstruction, bleeding, and perforation. The ultimate decision of the best management approach for such cases should be made based on the available expertise as well as the patient's specific factors. Observation, endoscopic removal, and surgical intervention are all acceptable approaches in cases of metal foreign body ingestion. We report a case of a 29-year-old male patient brought to the emergency department following ingestion of multiple sharp nails. He underwent surgical exploration, which resulted in the retrieval of 73 metallic nails.
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Affiliation(s)
- Ahmed M AlMuhsin
- Department of General Surgery, Security Forces Hospital, Dammam, SAU
| | - Fatima Alsalman
- Department of General Surgery, Security Forces Hospital, Dammam, SAU
| | - Ahmad Bubshait
- Department of General Surgery, Security Forces Hospital, Dammam, SAU
| | - Rami O Abu Hajar
- Department of General Surgery, Security Forces Hospital, Dammam, SAU
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Song JT, Chang XH, Liu SS, Chen J, Liu MN, Wen JF, Hu Y, Xu J. Individualized endoscopic management strategy for impacting jujube pits in the upper gastrointestinal tract: a 3-year single-center experience in northern China. BMC Surg 2021; 21:18. [PMID: 33407359 PMCID: PMC7788756 DOI: 10.1186/s12893-020-01008-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/09/2020] [Indexed: 02/06/2023] Open
Abstract
Background Impaction of jujube pits in the upper gastrointestinal (GI) tract is a special clinical condition in the northern Chinese population. Endoscopic removal is the preferred therapy, but there is no consensus on the management strategies. We reported our individualized endoscopic strategies on the jujube pits impacted in the upper GI tract. Methods In this retrospective study, we included 191 patients (male: 57; female: 134) who presented to our hospital with ingestion of jujube pits between January 2015 and December 2017. Demographic information, times of hospital visiting, locations of jujube pits, endoscopic procedures, post-extraction endoscopic characteristics were analyzed. Management strategies including sufficient suction, repeated irrigation, jejunal nutrition and gastrointestinal decompression were given based on post-extraction endoscopic characteristics and impacted locations. Results Peak incidence was in the second quarter of each year (85/191 cases, 44.5%). Among the 191 cases, 169 (88.5%) showed pits impaction in the esophagus, 20 (10.5%) in the prepyloric region and 2 (1.0%) in the duodenal bulb. A total of 185 patients (96.9%) had pits removed with alligator jaw forceps, and 6 (3.1%) underwent suction removal with transparent caps placed over the end of the endoscope to prevent injury on removal of these pits with two sharp painted edges. Post-extraction endoscopic manifestations included mucosal erosion (26.7%), mucosa laceration (24.6%), ulceration with a white coating (18.9%) and penetrating trauma with pus cavity formation (29.8%). All patients received individualized endoscopic and subsequent management strategies and showed good outcomes. Conclusions Individualized endoscopic management for impacted jujube pits in the upper GI tract based on post-extraction endoscopic characteristics and impacted locations was safe, effective, and minimally invasive.
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Affiliation(s)
- Ji-Tao Song
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, 246 Xue-Fu Road, Nan-Gang District, Harbin, 150086, China
| | - Xiao-Hua Chang
- Department of Gastroenterology and Hepatology, The First Hospital of Harbin, Harbin, China
| | - Shan-Shan Liu
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, 246 Xue-Fu Road, Nan-Gang District, Harbin, 150086, China.,Faculty of Health Service, Logistics University of Chinese People's Armed Police Force, Tianjin, China
| | - Jing Chen
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, 246 Xue-Fu Road, Nan-Gang District, Harbin, 150086, China
| | - Ming-Na Liu
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, 246 Xue-Fu Road, Nan-Gang District, Harbin, 150086, China
| | - Ji-Feng Wen
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, 246 Xue-Fu Road, Nan-Gang District, Harbin, 150086, China
| | - Ying Hu
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, 246 Xue-Fu Road, Nan-Gang District, Harbin, 150086, China
| | - Jun Xu
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, 246 Xue-Fu Road, Nan-Gang District, Harbin, 150086, China.
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Wang H, Lin DL, Wang XF, Qu YW, Wu LS, Yu P, Wang WA. Endoscopic management of foreign bodies in the gastrointestinal tract: A retrospective study of 109 cases. Shijie Huaren Xiaohua Zazhi 2020; 28:1243-1248. [DOI: 10.11569/wcjd.v28.i24.1243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The ingestion of foreign bodies in the gastrointestinal tract is commonly encountered in clinical practice. Reports on individualized endoscopic removal of gastrointestinal foreign bodies are scarce.
