Emergency Bedside Deep Enteroscopy Without Balloons to Remove a Sharp Foreign Body

Abstract

Purpose: Until recently, most of the small bowel was beyond the reach of the GI endoscopist. However, with the help of overtube and single or double balloons deep enteroscopy is possible. These methods require expensive new equipment, are time consuming and have a potential for complications such as duodenal perforation, acute pancreatitis and hyperamylasemia. We have been performing deep enteroscopy using a stiffening wire and a commercially available 245 cms long enteroscope without overtube, balloons or fluoroscopy. We used this method to perform an emergency bedside deep enteroscopy to remove a sharp foreign body. The patient was a 22 year old woman with psychiatric problems including PTSD and schozoaffective depresive type disorder. Her other problems are exogenous obesity and diabetes mellitus. Under the influence of auditory hallucinations, she broke a glass bulb and ingested the glass pieces. She developed abdominal pain. She had no nausea, vomiting, hematemesis, melena or hematochezia. There was no abdominal guarding and the bowel sound were normal. A CT of the abdomen showed foreign body pieces in proximal duodenum. An emergency bedside EGD was performed in the usual manner under usual sedation. The endoscope was passed into the third portion of the duodenum: no F.B. was seen and the scope was withdrawn. A commercially avaiable 245 cm long enteroscope (outer diameter 8.5 mm; biopsy channel 2.8 mm) was introduced without overtube and without balloons using a stiffening wire. The enteroscope was advanced to 200 cm beyond the ligament of Treitz using suction, advancement and withdrawl. At 180 cms a shiny foreign body (broken glass) 2.0 cm in diameter was seen. Glucagon 1.0 mg I/V was given. The F.B. was snared in a Roth net & the scope was withdrawn. No other F.B. was seen. The glass piece tore through the net and fell in the stomach. The enteroscope was withdrawn. An EGD scope was passed using an overtube. Using another Roth basket,the glass piece was withdrawn through the overtube. There were no complications and the patient tolerated the procedure well. The total time for the procedure was 59 minutes; the time required for Enteroscopy only was 35 minutes. For the enteroscopy portion of the procedure, no overtube, balloons or fluoroscopy was used. The enteroscopy was performed bedside in the emergency department.