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Gandagule RR, Korde S, Masih A, Saini N. Accidental Aspiration of an Implant Driver Into the Right Bronchus During Implant Surgery. Cureus 2025; 17:e80955. [PMID: 40255851 PMCID: PMC12009604 DOI: 10.7759/cureus.80955] [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: 03/21/2025] [Indexed: 04/22/2025] Open
Abstract
Accidental aspiration of dental instruments during implant surgery is a rare yet serious complication that demands immediate attention. This report presents a case involving a 67-year-old male who accidentally aspirated an implant driver during the placement of mandibular implants. Despite the absence of immediate symptoms such as coughing, choking, or wheezing, radiographic evaluation was crucial in identifying the foreign object. Thoracic and spinal X-rays, followed by computed tomography scans, confirmed its location in the right main bronchus. A thoracic surgeon successfully removed the implant driver using a rigid fiber-optic bronchoscope under general anesthesia. Postoperative care included monitoring in the intensive care unit with nebulization, antibiotics, and corticosteroids to prevent complications. This case highlights the importance of rapid diagnosis and intervention in such emergencies while emphasizing the need for preventive measures to mitigate aspiration risks during dental procedures.
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Affiliation(s)
- Ranjeet R Gandagule
- Department of Prosthodontics and Crown and Bridge, Dr. Hedgewar Smruti Rugna Seva Mandal's Dental College and Hospital, Hingoli, IND
| | - Sayali Korde
- Department of Prosthodontics and Crown and Bridge, Sinhgad Dental College and Hospital, Pune, IND
| | - Abhilasha Masih
- Department of Prosthodontics and Crown and Bridge, Dr. Hedgewar Smruti Rugna Seva Mandal's Dental College and Hospital, Hingoli, IND
| | - Nikita Saini
- Department of Pedodontics and Preventive Dentistry, Hitkarini Dental College and Hospital, Jabalpur, IND
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2
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Kammoun N, Guelbi M, Trabelsi MM, Bouasker I, Jerraya H, Nouira R. Abdominal foreign body migration causing cardiac tamponade: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241287380. [PMID: 39380883 PMCID: PMC11459493 DOI: 10.1177/2050313x241287380] [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: 05/14/2024] [Accepted: 08/22/2024] [Indexed: 10/10/2024] Open
Abstract
Chronic asymptomatic retention of an intragastric foreign body can pose a life-threatening scenario. In the event of migration, it may result in perforation, as shown in our unique case of pericardial perforation through the fundus. Beyond illustrating a rare condition, this case prompts us to engage in a debate about whether to retain or remove asymptomatic foreign bodies in the gastrointestinal tract. It is a 28-year-old male patient, a prisoner, with a history of recurrent foreign body ingestion leading to five previous interventions, presented a year ago to our emergency department after ingesting four metal rods. Despite recommendations, the patient refused the intervention. After 1 year, he presented to our emergency department for respiratory distress. On examination, he had tachycardia, cardiac auscultation revealed a high-pitched sound signing a pericardial knock and abdominal palpation revealed epigastric tenderness. An abdominal X-ray revealed the presence of metallic foreign bodies located in the gastric area. An electrocardiogram showed a low voltage. Given these findings, there was a strong suspicion of rod migration from the stomach to the thoracic cavity with a cardiac tamponade. An emergency CT scan revealed that the rod had pierced through the stomach and pericardium, causing pericardial effusion. The patient was promptly transported to the operating room to discover the tip of the rod out of the stomach and penetrating the left diaphragm and the pericardial layer. The foreign body was removed.
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Affiliation(s)
- Neirouz Kammoun
- Department B of Surgery, Charles Nicolle Hospital, Tunis, Tunisia
| | - Mohamed Guelbi
- Department B of Surgery, Charles Nicolle Hospital, Tunis, Tunisia
| | | | | | - Hichem Jerraya
- Department B of Surgery, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ramzi Nouira
- Department B of Surgery, Charles Nicolle Hospital, Tunis, Tunisia
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Jallouli M, Zoriquat EN, Kamel TB. Flexible Endoscopic Management of Tracheo-oesophageal Magnet Foreign Bodies with Acquired Fistula in a Toddler. Afr J Paediatr Surg 2024:01434821-990000000-00021. [PMID: 39316033 DOI: 10.4103/ajps.ajps_50_23] [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] [Received: 04/11/2023] [Accepted: 10/23/2023] [Indexed: 09/25/2024] Open
Abstract
ABSTRACT Aerodigestive foreign bodies (FBs) aspiration is a common problem in children; however, simultaneous aerodigestive localisation is rare. Ingestion of multiple magnetic FBs can lead to serious complications, especially tracheo-oesophageal fistula and recurrent chest infections. These depend on the duration of foreign-body ingestion/aspiration, prompt intervention and adequate technique for foreign-body retrieval. A 1.8-year-old female child was found to have two magnetic FBs lodged simultaneously in the oesophagus and trachea. The magnetic FBs in the aerodigestive tract in children were removed in the same session using flexible endoscopes.
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Affiliation(s)
- Mohamed Jallouli
- Department of General Surgery, Pediatric Surgery Unit, Mouwasat Hospital Dammam, Saudi Arabia
- Sfax Medical School, Sfax University, Sfax, Tunisia
| | - Ehab Nicolas Zoriquat
- Department of Pediatric, Pediatric Gastroenterology Unit, Mouwasat Hospital, Dammam, Saudi Arabia
| | - Terez Boshra Kamel
- Department of Pediatric, Pediatric Pulmonology Unit, Mouwasat Hospital, Dammam, Saudi Arabia
- Ain Shams University, Cairo, Egypt
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Syamal MN. Adult Esophageal Foreign Bodies. Otolaryngol Clin North Am 2024; 57:609-621. [PMID: 38350826 DOI: 10.1016/j.otc.2024.01.003] [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] [Indexed: 02/15/2024]
Abstract
This manuscript reviews and outlines the necessary tools to efficiently assess and manage an adult patient where an esophageal foreign body is suspected. It reviews the vulnerable populations and relevant diagnostics and provides a triage diagram to aid in timely intervention. Management with esophagoscopy is reviewed as well as potential complications that may arise. Lastly, to illustrate the concepts of this section, a case study is presented to highlight the salient points.
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Affiliation(s)
- Mausumi Natalie Syamal
- Laryngology, Department of Otorhinolaryngology, Division of Laryngology, Rush University Medical Center, 1611 West Harrison Street, Suite 550, Chicago, IL 60612, USA.
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Quitadamo P, Pascarella A, Gragnaniello P, Isoldi S, Bucci C, Turco R, Puoti MG, Furio S, Caldore M, Di Nardo G. Esophageal food bolus impaction in pediatric age. J Pediatr Gastroenterol Nutr 2024; 78:1398-1402. [PMID: 38623937 DOI: 10.1002/jpn3.12222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVES Esophageal food impaction (EFI) is the sudden onset of dysphagia that occurs when a food bolus becomes lodged in the esophagus, requiring endoscopic removal. Scientific data on the prevalence and causes of EFI in children is lacking. The aim of this study was to provide further insights into EFI episodes in children. METHODS We have prospectively enrolled all children admitted for a first episode of EFI between March 2018 and March 2023. A fluoroscopic contrast study was performed in all patients to confirm the boluses and assess their position. Boluses were extracted by esophagogastroduodenoscopies, and esophageal biopsies were routinely obtained for histologic evaluation. RESULTS Over the study period, 41 children were admitted for a first episode of food impaction. Drooling was the most commonly reported symptom. Half children experiencing a first episode of food bolus were diagnosed with EoE (20/41, 48.8%). Almost a fourth of the episodes subtended a different condition, such as esophageal anastomotic, peptic or congenital strictures, stricturing caustic esophagitis, esophageal duplication, and achalasia. In the last fourth of patients the cause of EFI was not identified and thus probably related to quick eating and inadequate chewing of food. DISCUSSION Our study represents the largest known series of pediatric patients evaluated for food bolus impaction. Our main finding is the high frequency of EoE, which accounts for a half of EFI episodes in pediatric age, especially in older children. This finding highlights the importance of obtaining esophageal biopsies after the endoscopic bolus removal in children with EFI to provide a complete diagnostic evaluation.