AIM To explore the method of individualized endoscopic removal of indigested foreign bodies in the gastrointestinal tract to improve the success rate of foreign body endoscopic removal.
METHODS The clinical data of patients with digestive tract foreign bodies treated at the Third Medical Center of PLA General Hospital (former General Hospital of Armed Police Forces) from July 2014 to April 2019 were retrospectively analyzed.
RESULTS One hundred and nine patients were included in the study, including 46 men (42.2%) and 63 women (57.8%). Their age ranged from 11 to 88 years, with an average age of 57.3 years; 52 cases (47.7%) were elderly. The most common type of foreign body was jujube kernel (53 cases, 48.6%), followed by fish bone (24 cases, 22%) and food mass (15 cases, 13.8%). The most common location of foreign bodies in the digestive tract was the esophagus (84 cases, 76.9%), followed by the colon (7 cases, 6.4%), anastomosis (6 cases, 5.5%), stomach (5 cases, 4.5%), and duodenum (2 cases, 1.8%). Pharynx foreign bodies can be directly removed with foreign body forceps, with the shortest time taken (average, 2.5 ± 0.7 min). For esophageal foreign bodies, foreign body forceps were used to clamp one end of the foreign bodys, exert to the opposite side, make it leave the mucous membrane and parallel to the lumen, and then remove. The foreign body in the upper part of the esophagus can be added with a casing or transparent cap. The foreign body in the lower esophagus can be pushed into the stomach and then removed under the endoscope. The average time taken for removal of foreign bodies in the upper, middle, and lower esophagus was 7.0 ± 5.3, 8.3 ± 6.3, and 3.3 ± 1.2, respectively. Anastomosis foreign bodies were often removed using a trap, and the average time taken was 6.2 ± 4.1 min. When removing the foreign body in the stomach, appropriate instrument should be selected according to the shape of the foreign body. In order to avoid scratching the mucosa by the tip of the foreign body, a transparent cap or a self-made protective device can be used. The average time used was 8.4 ± 1.7 min. Duodenal foreign body was usually dragged into the stomach tbefore removal, and the average time taken was 9.2 ± 3.1 min. Colonic foreign bodies mainly occurred in the sigmoid colon and were very difficult to remove. A clamp was usually used to clamp one end of the foreign body, exert to the opposite side, cause it to be parallel to the intestinal lumen, and then remove. The longest time was taken for colonic foreign bodies, with an average time of 15.6 ± 8.0 min. The success rate of endoscopic removal of foreign bodies in the digestive tract was 97.2% (106/109).
CONCLUSION Individualized endoscopic removal of gastrointestinal foreign bodies is a safe and effective method.
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Affiliation(s)
- Huan Wang
- Department of Gastroenterology, The Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Dong-Lei Lin
- Department of Gastroenterology, The Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Xiao-Feng Wang
- Department of Gastroenterology, The Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Ya-Wei Qu
- Department of Gastroenterology, The Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Li-Sha Wu
- Department of Gastroenterology, The Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Peng Yu
- Department of Gastroenterology, The Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Wei-An Wang
- Department of Gastroenterology, The Third Medical Center of PLA General Hospital, Beijing 100039, China
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Rahhal R, Pitcher G. Removal of a chronically impacted cylindrical esophageal foreign body by innovative fiberoptic endoscopy with a team approach. VideoGIE 2020; 6:71-73. [PMID: 33884331 PMCID: PMC7859497 DOI: 10.1016/j.vgie.2020.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Riad Rahhal
- Division of Pediatric Gastroenterology, Stead Family Department of Pediatrics, UI Stead Family Children's Hospital, University of Iowa Health Care, Iowa City, Iowa
| | - Graeme Pitcher
- Division of Pediatric Surgery, Department of Surgery, University of Iowa Children's Hospital, Iowa City, Iowa
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Becq A, Camus M, Dray X. Foreign body ingestion: dos and don'ts. Frontline Gastroenterol 2020; 12:664-670. [PMID: 34917324 PMCID: PMC8640419 DOI: 10.1136/flgastro-2020-101450] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/27/2020] [Accepted: 08/30/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- Aymeric Becq
- Endoscopy Department, Hôpital Saint Antoine, APHP, Sorbonne Université, Paris, Île-de-France, France,Paris On-call Endoscopy Team, Assistance Publique Hopitaux de Paris, Paris, Île-de-France, France
| | - Marine Camus
