234 Case of Foreign Bodies in Gastrointestinal (GI) Tract

Abstract

<h3>Rationale</h3> Foreign Body in GI Tract is an emergency state commonly treated in paediatric gastroenterology as well as paediatric surgery departments. Removal techniques (endoscopy vs. surgery) should be always carefully considered. <h3>Patient</h3> An 8 year old boy was admitted to our Department because of intentional swallowing 9 magnetic balls (before 5 days). Abdominal pain, numerous vomiting and lack of appetite had been presented. <h3>Intervention</h3> After X-Ray he was qualified to gastroduodenoscopy. 9 linearly connected magnetic balls were found. One boarder coated by pyloric mucosa and the second superficially fused with anterior wall of duodenal bulb. Foreign bodies were successfully removed with Roth net. We discovered horizontal transmucosal ulcer in pylorus and deep penetrating ulcer of duodenal bulb with suspicion of its microperforation. <h3>Further Treatment</h3> Physical examination revealed tenderness and muscle rigidity in epigastrium. Microperforation was not radiologically confirmed (2x X-Ray, Abdomen CT). PPI, TPN, Nasogastric aspiration and Antibiotics (Co-Amoxiclav changed into Piperacillin/tazobactam because of WBC and CRP elevation) were ordered. Bradycardia after central venous catheter insertion was periodically observed (treated with Theophylline and Atropine). After 2 weeks oral nutrition was gradually included. No changes in duodenal bulb and proper healing pyloric ulcer were discovered in control endoscopy (after 4 weeks). <h3>Discussion</h3> Time of PPI Treatment. Our patient was treated for 8 weeks. Surgical treatment was avoided. Possibly early endoscopic intervention might have been considered (no experience).