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Affiliation(s)
- Paolo Quitadamo
- Pediatric Gastroenterology and Epatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Antonia Pascarella
- Pediatric Department, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Piergiorgio Gragnaniello
- Department of Translational Medical Science, Section of Pediatrics, University "Federico II", Naples, Italy
| | - Sara Isoldi
- Pediatric Gastroenterology and Epatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Cristina Bucci
- Pediatric Gastroenterology and Epatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Rossella Turco
- Pediatric Gastroenterology and Epatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Maria Giovanna Puoti
- Pediatric Gastroenterology and Epatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Silvia Furio
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Mariano Caldore
- Pediatric Gastroenterology and Epatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Giovanni Di Nardo
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy
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Karad A, Dandi K, Banerjee D, Dahale AS, Bade Y. Accidental Toothbrush Ingestion. Cureus 2024; 16:e62955. [PMID: 39050279 PMCID: PMC11265967 DOI: 10.7759/cureus.62955] [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] [Received: 05/31/2024] [Accepted: 06/23/2024] [Indexed: 07/27/2024] Open
Abstract
The accidental ingestion of a toothbrush is an extremely rare occurrence, typically involving young women with psychiatric disorders such as schizophrenia, bulimia, or anorexia nervosa. There are no known cases of a swallowed toothbrush being expelled naturally through the rectum. Therefore, prompt extraction of an ingested toothbrush from the gastrointestinal tract using a surgical or endoscopic method is a necessity. Here, we report a case of a psychologically healthy woman ingesting a toothbrush accidentally while cleaning her tongue with the back of the toothbrush. In our report, we document the successful extraction of a toothbrush from the esophagus endoscopically without any complications.
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Affiliation(s)
- Abhijeet Karad
- Department of Gastroenterology and Hepatology, Dr. D.Y. Patil Vidyapeeth, Pune, IND
| | - Kranthi Dandi
- Department of Gastroenterology and Hepatology, Dr. D.Y. Patil Vidyapeeth, Pune, IND
| | - Debabrata Banerjee
- Department of Gastroenterology and Hepatology, Dr. D.Y. Patil Vidyapeeth, Pune, IND
| | - Amol S Dahale
- Department of Gastroenterology and Hepatology, Dr. D.Y. Patil Vidyapeeth, Pune, IND
| | - Yogesh Bade
- Department of Gastroenterology and Hepatology, Dr. D.Y. Patil Vidyapeeth, Pune, IND
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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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Kaplan TT, Çakır RC, Çöpelci Y, Öner OZ, Koşar MN. Non-Accidental Foreign Body Ingestion Among Prisoners in Turkey. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03605-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Delayed Endoscopic Management of Esophageal Sharp-Pointed Food Impaction: An Analysis of 829 Cases in China. Dig Dis Sci 2022; 67:3166-3176. [PMID: 34342753 DOI: 10.1007/s10620-021-07133-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/20/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Esophageal foreign body impaction is the most common cause of endoscopic emergency. However, there are limited available data on delayed endoscopic management of esophageal sharp-pointed food impaction. AIMS To investigate cases of esophageal sharp-pointed food impaction with endoscopic removal findings. METHODS This single-center retrospective study collected medical records to identify patients with esophageal sharp-pointed food impaction who underwent endoscopic removal between April 2018 and April 2020. The patients were divided into the early (endoscopic removal <12 h) and delayed intervention (>12 h) cohorts. RESULTS Overall, 133 and 696 patients received early and delayed intervention, respectively. The success rate of endoscopic foreign body removal was 96.45%. The most common foreign body was fish bone (66.90%), and the most common shape was "I" (56.26%). Patients from the delayed intervention cohort received general anesthesia with a higher risk for perforation, and no foreign body was identified. The duration of endoscopy, distance between the foreign body/wound and the incisor, and longest diameter of the foreign body were not different between the groups. In multivariate analysis, male sex (odds ratio = 1.792 [1.159, 2.771]; P = 0.009), longer duration of impaction (odds ratio = 2.212 [1.121, 4.365]; P = 0.022) and endoscopy (odds ratio = 1.502 [1.253, 1.800]; P < 0.001), and longest diameter of the foreign body (odds ratio = 1.632 [1.329, 2.003]; P < 0.001) were associated with a higher incidence of perforation in patients with foreign body impaction. CONCLUSIONS Endoscopic removal is a safe and effective treatment method for sharp-pointed food impaction. Delayed endoscopic removal can increase the risk of esophageal perforation.
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10
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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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11
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Tavallaei M, Bahadorinia M, Haj Mohamad Ebrahim Ketabforoush A. Intentional Ingestion of a Metallic Wire Causing Perforation and Retroperitoneal Abscess: A Case Report. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2021; 14:11795476211025919. [PMID: 34262387 PMCID: PMC8252360 DOI: 10.1177/11795476211025919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/30/2021] [Indexed: 12/11/2022]
Abstract
Foreign body ingestion is a frequent condition, with the majority of foreign bodies (FBs) tending to spontaneously proceed along the gastrointestinal tract without any major complications. A wide range of procedures are available to remove FBs; however, a real challenge exists in managing sharp, rigid, and long foreign objects, which are related to higher rates of complications. A 34-year-old man who intentionally swallowed a metallic wire of 20 cm length, presented to our ED with abdominal pain 2 weeks after the ingestion. The FB had migrated to the stomach and duodenum. Complications included perforation of the duodenum and ascending colon and a retroperitoneal abscess. FB removal was done via laparotomy, followed by the repair of perforations and damaged tissues. This case highlights the complications of a FB presence in the gastrointestinal tract for 14 days and emphasizes the importance of urgent and appropriate management of such conditions.