- Endoscopy Department, Hôpital Saint Antoine, APHP, Sorbonne Université, Paris, Île-de-France, France,Paris On-call Endoscopy Team, Assistance Publique Hopitaux de Paris, Paris, Île-de-France, France
| | - Xavier Dray
- Endoscopy Department, Hôpital Saint Antoine, APHP, Sorbonne Université, Paris, Île-de-France, France,Paris On-call Endoscopy Team, Assistance Publique Hopitaux de Paris, Paris, Île-de-France, France
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Saltiel J, Molinsky R, Lebwohl B. Predictors of Outcomes in Endoscopies for Foreign Body Ingestion: A Cross-Sectional Study. Dig Dis Sci 2020; 65:2637-2643. [PMID: 31907772 DOI: 10.1007/s10620-019-06033-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 12/24/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND As foreign body ingestion/food impaction is one of the less common indications for upper endoscopy in adults, few studies have investigated outcomes. We aimed to determine the distribution of ingested items warranting endoscopy and to identify factors associated with successful endoscopic retrieval. METHODS We conducted a retrospective, cross-sectional study, identifying all endoscopies performed between June 2006 and June 2018 for foreign body ingestion or food impaction. We performed univariate and multivariate analyses to identify variables associated with endoscopic foreign body visualization and successful removal from the mouth. RESULTS Of the 168 endoscopies identified, the ingested item was visualized in 131 (78%) and was removed from the mouth in 88 (52.4%). 6.5% of cases required surgery and 2.4% of cases had a perforation noted. The two most common foreign bodies were food boluses (51.2%) and bones (28.6%). Older patients were more likely to have their ingested foreign body visualized during endoscopy (age ≥ 70 compared to 18-29 adjusted odds ratio [aOR] 8.78; 95% CI 1.62-47.70) and more likely to have it removed from the mouth (aOR 5.57; 95% CI 1.34-22.85). Bones were less likely to be visualized on endoscopy (aOR 0.16; 95% CI 0.04-0.57) but not less likely to be removed successfully (aOR 0.85; 95% CI 0.42-1.72). Foreign bodies visible on radiography were more likely to be identified on endoscopy (aOR 9.07; 95% CI 2.71-30.37) and more likely to be successfully removed (aOR 2.82; 95% CI 1.26-6.32). CONCLUSIONS Factors such as age, radiographic visibility, and the suspected foreign body may affect the likelihood that it can be visualized and removed. Future studies should focus on further characterizing complications of foreign body ingestions and the types of patients and objects most at risk.
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Affiliation(s)
- Jason Saltiel
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th St, New York, NY, 10032, USA.
| | - Rebecca Molinsky
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St, New York, NY, 10032, USA
| | - Benjamin Lebwohl
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th St, New York, NY, 10032, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St, New York, NY, 10032, USA
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, 180 Fort Washington Avenue, Suite 936, New York, NY, 10032, USA
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Wang Z, Du Z, Zhou X, Chen T, Li C. Misdiagnosis of peripheral abscess caused by duodenal foreign body: a case report and literature review. BMC Gastroenterol 2020; 20:236. [PMID: 32703254 PMCID: PMC7376966 DOI: 10.1186/s12876-020-01335-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/05/2020] [Indexed: 12/27/2022] Open
Abstract
Background The induction of chronic inflammation, perforation, and abscess by foreign bodies (FBs) in adults is uncommon. We present a delayed diagnosis case for a patient who had a fishbone stuck in the duodenal bulb, resulting in chronic abdominal pain for nearly 3 months. We present the diagnosis and treatment procedures for chronic patients, which differ from those for acute and emergency FB ingestion, and also summarize the characteristics of such patients through a systematic literature review. Case presentation A 68-year-old woman was brought to our hospital with repeated right upper abdominal pain lasting for 3 months and aggravation for 9 h. Computed tomography (CT) showed a streaky high-density shadow (approximately 3 cm in length) on the posterior wall of the gastric antrum extending outside the wall. Endoscopic ultrasonography showed hyperechoic space with a cross-section of approximately 0.1 × 0.1 cm in the deep submucosal layer of the local stomach, accompanied by an acoustic shadow in the rear. The possibility of a fishbone as well as perforation was considered and the object was removed using FB forceps. Fasting as well as acid inhibition and anti-infection medication were prescribed for the patient. She eventually recovered and was discharged from the hospital. Conclusion Endoscopic intervention can be recommended as the first option for patients with gastrointestinal FBs.
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Affiliation(s)
- Zhihui Wang
- Department of Gastroenterology, Jianyang People's Hospital, No. 180 Yiyuan Road, Jianyang City, 641400, China
| | - Zhiqiang Du
- Department of Gastroenterology, Jianyang People's Hospital, No. 180 Yiyuan Road, Jianyang City, 641400, China.
| | - Xiangrong Zhou
- Department of Gastroenterology, Jianyang People's Hospital, No. 180 Yiyuan Road, Jianyang City, 641400, China
| | - Tianming Chen
- Department of Gastroenterology, Jianyang People's Hospital, No. 180 Yiyuan Road, Jianyang City, 641400, China
| | - Chunyan Li
- Department of Gastroenterology, Jianyang People's Hospital, No. 180 Yiyuan Road, Jianyang City, 641400, China
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Abstract
INTRODUCTION This study aimed to present the case of a patient in whom a chopstick, which had been in the duodenum for 10 years, was finally removed by endoscopy. This case was reported because of the long-time retention and noninvasive removal by endoscopy without sedation or complication. PATIENT CONCERNS A 30-year-old male patient with intermittent upper abdominal pain. DIAGNOSES During upper-gastrointestinal (GI) endoscopy, a long-strip foreign body (Fb) was seen in the descending part of the duodenum. An upper-GI barium examination was performed, which revealed a linear Fb in the duodenum cavity. The Fb was >10-cm long. Combined with his history (the patient admitted swallowing a chopstick 10 years ago in a bet), the diagnosis of Fb in the duodenum was confirmed. INTERVENTIONS The Fb was removed from the duodenum cavity by upper-GI endoscopy successfully. OUTCOMES The patient was discharged after the removal of the Fb. CONCLUSION Endoscopic removal and nonoperative management might be feasible in carefully selected patients with a long and old Fb in the duodenum without the need for anesthesia or surgery as well as no occurrence of complications and laceration.
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Affiliation(s)
- Ya-nan Guo
- Shaanxi University of Traditional Chinese Medicine, Xian-yang, Shaanxi
- Department of spleen and stomach, Shaanxi Traditional Chinese Medicine Hospital, Xi-an, China
| | - Fang Li
- Department of spleen and stomach, Shaanxi Traditional Chinese Medicine Hospital, Xi-an, China
| | - Fu Huang
- Department of spleen and stomach, Shaanxi Traditional Chinese Medicine Hospital, Xi-an, China
| | - Tao Yu
- Shaanxi University of Traditional Chinese Medicine, Xian-yang, Shaanxi
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McElroy M, Ganti L, Houck J, Webb AL, Lebowitz D. Ingested Fish Bone Lodged in the Vallecula. Cureus 2020; 12:e8761. [PMID: 32714699 PMCID: PMC7377669 DOI: 10.7759/cureus.8761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/21/2020] [Indexed: 11/05/2022] Open
Abstract
Although foreign body ingestions are less common in adults than children, when they do occur, it is often due to a fish or chicken bone. The authors present a case of a fish bone ingestion, and highlight its appearance on imaging.