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Affiliation(s)
- Mehdi Tavallaei
- Department of Surgery, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Mahsa Bahadorinia
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
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Langham J, Sulton C, Holmes S. A 3-Year-Old Male Presenting With Sore Throat and Torticollis. Glob Pediatr Health 2020; 7:2333794X20953304. [PMID: 33062807 PMCID: PMC7536469 DOI: 10.1177/2333794x20953304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Carmen Sulton
- Emory University School of Medicine, Atlanta, GA, USA
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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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Limpias Kamiya KJL, Hosoe N, Takabayashi K, Hayashi Y, Sun X, Miyanaga R, Fukuhara K, Fukuhara S, Naganuma M, Nakayama A, Kato M, Maehata T, Nakamura R, Ueno K, Sasaki J, Kitagawa Y, Yahagi N, Ogata H, Kanai T. Endoscopic removal of foreign bodies: A retrospective study in Japan. World J Gastrointest Endosc 2020; 12:33-41. [PMID: 31942232 PMCID: PMC6939123 DOI: 10.4253/wjge.v12.i1.33] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/09/2019] [Accepted: 11/18/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The ingestion of foreign bodies (FBs) and food bolus impaction (FBI) in the digestive tract are commonly encountered clinical problems. Methods to handle such problems continue to evolve offering advantages, such as the avoidance of surgery, reduced cost, improved visualization, reduced morbidity, and high removal success rate. However, to date, no studies have evaluated the endoscopic management of FBs in Japan. AIM To elucidate level of safety and efficacy in the endoscopic management of FBs and FBI. METHODS A total of 215 procedures were performed at Keio University Hospital between November 2007 and August 2018. Data were collected from medical charts, and endoscopic details were collected from an endoscopic reporting system. Procedures performed with a flexible gastrointestinal endoscope were only taken into account. Patients who underwent a technique involving FB or FBI from the digestive tract were only included. Data on patient sex, patient age, outpatient, inpatient, FB type, FB location, procedure time, procedure type, removal device type, success, and technical complications were reviewed and analyzed retrospectively. RESULTS Among the 215 procedures, 136 (63.3%) were performed in old adults (≥ 60 years), 180 (83.7%) procedures were performed in outpatients. The most common type of FBs were press-through-pack (PTP) medications [72 (33.5%) cases], FBI [47 (21.9%)], Anisakis parasite (AP) [41 (19.1%) cases]. Most FBs were located in the esophagus [130 (60.5%) cases] followed by the stomach [68 (31.6%) cases]. AP was commonly found in the stomach [39 (57.4%) cases], and it was removed using biopsy forceps in 97.5% of the cases. The most common FBs according to anatomical location were PTP medications (40%) and dental prostheses (DP) (40%) in the laryngopharynx, PTP (48.5%) in the esophagus, AP (57.4%) in the stomach, DP (37.5%) in the small intestine and video capsule endoscopy device (75%) in the colon. A transparent cap with grasping forceps was the most commonly used device [82 (38.1%) cases]. The success rate of the procedure was 100%, and complication were observed in only one case (0.5%). CONCLUSION Endoscopic management of FBs and FBI in our Hospital is extremely safe and effective.
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Affiliation(s)
- Kenji JL Limpias Kamiya
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Kaoru Takabayashi
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Yukie Hayashi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Xi Sun
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo 160-8582, Japan
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - Ryoichi Miyanaga
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Kayoko Fukuhara
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Seiichiro Fukuhara
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Makoto Naganuma
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Atsushi Nakayama
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Motohiko Kato
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Tadateru Maehata
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Rieko Nakamura
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Koichi Ueno
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Naohisa Yahagi
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Haruhiko Ogata
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
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15
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Oka A, Ishihara S, Mikami H, Sonoyama H, Mishiro T, Tobita H, Kawashima K, Miyake T, Ishimura N, Furuta K, Kinoshita Y, Nishina M. Retained Rice Cake: A Unique Upper Gastrointestinal Foreign Body: Case Report and a Literature Review. Intern Med 2019; 58:2485-2494. [PMID: 31178509 PMCID: PMC6761341 DOI: 10.2169/internalmedicine.2760-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/11/2019] [Indexed: 12/31/2022] Open
Abstract
As a rarely recognized foreign body in the upper gastrointestinal tract, rice cake frequently requires endoscopic removal. We herein report six patients with characteristic sonography, computed tomography (CT), spectroscopy, endoscopy, and histological findings. A review of all published cases, including ours, revealed that retained rice cake in the stomach typically shows the following: abdominal pain (93.3%), mucosal injury (93.3%) with bleeding (42.9%); high-density (120-206 Hounsfield units) CT findings; and indication for endoscopy (80%). In the esophagus, hot, toasted rice cake causes thermal injury. Primary physicians should be aware of this popular-food-induced, but rare, disorder.
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Affiliation(s)
- Akihiko Oka
- Department of Emergency and Critical Care Medicine, Shimane University, Faculty of Medicine, Japan
- Department of Internal Medicine II, Shimane University, Faculty of Medicine, Japan
- Center for Gastrointestinal Biology and Disease, Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, USA
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University, Faculty of Medicine, Japan
- Inflammatory Bowel Disease Center, Shimane University Hospital, Japan
| | - Hironobu Mikami
- Department of Internal Medicine II, Shimane University, Faculty of Medicine, Japan
- Division of Gastroenterology, National Hospital Organization Hamada Medical Center, Japan
| | - Hiroki Sonoyama
- Department of Internal Medicine II, Shimane University, Faculty of Medicine, Japan
| | - Tsuyoshi Mishiro
- Department of Internal Medicine II, Shimane University, Faculty of Medicine, Japan
- Division of Gastroenterology, National Hospital Organization Hamada Medical Center, Japan
| | - Hiroshi Tobita
- Department of Internal Medicine II, Shimane University, Faculty of Medicine, Japan
| | - Kousaku Kawashima
- Department of Internal Medicine II, Shimane University, Faculty of Medicine, Japan
- Inflammatory Bowel Disease Center, Shimane University Hospital, Japan
| | - Tatsuya Miyake
- Department of Internal Medicine II, Shimane University, Faculty of Medicine, Japan
- Division of Hepatology, Shimane Prefectural Central Hospital, Japan
| | - Norihisa Ishimura
- Department of Internal Medicine II, Shimane University, Faculty of Medicine, Japan
| | - Kenji Furuta
- Department of Internal Medicine II, Shimane University, Faculty of Medicine, Japan
- Otsu Internal Medicine Clinic, Japan
| | - Yoshikazu Kinoshita
- Department of Internal Medicine II, Shimane University, Faculty of Medicine, Japan
| | - Masayoshi Nishina
- Department of Emergency and Critical Care Medicine, Shimane University, Faculty of Medicine, Japan
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16
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Long B, Koyfman A, Gottlieb M. Esophageal Foreign Bodies and Obstruction in the Emergency Department Setting: An Evidence-Based Review. J Emerg Med 2019; 56:499-511. [PMID: 30910368 DOI: 10.1016/j.jemermed.2019.01.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/11/2019] [Accepted: 01/22/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with esophageal foreign bodies or food bolus impaction may present to the emergency department with symptoms ranging from mild discomfort to severe distress. There is a dearth of emergency medicine-focused literature concerning these conditions. OBJECTIVE OF THE REVIEW This narrative review provides evidence-based recommendations for the assessment and management of patients with esophageal foreign bodies and food bolus impactions. DISCUSSION Esophageal foreign bodies and food bolus impaction are common but typically pass spontaneously; however, complete obstruction can lead to inability to tolerate secretions, airway compromise, and death. Pediatric patients are the most common population affected, while in adults, edentulous patients are at greatest risk. Foreign body obstruction and food bolus impaction typically occur at sites of narrowing due to underlying esophageal pathology. Diagnosis is based on history and examination, with most patients presenting with choking/gagging, vomiting, and dysphagia/odynophagia. The preferred test is a plain chest radiograph, although this is not required if the clinician suspects non-bony food bolus with no suspicion of perforation. Computed tomography is recommended if radiograph is limited or there are concerns for perforation. Management requires initial assessment of the patient's airway. Medications evaluated include effervescent agents, glucagon, calcium channel blockers, benzodiazepines, nitrates, and others, but their efficacy is poor. Before administration, shared decision making with the patient is recommended. Endoscopy is the intervention of choice, and medications should not delay endoscopy. Early endoscopy for complete obstruction is associated with improved outcomes. CONCLUSIONS This review provides evidence-based recommendations concerning these conditions, focusing on evaluation and management.
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Affiliation(s)
- Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois
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17
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Fung BM, Sweetser S, Wong Kee Song LM, Tabibian JH. Foreign object ingestion and esophageal food impaction: An update and review on endoscopic management. World J Gastrointest Endosc 2019; 11:174-192. [PMID: 30918584 PMCID: PMC6425280 DOI: 10.4253/wjge.v11.i3.174] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 03/08/2019] [Accepted: 03/11/2019] [Indexed: 02/06/2023] Open
Abstract
Foreign body ingestion encompasses both foreign object ingestion (FOI) and esophageal food impaction (EFI) and represents a common and clinically significant scenario among patients of all ages. The immediate risk to the patient ranges from negligible to life-threatening, depending on the ingested substance, its location, patient fitness, and time to appropriate therapy. This article reviews the FOI and EFI literature and highlights important considerations and implications for pediatric and adult patients as well as their providers. Where published literature is insufficient to provide evidence-based guidance, expert opinion is included to supplement the content of this comprehensive review.