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Affiliation(s)
- Mitchell McElroy
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Latha Ganti
- Emergency Medicine, Envision Physician Services, Nashville, USA
- Emergency Medicine, University of Central Florida College of Medicine/Hospital Corporation of America Graduate Medical Education Consortium of Greater Orlando, Orlando, USA
- Emergency Medical Services, Polk County Fire Rescue, Bartow, USA
| | - Jessica Houck
- Emergency Medicine, University of Central Florida College of Medicine/Hospital Corporation of America Graduate Medical Education Consortium, Kissimmee, USA
| | - Amanda L Webb
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - David Lebowitz
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA
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Zong Y, Zhao H, Sun C, Ji M, Wu Y, Zhang S, Wang Y. Differences between intentional and accidental ingestion of foreign body in China. BMC Gastroenterol 2020; 20:90. [PMID: 32252651 PMCID: PMC7137476 DOI: 10.1186/s12876-020-01224-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 03/18/2020] [Indexed: 12/28/2022] Open
Abstract
Backgrounds Previous reports of foreign-body ingestion focused primarily on accidental ingestion and very few studies focused on intentional ingestion of foreign body (FB) in China. Our study aimed to compare the prevalence of different age, gender, types, locations and management of FB ingested between intentional ingestion and accidental ingestion of FB in Northern China. Methods A retrospective case series studied all patients with suspected FB ingestion in Digestive Endoscopy Center of Beijing Friendship Hospital, between January 2011 and January 2019. The patients were divided into 2 groups. Group A included the patients who intentionally ingested FBs, and Group B included the patients who accidentally ingested FBs. Patients’ database (demographics, past medical history, characteristics of FB, endoscopic findings and treatments) were reviewed. Statistical analyses were conducted using SPSS software. Results Group A consisted of 77 prisoners, 2 suspects and 11 psychologically disabled persons. Group B consisted of 1020 patients with no prisoners, suspects or psychologically disabled persons. In Group A, there were no food-related foreign bodies, and the majority of FBs were metallic objects (54.44%). However in Group B, food-related FBs were the most common (91.37%). In Group A, 58 cases (64.44%) were located in the stomach, while in Group B, 893 cases (87.55%) were located in the esophagus (P < 0.05). 1096 patients successfully underwent endoscopic removal and 14 failed, including 9 cases in Group A and 5 cases in Group B. The duration of FBs impaction was longer in Group A than that in Group B (P < 0.05). Conclusions In our study, the patients who intentionally ingested FB were mainly prisoners, FBs were mostly sharp metallic objects, the duration of FBs impaction was longer, and the rate of successful endoscopic treatment was lower than that of the general population. Attention should be focused on these patients.
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Affiliation(s)
- Ye Zong
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
| | - Haiying Zhao
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Can Sun
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Ming Ji
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Yongdong Wu
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Shutian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Yongjun Wang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
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Krill T, Samuel R, Vela A, Marcondes F, Zaibaq J, Guturu P, Parupudi S. Outcomes of delayed endoscopic management for esophageal soft food impactions. Gastrointest Endosc 2020; 91:806-812. [PMID: 31874159 DOI: 10.1016/j.gie.2019.12.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 12/06/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Food impactions are a common reason for emergent upper endoscopy. Current guidelines call for urgent upper endoscopy (within 24 hours) for food impactions without complete esophageal obstruction and emergent endoscopy (within 6 hours) for those with complete esophageal obstruction. Multiple adverse events can arise from esophageal foreign bodies. Cases with longer delays from symptom onset to presentation have been associated with higher rates of surgical intervention. However, data on esophageal soft food impactions are scant. We set out to determine differences in outcomes for food impactions undergoing intervention within 12 hours versus over 12 hours of symptom onset. METHODS A retrospective review of medical records was conducted to identify patients who presented to our hospital with an esophageal soft food impaction and underwent an EGD between January 2010 and January 2018. Patients were divided into 2 groups based on the timing from symptom onset to EGD. An EGD within 12 hours was considered an early intervention and over 12 hours was considered a delayed intervention. Patients who had ingested bones or hard objects were not included. Primary outcomes studied were rates of aspiration, admission, local esophageal adverse events, and 30-day all-cause mortality. RESULTS We identified 110 patients with a soft food impaction who underwent an EGD. Forty- two patients had an early intervention and 68 a delayed intervention. There were no differences in basic demographics and comorbidities. Additionally, there were no differences in rates of local esophageal adverse events, aspiration, admission, or 30-day mortality. Multivariate analysis revealed endoscopic accessory use was associated with increased odds of local esophageal adverse events (odds ratio, 6.37; P = .01). CONCLUSIONS The overall rates of serious adverse events in esophageal soft food impactions are low. Delayed intervention is not associated with increased adverse events or 30-day mortality compared with early intervention. However, accessory use is associated with higher adverse event rates.