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Affiliation(s)
- Brian M Fung
- UCLA-Olive View Internal Medicine Residency Program, Sylmar, CA 91342, United States
| | - Seth Sweetser
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
| | - Louis M Wong Kee Song
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
| | - James H Tabibian
- Division of Gastroenterology, Olive View-UCLA Medical Center, Sylmar, CA 91342, United States
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18
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Benson M, Pfau PR. Ingested Foreign Objects and Food Bolus Impactions. CLINICAL GASTROINTESTINAL ENDOSCOPY 2019:255-262.e2. [DOI: 10.1016/b978-0-323-41509-5.00022-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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19
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Kim BR, Kim HJ, Hahm JR, Ha CY, Jung WT, Lee OJ. A case of intra-abdominal abscess caused by unconsciously ingestion of fish bone in elderly patient. KOSIN MEDICAL JOURNAL 2018. [DOI: 10.7180/kmj.2018.33.3.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Cases showing complications such as esophageal injury, deep neck infection, and mediastinitis caused by accidental ingestion of fish bone are common. But ingestion of fish bone rarely causes perforation of the gastrointestinal tract or an intra-abdominal abscess. We report herein a case of a 78-year-old man with a periumbilical mesenteric abscess caused by fish bone which was ingested unconsciously. The fish bone was found in the terminal ileum and it was removed by colonoscopy. The patient improved and he was discharged after systemic antibiotic therapy. Occasionally, when patients swallow fish bone without a foreign body sensation, clinicians should suspect perforation caused by fish bone in case of an intra-abdominal abscess of unknown cause.
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20
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Lin AY, Tillman BN, Thatcher AL, Graves CR, Prince ME. Comparison of Outcomes in Medical Therapy vs Surgical Intervention of Esophageal Foreign Bodies. Otolaryngol Head Neck Surg 2018; 159:656-661. [PMID: 29865972 DOI: 10.1177/0194599818778277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objectives (1) Compare efficacy of primary medical therapy vs primary surgical intervention in patients with esophageal foreign bodies (EFBs). (2) Investigate variables that may predict successful outcomes in patients treated for EFBs. Study Design Case series with chart review. Setting Single-institution academic tertiary care medical center. Subjects and Methods Adult patients (older than 18 years) seen at the University of Michigan Emergency Department (ED) over an 8-year period with the diagnosis of EFBs (January 1, 2003, to December 31, 2011; N = 250). Decision was made by ED physicians whether to treat patients with first-line medical therapy vs surgical intervention. Pertinent clinical and demographic data were extracted from medical records and summarized by descriptive statistics. Results First-line treatment with surgical intervention (flexible or rigid esophagoscopy with foreign body removal) was much more likely to lead to resolution of symptoms than medical therapy (glucagon alone or in combination with other medical therapy) (98% vs 28%, P < .0001). When delivered within 12 hours of symptom onset, medical therapy was more likely to be successful (34% resolution vs 12% resolution, P < .01). There was no difference in complication rates for primary medical therapy vs surgical intervention (8% vs 8%). Conclusions Patients with EFBs are a commonly encountered consultation for both otolaryngologists and gastroenterologists. In these patients, first-line surgical intervention is superior to medical therapy and should not be avoided for a trial of medical therapy or concern for higher morbidity. Implementation of these findings has the ability to positively affect treatment patterns, outcomes, and patient quality of life.
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Affiliation(s)
- Austin Y Lin
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Michigan Hospitals, Ann Arbor, Michigan, USA.,2 Department of Internal Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Brittny N Tillman
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Michigan Hospitals, Ann Arbor, Michigan, USA.,3 Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Aaron L Thatcher
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Michigan Hospitals, Ann Arbor, Michigan, USA
| | - Casey R Graves
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Michigan Hospitals, Ann Arbor, Michigan, USA.,4 Department of Emergency Medicine, Palmetto Health, Columbia, South Carolina, USA
| | - Mark E Prince
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Michigan Hospitals, Ann Arbor, Michigan, USA
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Yeh HY, Chao HC, Chen SY, Chen CC, Lai MW. Analysis of Radiopaque Gastrointestinal Foreign Bodies Expelled by Spontaneous Passage in Children: A 15-Year Single-Center Study. Front Pediatr 2018; 6:172. [PMID: 29946536 PMCID: PMC6006757 DOI: 10.3389/fped.2018.00172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/24/2018] [Indexed: 12/20/2022] Open
Abstract
Background: Most ingested foreign bodies (FBs) pass spontaneously through the gastrointestinal (GI) tract, but only limited data on transit time are available. We evaluated the relationship of FB size and shape with transit time. Methods: We retrospectively reviewed medical records collected over 15 years (January 2001 to December 2015) on pediatric patients with radiopaque FBs in the GI tract. We categorized the FBs as regularly (round or spherical) or irregularly shaped (ovoid, long, flake-like, or projecting) and measured their sizes radiographically. The diameter of regularly shaped FBs and the length of irregularly shaped FBs were correlated with transit time. Results: In total, 484 patients with GI FBs were surveyed, and 267 (55.1%) FBs were radiopaque. Among the 267 radiopaque FBs, 88 (33.1%) required endoscopic removal and 7 (2.6%) underwent surgical intervention. Eighty-seven patients with single FBs in the GI tract for whom precise details of transit time were enrolled into the analysis of transit time; their mean age was 3.48 ± 2.21 years. Of the 87 FBs, 61 (70.1%) were regularly shaped, and 26 (29.9%) were irregularly shaped. The diameter of regularly shaped FBs was positively associated with transit time, as revealed by Mann-Whitney U test; diameters >1.5 and >2 cm were significantly correlated with longer transit times (both p = 0.003). A trend toward an increased transit time for long irregularly shaped FBs was also apparent; the p-values for lengths of 1.5, 2, and 2.5 cm were 0.824, 0.153, and 0.055, respectively. Under receiver operating characteristic (ROC) curve analysis, the optimal cutoff diameter for regularly shaped FBs, and length for irregularly shaped FBs, to predict a transit time of longer than 72 h were 1.95 and 2.25 cm, respectively. Conclusions: The passage rate of ingested radiopaque FBs is 64.4%. Small FBs that have passed the duodenal curve should be managed conservatively via clinical observation and radiographic surveillance. Our results indicate that the larger an FB is, the longer the transit time will be.
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Affiliation(s)
- Hung-Yu Yeh
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsun-Chin Chao
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Yen Chen
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Chang Chen
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Wei Lai
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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22
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Binvel M, Poujol L, Peyron C, Dunie-Merigot A, Bernardin F. Endoscopic and surgical removal of oesophageal and gastric fishhook foreign bodies in 33 animals. J Small Anim Pract 2017; 59:45-49. [PMID: 29194670 DOI: 10.1111/jsap.12794] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 09/03/2017] [Accepted: 09/19/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe the location, retrieval, frequency of surgery and complications associated with fishhook foreign bodies. MATERIALS AND METHODS Retrospective evaluation of the medical records of cats and dogs admitted between 2010 and 2016 after fishhook ingestion. RESULTS A total of 33 cases (2 cats and 31 dogs) were included. The most common locations were the proximal oesophagus [12/33 (36%)] and stomach [11/33 (33%)]. Endoscopic retrieval was successful in 27 of 33 cases (82%); oesophageal perforation was the only recorded complication, occurring in six of 33 (18%) cases. Surgery was performed in six cases (18%), and no early complications were recorded. The survival rate was 100%. CLINICAL SIGNIFICANCE The endoscopic removal of ingested fishhooks is highly successful. In the present study, survival to discharge was 100%, even in cases of oesophageal perforation or in cases requiring surgery.
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Affiliation(s)
- M Binvel
- Department of Clinical Sciences, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, QC J2S 2M2, Canada
| | - L Poujol
- Department of Internal Medicine, Clinique Languedocia, 34080, Montpellier, France
| | - C Peyron
- Department of Internal Medicine, Clinique Languedocia, 34080, Montpellier, France
| | - A Dunie-Merigot
- Department of Surgery, Clinique Languedocia, 34080, Montpellier, France
| | - F Bernardin
- Department of Internal Medicine, Clinique Languedocia, 34080, Montpellier, France
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23
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Vats M, Ramasamy S, Neogi S, Tudu SK. Ingestion of nine metallic nails with corrosive: what happened next? BMJ Case Rep 2017; 2017:bcr-2017-222338. [PMID: 29167219 DOI: 10.1136/bcr-2017-222338] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
A 20-year-old woman was brought to the surgery emergency department with the complaint of epigastric pain since 1 day following ingestion of multiple metallic nails with a cup full of toilet cleaner (corrosive acid) with a suicidal intention. Physical examination was essentially unremarkable, and the abdomen showed no signs of perforation peritonitis. X-rays of the abdomen showed multiple 'nail'-like radiopaque shadows in the abdominal cavity with no evidence of free gas under the domes of the diaphragm. A non-operative expectant management was pursued. The patient had passed all the sharps in stools without any complication and was discharged after 12 days. After 3 weeks, the patient presented with non-bilious vomiting. Further investigations revealed pyloric stenosis with no oesophageal luminal stenosis. To bypass the pyloric stenosis, a Billroth II gastrojejunostomy was performed. The postoperative period was uneventful, and the recovery was smooth.
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Affiliation(s)
- Manu Vats
- General Surgery, Maulana Azad Medical College, New Delhi, India
| | | | - Sushanto Neogi
- General Surgery, Maulana Azad Medical College, New Delhi, India
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24
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Abstract
Esophageal perforation (EP) is a rare complication that is often iatrogenic in origin. In contrast with adult patients in whom surgical closure of the defect is preferred, nonoperative treatment has become a common therapeutic approach for EP in neonates and children. Principles of management pediatric EP includes rapid diagnosis, appropriate hemodynamic monitoring and support, antibiotic therapy, total parenteral nutrition, control of extraluminal contamination, and restoration of luminal integrity either through time or operative approaches.
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Affiliation(s)
- Rebecca M Rentea
- Deparment of Surgery, Children׳s Mercy Hospital, 2401 Gillham Rd, Kansas City, Missouri 64108
| | - Shawn D St Peter
- Deparment of Surgery, Children׳s Mercy Hospital, 2401 Gillham Rd, Kansas City, Missouri 64108.
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25
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26
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Abstract
This study aims to demonstrate the safety and feasibility of laparoscopic management of complicated foreign body (FB) ingestion in a series of 5 patients. We present the merits of a minimally-invasive approach in this clinical setting from our series as well as published case reports. FB ingestion is occasionally complicated by abscess formation or perforation, requiring surgical intervention. Anecdotal reports of such cases managed by laparoscopic surgery have alluded to its merits over the conventional approach of open surgery. Over an 18-month period, 5 of 256 patients with FB ingestion at our unit were managed by laparoscopic surgery. Clinical and operative data were collected for this study. In all 5 cases, patients could not recall their FB ingestion and had normal plain radiographs. The diagnosis was made on a computed tomography (CT) scan. Laparoscopy was successfully employed to retrieve all FBs (fish bones), deroof abscesses, and primarily repair gastrointestinal perforations. The mean operative time was 69 minutes (55-85), utilizing 2 to 4 noncamera ports. There was no operative mortality and patients were discharged on average postoperative day (POD) 5 (2-8). Laparoscopic surgery is safe and feasible in small-diameter, complicated FB ingestion requiring surgical intervention and should be considered in similar patients.
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27
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Swallowed and aspirated dental prostheses and instruments in clinical dental practice: a report of five cases and a proposed management algorithm. J Am Dent Assoc 2016; 145:459-63. [PMID: 24789239 DOI: 10.14219/jada.2013.55] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Accidental swallowing or aspiration of dental instruments and prostheses is a complication of dental procedures. Failure to manage these complications appropriately can lead to significant morbidity and possibly death. CASE DESCRIPTION The authors present three cases of accidental swallowing of dental instruments during procedures and two cases of aspiration, one during a procedure and one long after the procedure. Although three of these five cases of foreign-body aspiration or ingestion were caught early and the patients were referred for endoscopic retrieval, two patients experienced prolonged symptoms that affected their quality of life before intervention occurred. Practical Implications The authors reviewed the literature and propose an evidence-based algorithm for management of such complications. Adherence to the proposed algorithm may decrease morbidity and mortality and improve patient outcomes.
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28
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Almuallem S, Yousef YAM, Suhail A. Unusual presentation of a retained foreign body in a child. BMJ Case Rep 2015; 2015:bcr-2015-210997. [PMID: 26542687 DOI: 10.1136/bcr-2015-210997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 4-year-old boy, not known to have any medical illness, presented to several medical facilities reporting right upper quadrant and right flank pain, intermittent fever and chills for 3 months. A CT of the abdomen showed that a swallowed 'bobby pin' had pierced through the right kidney. This finding explained the boy's symptoms. The pin was removed by laparotomy without any subsequent complication. The patient had an uneventful postoperative recovery.
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Affiliation(s)
- Sultan Almuallem
- Department of Surgery KAMC-JD, National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Yasmin A M Yousef
- Department of surgery, Pediatric surgery section, KAMC-JD, KSAU-HS (COM-J) National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Abdulmalik Suhail
- Department of surgery, Pediatric surgery section, KAMC-JD, National Guard Health Affairs, Jeddah, Saudi Arabia
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29
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Pugmire BS, Lim R, Avery LL. Review of Ingested and Aspirated Foreign Bodies in Children and Their Clinical Significance for Radiologists. Radiographics 2015; 35:1528-38. [PMID: 26295734 DOI: 10.1148/rg.2015140287] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ingested and aspirated foreign bodies are a common occurrence in children and are important causes of morbidity and mortality in the pediatric population. Imaging plays an important role in the diagnosis of ingested and aspirated foreign bodies in children and can be crucial to guiding the clinical management of these patients. Prompt identification and localization of ingested foreign bodies is essential to determining the appropriate treatment, as several types of commonly ingested foreign bodies require urgent removal and others can be managed conservatively. In particular, disk batteries impacted in the esophagus carry a high risk of esophageal injury or perforation; multiple ingested magnets can become attracted to each other across bowel walls and cause bowel perforation and fistula formation; and sharp objects commonly cause complications as they pass through the gastrointestinal tract. Accordingly, these ingested foreign bodies warrant aggressive clinical management and therefore radiologists must be familiar with their imaging appearances and clinical implications. Prompt recognition of secondary radiographic signs of foreign-body aspiration is also crucial, as clinical symptoms can sometimes be nonspecific and most aspirated foreign bodies are radiolucent. Overall, radiography is the most important modality in the evaluation of ingested or aspirated foreign bodies; however, fluoroscopy and computed tomography play an ancillary role in complicated cases. It is essential that every radiologist who interprets imaging examinations of children be aware of the imaging appearances of commonly ingested and aspirated foreign bodies and their clinical significance.