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Affiliation(s)
- Timothy Krill
- Department of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Ronald Samuel
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Andrew Vela
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Felippe Marcondes
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Jenine Zaibaq
- Department of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Praveen Guturu
- Department of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Sreeram Parupudi
- Department of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, Texas, USA
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Guo C, Wu J, He H, Liu H, Wang Y, Wei N, Wang C, Lin W, Su H. Evaluation of the medical economics and safety: two methods for the endoscopic removal of jujube pits. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 111:209-213. [PMID: 30449119 DOI: 10.17235/reed.2018.5794/2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE to evaluate the medical economics and safety of two methods for the endoscopic removal of jujube pits, one with a transparent cap combined with a stone basket and the other with a transparent cap combined with foreign body forceps. METHODS consecutive patients with a suspected jujube pit ingestion in the esophagus between January 2008 and December 2017 were enrolled into the study. Fifty-three patients who met the criteria were divided into two groups. Group A patients were treated by a transparent cap combined with a stone basket and group B patients were treated by a transparent cap combined with foreign body forceps. The following clinical data were collected: age, sex, location of jujube pits, complications, operation time, extraction success and average hospital costs. RESULTS a total of 53 patients who met the criteria were enrolled into the study; 29 cases in group A and 24 cases in group B. Endoscopic removal was successful in 98.1% (52/53) of the patients and the remaining 1.9% (1/53) required surgery. Severe complications were less frequent in group A than in group B (p = 0.017). Surgery time was not significantly different between the two groups (p = 0.647). The extraction success in group A was higher than in group B (p = 0.001). The medical costs including the total cost, inspection, treatment, radiation and drug cost were not significantly different between the two groups (p > 0.05 in all cases). CONCLUSION endoscopic baskets are suitable for cases of jujube pit ingestion and have a higher extraction success and a lower proportion of severe complications. Surgery time was not significantly extended and the medical costs did not increase.
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Affiliation(s)
- Chunmei Guo
- Gastroenterology, Beijing Shijitan Hospital, China
| | - Jing Wu
- Beijing Shijitan Hospital,Capital Medical University
| | - Haiyan He
- Beijing Institute of Space Mechanics and Electricity
| | - Hong Liu
- Beijing Shijitan Hospital, Capital Medical University
| | - Yadan Wang
- Beijing Shijitan Hospital, Capital Medical University
| | - Nan Wei
- Beijing Shijitan Hospital, Capital Medical University
| | - Canghai Wang
- Beijing Shijitan Hospital, Capital Medical University
| | - Wu Lin
- Beijing Shijitan Hospital, Capital Medical University
| | - Hui Su
- Beijing Shijitan Hospital, Capital Medical University
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50
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Ruan WS, Li YN, Feng MX, Lu YQ. Retrospective observational analysis of esophageal foreign bodies: a novel characterization based on shape. Sci Rep 2020; 10:4273. [PMID: 32144333 PMCID: PMC7060256 DOI: 10.1038/s41598-020-61207-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 02/24/2020] [Indexed: 11/09/2022] Open
Abstract
This single-center retrospective study aims to investigate the clinical features of esophageal foreign bodies (EFBs) and determine the influence of EFB shapes on management and prognosis. A total of 427 patients aged 13 to 95 years with suspected EFB ingestion were enrolled between January 2013 and June 2018, 183 of whom were male. EFBs were divided into six shapes: pin (n = 161), sheet (n = 97), trident (n = 51), spindle (n = 66), irregular (n = 46), and sphere (n = 6). Spindle-shaped EFBs correlated with a significantly higher rate of perforation and severe complications (P < 0.001 and P = 0.021, respectively) than any other EFB shape, while sheet-shaped EFBs were linked to less severe complications (P = 0.006). The number of pressure points was provided to stratify the risk of poor prognosis for each shape. EFBs with only two pressure points (pin and spindle EFBs) required more advanced management strategies and were correlated with a higher number of patients suffering esophageal perforation (27.11%) and severe complications (12.44%) when compared with other shapes (χ2 = 11.149 and P = 0.001; χ2 = 5.901 and P = 0.015, respectively). Spindle shape was an independent risk factor for poor prognosis, and contributed a more clinical risk than the pin shape. In conclusion, clinical features, management, perforation rate, and severe complications differed based on EFB shape. The EFBs with two pressure points, especially the spindle-shaped EFBs, were more dangerous compared with those with more pressure points.
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Affiliation(s)
- Wei-Shuyi Ruan
- Department of Emergency Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China.,Department of Geriatric Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China.,Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Yu-Ning Li
- School of Mathematical Sciences, Zhejiang University, Hangzhou, 310058, Zhejiang, People's Republic of China
| | - Meng-Xiao Feng
- Department of Emergency Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China.,Department of Geriatric Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China.,Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Yuan-Qiang Lu
- Department of Emergency Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China. .,Department of Geriatric Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China. .,Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China.
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