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Affiliation(s)
- Brian S Pugmire
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229 (B.S.P.) and the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, Mass (R.L., L.L.A.)
| | - Ruth Lim
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229 (B.S.P.) and the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, Mass (R.L., L.L.A.)
| | - Laura L Avery
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229 (B.S.P.) and the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, Mass (R.L., L.L.A.)
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Analysis of Clinical Feature and Management of Fish Bone Ingestion of Upper Gastrointestinal Tract. Clin Exp Otorhinolaryngol 2015; 8:261-7. [PMID: 26330922 PMCID: PMC4553358 DOI: 10.3342/ceo.2015.8.3.261] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 03/23/2014] [Accepted: 03/26/2014] [Indexed: 12/17/2022] Open
Abstract
Objectives Fish bone impaction in the upper gastrointestinal tract is a common reason for patients to seek emergent care. The aim of this study was to find a clinical characteristics of patients with fish bone impaction in the upper gastrointestinal tract. Methods The study was conducted on 286 fish bone ingestion patients who complained of dysphagia and irritation after eating fish. The patients were treated according to the hospital protocol regarding the removal of fish bone. The parameters for the analysis included the age and sex of the patients, location and characteristics of the foreign body, method of removal, and type of fish. Results The fish bone could be observed by the physical examination in the oral cavity and laryngopharynx in 198 patients (69.23%). For those patients in whom the foreign body could not be observed in oral cavity and laryngopharynx, noncontrast computed tomography (CT) (from nasopharynx to diaphragm) was performed. The fish bone was discovered in the esophagus of 66 patients (23.08%). The esophageal fish bone was successfully removed by transnasal flexible esophagoscopy (TNE) in 55 patients, the fish bone moved to the stomach in 10 patients and one fish bone was removed by rigid esophagoscopy due to esophageal abscess. The esophageal fish bone was mostly found in patients aged 50 years and older. Conclusion Fish bone foreign body ingestion in the esophagus appeared to be more common in older patients. Incorporating noncontrast CT and TNE can facilitate decision-making and adequate treatment for patients with fish bone impactions.
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Endoscopic Management of Foreign Bodies in the Upper Gastrointestinal Tract of Adults. BIOMED RESEARCH INTERNATIONAL 2015; 2015:658602. [PMID: 26258140 PMCID: PMC4518178 DOI: 10.1155/2015/658602] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 06/28/2015] [Accepted: 07/06/2015] [Indexed: 12/12/2022]
Abstract
Background. Foreign object ingestion and food bolus impaction are a common clinical problem. We report our clinical experiences in endoscopic management for adults, foreign body ingestion, and food bolus impaction. Method. A retrospective chart review study was conducted on adult patients with foreign body ingestion and food bolus impaction between January 2011 and November 2014. Patients with incomplete medical records were excluded. Results. A total of 198 patients (226 incidents) were included in the study (male/female: 1.54/1; age 57 ± 16 years). Among them, 168 foreign bodies were found successfully (74.3%). 75.6% of the foreign bodies were located in the esophagus. Food bolus impaction was most common (41.6%). 93.5% of foreign bodies in current study cohort were successfully extracted and 5 patients required surgical interventions. Comparisons between symptomatic and asymptomatic patients revealed that locations of foreign bodies in the pharynx and esophagus were the significant relevant factors (P < 0.001). Shorter time taken to initiate endoscopic interventions increased detection rate (289.75 ± 465.94 versus 471.06 ± 659.93 minutes, P = 0.028). Conclusion. Endoscopic management is a safe and highly effective procedure in extracting foreign body ingestion and food bolus impaction. Prompt endoscopic interventions can increase the chance of successful foreign bodies' detection.
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Endoscopic foreign body removal in the upper gastrointestinal tract: risk factors predicting conversion to surgery. Surg Endosc 2015; 30:106-13. [PMID: 25805240 DOI: 10.1007/s00464-015-4167-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 03/02/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND/AIMS Most foreign bodies of the upper gastrointestinal tract (UGIT) are successfully removed by endoscopic techniques without complications. However, some require conversion to surgery due to failure of endoscopic removal. The aim of this study was to analyze the risk factors predicting the need to convert to surgery after inability to endoscopically remove the foreign body. PATIENTS AND METHODS The medical records of 885 patients treated between January 2006 and March 2014 for suspected foreign bodies in the UGIT were retrospectively reviewed. Patient characteristics, the type of foreign bodies, clinical outcomes, and risk factors predicting the conversion to surgery were analyzed. RESULTS While endoscopic removal was successful in 94.7% (665/702) of the patients, the remaining 5.3% (37/702) needed conversion to surgery. There were no procedure-related deaths. According to the multivariate logistic regression analyses, older age (>70 years, p = 0.004), location (upper esophagus, p = 0.001), larger size (maximal diameter > 30 mm, p = 0.005), and longer impaction time (>40 h, p < 0.001) were significant risk factors predicting conversion to surgery due to inability to remove the foreign body endoscopically. CONCLUSIONS Most of the foreign bodies in the UGIT were successfully removed by endoscopic techniques. However, surgical removal might need to be considered in patients with age >70 years, and those with foreign bodies in the upper esophagus, maximal diameter >30 mm, and impaction time >40 h, due to the possible high failure rate of endoscopic removal.
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Halleran DR, Karjoo M, Beg MBB, Seeherunvong T. Unrecognized foreign bodies in the gastrointestinal tract of developmentally delayed children: A case series. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Pratt CL, Reineke EL, Drobatz KJ. Sewing needle foreign body ingestion in dogs and cats: 65 cases (2000–2012). J Am Vet Med Assoc 2014; 245:302-8. [DOI: 10.2460/javma.245.3.302] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cho MK, Lee MS, Han HY, Woo SH. Fish bone migration to the urinary bladder after rectosigmoid colon perforation. World J Gastroenterol 2014; 20:7075-7078. [PMID: 24944504 PMCID: PMC4051954 DOI: 10.3748/wjg.v20.i22.7075] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 01/22/2014] [Accepted: 03/10/2014] [Indexed: 02/06/2023] Open
Abstract
Fish bones are the most common foreign objects leading to bowel perforation. Most cases are confined to the extraluminal space without penetration of an adjacent organ. However, abscess formation due to the perforation of the rectosigmoid colon by a fish bone can lead to the penetration of the urinary bladder and may subsequently cause the fish bone to migrate into the urinary bladder. In the presented case, a 42-year-old female was admitted for lower abdominal pain. The computed tomography (CT) demonstrated a 5cm pelvic abscess containing a thin and curvilinear foreign body. After conservative management, the patient was discharged. After 1 mo, the subject developed a mechanical ileus. Surgery had to be delayed due to her hyperthyroidism. Migration of the foreign body to the urinary bladder was shown on additional CT. A Yellowish fish bone 3.5 cm in size was removed through intra-operative cystoscopy. The patient was discharged 8 d after the operation without any unexpected event.
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Abstract
AbstractObjective:This study presents the incidence of denture impaction in the oesophagus, and discusses the difficulties of managing such cases.Method:A total of 262 patients with a history of foreign body ingestion (between 1999 and 2010) were reviewed; 46 of these patients had dentures impacted in the oesophagus.Results:The cervical section of the oesophagus was the commonest site of impaction. Dysphagia and tracheal tenderness were the most consistent features when dentures became impacted in the upper oesophagus. In most cases, rigid oesophagoscopy enabled successful removal of the impacted denture. Locating an impacted denture hidden within the oesophageal mucosal folds sometimes proved difficult.Conclusion:In cases of impacted dentures in the oesophagus, a positive history helps in the diagnosis, but a high degree of clinical suspicion aids early detection. Conventional radiographs are important but may not always be of assistance. Early intervention reduces complications. Dentures that are poorly maintained and old are more likely to be swallowed accidentally. The inclusion of radiopaque filler within dentures would assist localisation following accidental swallowing.
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Predictors of recurrent ingestion of gastrointestinal foreign bodies. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2014; 27:e1-4. [PMID: 23378983 DOI: 10.1155/2013/671273] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Gastrointestinal foreign bodies are commonly encountered; however, little knowledge exists as to the causes of foreign body ingestions and why they occur repeatedly in some patients. OBJECTIVE To identify and define patients at high risk for recurrent foreign body ingestion. METHODS A retrospective chart review of foreign body ingestion was conducted at a tertiary care medical centre over an 11-year period. Variables analyzed included age, sex, incarceration status, Diagnostic and Statistical Manual of Mental Disorders-IV diagnosis, success of endoscopy, type of sedation used, method of extraction, complications, presence of gastrointestinal pathology, and incidence of recurrent food impaction or foreign body. RESULTS A total of 159 patients with a foreign body ingestion were identified. One hundred fourteen (77%) experienced a single episode of ingestion and 45 (23%) experienced multiple ingestions. Of the patients with multiple ingestions, 27 (60%) had recurrent food impactions while 18 (40%) ingested foreign objects. In the recurrent ingestor group, a psychiatric disorder had been diagnosed in 16 patients (35.6%) and there were 13 incarcerated individuals (28.9%). The average number of recurrences was 2.6 per patient (117 total recurrences). Individuals with a psychiatric disorder experienced 3.9 recurrences per patient, while prisoners averaged 4.1 recurrences per patient. The combination of a psychiatric disorder and being incarcerated was associated with the highest recurrence rate (4.33 per patient). Multivariable logistic regression revealed that male sex (OR 2.9; P=0.022), being incarcerated (OR 3.0; P=0.024) and the presence of a psychiatric disorder (OR 2.5; P=0.03) were risk factors for recurrent ingestion. CONCLUSION Risk factors for recurrent ingestion of foreign bodies were male sex, being incarcerated and the presence of a psychiatric disorder.
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Lee JS, Chun HJ, Lee JM, Hwang YJ, Kim SH, Kim ES, Jeen YT, Lee HJ. Salvage technique for endoscopic removal of a sharp fish bone impacted in the esophagus using a transparent cap and detachable snares. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2013; 61:215-8. [PMID: 23624736 DOI: 10.4166/kjg.2013.61.4.215] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
A sharp, impacted fish bone in the esophagus is an indication for urgent endoscopy. Endoscopic removal of such an object is a challenging task. An endoscopic protector hood is then used to remove the object. However, an endoscopic hood protector is not always available. In a patient with a large hiatal hernia, the protector hood may not return to the original shape when it passes through the gastroesophageal junction and therefore may not properly protect the esophageal mucosa from the sharp foreign body. In our case, it was impossible to deploy the endoscopic hood protector through the gastroesophageal junction despite multiple attempts. We propose an alternative solution for such cases. We safely removed a large sharp-edged flat fish bone that was folded and compressed using a detachable snare after releasing and pushing the fish bone into the stomach using an endoscope equipped with a transparent cap used for dilating the esophageal wall. This method of using an endoscopic cap and detachable snare is a safe, useful alternative for endoscopically removing a large sharp-edged flat foreign body from the upper gastrointestinal tract. This alternative technique has not been reported in the English medical literature.
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Affiliation(s)
- Jong Soo Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 136-705, Korea
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Fisher J, Mittal R, Hill S, Wulkan ML, Clifton MS. Yield of chest radiography after removal of esophageal foreign bodies. Pediatrics 2013; 131:e1497-501. [PMID: 23610210 DOI: 10.1542/peds.2012-3676] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The aim of this study was to determine the benefit of routine postoperative chest radiography after removal of esophageal foreign bodies in children. METHODS Medical records were reviewed of all patients evaluated with an esophageal foreign body at a single children's hospital over 10 years. Operative records and imaging reports were reviewed for evidence of esophageal injury. RESULTS Of 803 records identified, 690 were included. All underwent rigid esophagoscopy and foreign body removal. The most common items removed were coins (94%), food boluses (3%), and batteries (2%). The rate of esophageal injury was 1.3% (9 patients). No injuries were identified on chest radiographs done as routine or for concern of injury. Patients with operative findings suggestive of an esophageal injury (n = 105) were significantly more likely to have an injury (8.6% vs 0%, P = .0001). Of the 585 children who did not have physical evidence of injury, 40% (n = 235) received a routine chest radiograph. Regardless of the indication, no injuries were identified on chest films. CONCLUSIONS We conclude that intraoperative findings during rigid esophagoscopy suggestive of an injury are predictive of esophageal perforation. Routine chest radiography is not warranted in children who do not meet this criterion. In patients with a concern for injury, we suggest that chest radiography should be deferred in favor of esophagram.
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Affiliation(s)
- Jeremy Fisher
- Department of Surgery, Emory University School of Medicine/Children's Healthcare of Atlanta, Atlanta, GA 30322, USA
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Nassar E, Yacoub R, Raad D, Hallman J, Novak J. Foreign Body Endoscopy Experience of a University Based Hospital. Gastroenterology Res 2013; 6:4-9. [PMID: 27785219 PMCID: PMC5051113 DOI: 10.4021/gr517w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2013] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Guidelines support endoscopic removal of certain gastric FB and all FB lodged in the esophagus. We aim to report our experience on endoscopic foreign bodies (FB) removal in order to aid in the formation of future guidelines regarding this subject. METHODS Retrospective analysis of one hundred forty-four cases of FB removal involving 43 patients who underwent esophagogastroduodenoscopy (EGD) for FB removal from January 2005 through December 2010 in a university-based hospital. To evaluate to outcome of endoscopic FB removal, cost of procedures and complications. RESULTS Of all FB removal cases, 23 (53%) were males, with total mean age of 26.4 ± 11.3 years. Only 20% were performed on an outpatient bases. Abdominal x-ray was obtained to confirm ingestion of FB in 83%, and computed tomography scan was performed in 13%. Most procedures were performed in operation room (59%) while only 21% of the cases were performed in endoscopy lab. General anesthesia was used in 58%, while monitored anesthesia care in 28%. Average time to EGD was 17.14 hours. No major complications due to procedure were reported. Minor trauma and erosions due to FB were reported in 14%. FB extraction was unsuccessful in only three cases, and one case required surgical intervention. Cost of all procedures was over 430, 000 dollars with mean of 2,990 dollars for procedure. CONCLUSION Endoscopic retrieval is effective and safe procedure, but utilizes significant hospital resources.
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Affiliation(s)
- Eiad Nassar
- Department of Gastroenterology, State University of New York at Buffalo, NY, USA
| | - Rabi Yacoub
- Department of Medicine, State University of New York at Buffalo, NY, USA
| | - Dany Raad
- Department of Medicine, State University of New York at Buffalo, NY, USA
| | - Jason Hallman
- Department of Gastroenterology, State University of New York at Buffalo, NY, USA
| | - Jan Novak
- Department of Gastroenterology, State University of New York at Buffalo, NY, USA
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Park YK, Kim KO, Yang JH, Lee SH, Jang BI. Factors associated with development of complications after endoscopic foreign body removal. Saudi J Gastroenterol 2013; 19:230-4. [PMID: 24045597 PMCID: PMC3793475 DOI: 10.4103/1319-3767.118136] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND/AIMS We analyzed the clinical characteristics of patients who underwent endoscopic foreign body removal and the risk factors of complications. PATIENTS AND METHODS The medical records of 415 patients treated from January 2000 to August 2011 for suspected foreign bodies were retrospectively reviewed. Patient characteristics, endoscopic findings, clinical outcomes, and risk factors of complications were analyzed. RESULTS Foreign bodies were detected endoscopically in 315 patients. Fish bone fragment (36.9%) and coins (15.3%) were the most common type of foreign bodies in adults and children, respectively. Complications associated with endoscopic procedure occurred in 26 patients (8.3%); 20 of the patients were treated conservatively and the other six patients underwent surgical treatment. Perforation (14%) was the most common complication. By univariate and multivariate analysis, the risk factors associated with complication after endoscopic foreign body removal were long duration from ingestion to endoscopy ( P = 0.009) and existence of initial mucosal injury ( P = 0.018). CONCLUSIONS Most foreign bodies were successfully removed by endoscopy without complication, but long duration from ingestion to endoscopy and mucosal injury were risk factors of complications of endoscopic foreign body removal. Patients with these risk factors could require more careful treatment.
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Affiliation(s)
- Yu-Kyung Park
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Yeungnam University College of Medicine, Daegu, Korea
| | - Kyeong-Ok Kim
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Yeungnam University College of Medicine, Daegu, Korea,Address for correspondence: Dr. Kyeong Ok Kim, Department of Internal Medicine, Yeungnam University College of Medicine, 317-1, Daemyeong-dong, Nam-gu, Daegu 705-717, Korea. E-mail:
| | - Jae-Hong Yang
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Yeungnam University College of Medicine, Daegu, Korea
| | - Si-Hyung Lee
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Yeungnam University College of Medicine, Daegu, Korea
| | - Byung-Ik Jang
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Yeungnam University College of Medicine, Daegu, Korea
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Garment AR, Schwartz MB, Axsom KM. Foreign body-induced abscess resembling pancreatic neoplasia. J Gen Intern Med 2012; 27:1561-4. [PMID: 22539068 PMCID: PMC3475811 DOI: 10.1007/s11606-012-2064-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 12/19/2011] [Accepted: 03/07/2012] [Indexed: 10/28/2022]
Abstract
We report the case of a 44-year-old man presenting with abdominal pain and leukocytosis. His initial computed tomography demonstrated a pancreatic head mass concerning for pancreatic adenocarcinoma. However, on further review of the patient's imaging, the mass was determined to be an abscess caused by foreign body ingestion and gastric perforation rather than cancer. This report describes the clinical and radiographic distinctions between pancreatic neoplasia and abscess. It also reviews the pertinent medical literature on how such viscus perforations affect subsequent prognostication and clinical management.
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Affiliation(s)
- Ann R Garment
- Division of General Internal Medicine, New York University - Langone Medical Center, New York, NY, 10016, USA.
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Skeik N, Jabr FI, Stark M. Unusual case of foreign-body ingestion. J Emerg Med 2012; 44:e307-9. [PMID: 22989696 DOI: 10.1016/j.jemermed.2012.07.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 07/04/2012] [Indexed: 01/08/2023]
Affiliation(s)
- Nedaa Skeik
- Abbott Northwestern Hospital, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
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A little help from our friends: intra-operative endoscopy for the extraction of an ingested foreign body. Dig Dis Sci 2012; 57:2267-9. [PMID: 22183825 DOI: 10.1007/s10620-011-2022-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 12/01/2011] [Indexed: 12/09/2022]
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Alternative salvage technique for removing large sharp foreign body near upper esophageal sphincter. Surg Laparosc Endosc Percutan Tech 2012; 22:e48-52. [PMID: 22318080 DOI: 10.1097/sle.0b013e31824205a6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Removing sharp foreign bodies located in the esophagus can be dangerous and challenging. Proper apparatus and appropriate technique should be employed to avoid life-threatening complications such as perforation and mediastinitis. A 59-year-old man came to the emergency department with foreign body sensation in the upper esophagus which proved to be a large sharp fish bone impacted near upper esophageal sphincter. With the ordinary upper endoscope, the foreign body could not be retrieved even with the assistance of a cap. Foreign body removal was attempted again using a colonoscope with cap fitted at the end. Larger caliber of the scope rendered more stable support within the lumen enabling better maneuver of the scope tip to secure wider working space, and application of the cap permitted better visual field. Herein, we report the first case of successful removal of a large sharp fish bone impacted near the upper esophageal sphincter using cap assisted colonoscope.
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Unruh BT, Nejad SH, Stern TW, Stern TA. Insertion of foreign bodies (polyembolokoilamania): underpinnings and management strategies. Prim Care Companion CNS Disord 2012; 14:11f01192. [PMID: 22690353 DOI: 10.4088/pcc.11f01192] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 05/18/2011] [Indexed: 12/17/2022] Open
Abstract
The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. Such consultations require the integration of medical and psychiatric knowledge. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss the diagnosis and management of conditions confronted. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.Dr Unruh is an attending psychiatrist at McLean Hospital, Belmont, Massachusetts, and an instructor in psychiatry at Harvard Medical School, Boston, Massachusetts. Dr Nejad is an instructor in psychiatry at Harvard Medical School, Boston, Massachusetts, an attending physician on the Psychiatric Consultation Service at Massachusetts General Hospital, Boston, and the director of the Burns and Trauma Psychiatric Consultation Service at Massachusetts General Hospital, Boston. Mr Stern is a research assistant in the Department of Psychiatry at Massachusetts General Hospital, Boston. Dr Stern is chief of the Psychiatric Consultation Service at Massachusetts General Hospital, Boston, and a professor of psychiatry at Harvard Medical School, Boston, Massachusetts.Dr Stern is an employee of the Academy of Psychosomatic Medicine, has served on the speaker's board of Reed Elsevier, is a stock shareholder in WiFiMD (Tablet PC), and has received royalties from Mosby/Elsevier and McGraw Hill. Drs Unruh and Nejad and Mr Stern report no financial or other affiliations relevant to the subject of this article.
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Çakmak E, Cantimur AT, Yonem O. An uncommon cause of upper gastrointestinal bleeding, blister pack drug. J Am Geriatr Soc 2011; 59:1966-7. [PMID: 22091512 DOI: 10.1111/j.1532-5415.2011.03610_4.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mondal PJ, Saha S, Ghosh A, Sengupta M. Removal of foreign bodies from esophagus with flexible endoscope - a case report. Indian J Otolaryngol Head Neck Surg 2011; 66:78-80. [PMID: 24533363 DOI: 10.1007/s12070-011-0320-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 10/27/2011] [Indexed: 11/30/2022] Open
Abstract
To present a case of impacted artificial denture in esophagus and its removal by flexible endoscope. A 28 year old male presented with history of ingesting his denture 2 h back. It was removed by flexible endoscope and flexible fibre optic forceps. Though rigid endoscopic removal of foreign body is safe and effective, but often requires general anaesthesia. The flexible fibre optic endoscopic removal, which can be done under local anaesthesia in outpatient department is a suitable alternative.
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Affiliation(s)
- P J Mondal
- R.G. Kar Medical College, Kolkata, India
| | - Somnath Saha
- R.G. Kar Medical College, Kolkata, India ; 91 sarat Chatterjee Road, Barat Laketown, Kolkata, India
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González Carrera V, Vázquez Rodríguez S, Pereiro Carbajo A, Álvarez Sánchez V, Turnes Vázquez J. [Liver abscess as a delayed complication of a gastrointestinal foreign body]. GASTROENTEROLOGIA Y HEPATOLOGIA 2011; 34:720. [PMID: 22000029 DOI: 10.1016/j.gastrohep.2011.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Accepted: 06/08/2011] [Indexed: 10/16/2022]
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