Gastric Foreign Body Research Articles

Extraction of hollow gastric foreign bodies by flexible upper endoscopy assisted by a through-the-scope balloon catheter for anchoring

Various methods have been used to remove foreign bodies; hollow foreign bodies deserve special consideration. The main difficulty encountered in such situations is the anatomic obstacle of the lower and upper esophageal sphincters along with a risk of perforation. We describe a unique approach by using an esophageal balloon dilator to anchor a hollow foreign body onto an endoscope, which allows for the successful extraction of such objects with minimal risk. Case series. Shands Jacksonville and University of Florida/Jacksonville, Jacksonville, Florida. Two consecutive patients with hollow foreign bodies in the stomach that required removal. A combined approach by using an endoscope and a 20-mm by 8-cm esophageal balloon dilator to remove hollow foreign bodies from the stomach. Nonsurgical removal of hollow gastric foreign bodies. Both foreign bodies were successfully removed from the stomach and extracted by mouth with this technique. There were no complications after both procedures. The inflated esophageal balloon that anchors a hollow foreign body onto a flexible endoscopic technique is a safe and effective alternative to previously described methods for removal of such foreign bodies in the gastric cavity. This method may be applicable to the removal of other hollow objects within the gastric lumen.

SIMPLE ENDOSCOPIC TECHNIQUE FOR RETRIEVING A LONG FOREIGN BODY FROM THE STOMACH

Foreign body ingestion occurs frequently and is a common problem confronting the general surgeon or gastroenterologist. Most foreign bodies pass spontaneously, but long items such as forks and spoons are unable to pass through the duodenum. These foreign bodies present a unique challenge for the endoscopist as they tend to T-bone at the gastro-oesophageal junction, making it technically very difficult to remove. We present a case of a young woman ingesting a spoon. By using a single channel gastroscope, snare and altering the position of the operating table we were able to extract the long foreign body. We describe an alternate, new technique that may help avoid a laparotomy in a patient presenting after ingestion of a retained gastric foreign body.

Two Cases of Planned Relaparotomy for Severe Peritonitis Secondary to Gastrointestinal Pathology

Planned relaparotomy is a technique in which two or more surgeries are planned before or during the initial surgery. Two dogs underwent planned relaparotomy for severe peritonitis secondary to gastric ulceration and linear foreign body. Both dogs had good outcomes, and unnecessary procedures that would likely have led to increased morbidity were avoided. This technique may be useful in avoiding unnecessary procedures as well as providing for better stabilization of the animal.

Corps étranger intragastrique. Une complication rare de la mise en place de sonde gastrique

The use of an uncuffed endotracheal tube for the placement of nasogastric tubes during surgery is not a procedure free of any risk. We report a rare case of gastric foreign body secondary to this procedure. A 67-year-old patient who had underwent a coronary bypass for a three vessels disease two years before complained of postprandial epigastralgia lasting for a few months. The investigations reported a gastric ulcer associated with a tubular gastric foreign body. The endoscopic extraction found an endotracheal tube. It is a common habit in our institution to use this method when placing this tube through a nostril in order to ease the nasogastric tube insertion when it is difficult.

SURVEY OF THE USE OF RADIOGRAPHY VS. ULTRASONOGRAPHY IN THE INVESTIGATION OF GASTROINTESTINAL FOREIGN BODIES IN SMALL ANIMALS

A question frequently asked by clinicians who are treating small animals suspected of having gastrointestinal foreign bodies is whether one imaging test such as survey radiography or ultrasonography is sufficient to make the diagnosis. A study was undertaken to try and answer this question. Survey abdominal radiography and ultrasonography was performed on 16 small animals (11 dogs, five cats) with clinical signs of an obstruction because of a confirmed gastrointestinal foreign body. The majority of the foreign bodies (14/16) were confirmed by surgical removal and were located in the small intestine. A gastric foreign body was retrieved endoscopically and a colonic foreign body was passed in the feces. Radiographically identifiable foreign bodies were evident in nine animals. Small intestinal overdistension was present radiographically in seven animals. Ultrasonography detected a foreign body in all 16 animals. The foreign bodies were identified by their distal acoustic shadowing and variable degrees of surface reflection. An intestinal perforation was detected sonographically but not radiographically. The value of additional sonographic findings including thickening of the gastrointestinal wall and loss of layering, free peritoneal fluid, and lymphadenopathy in these animals is discussed. The findings in this series suggest that in a small animal with a gastrointestinal foreign body, ultrasonography alone could be used to make the diagnosis and may be a more appropriate choice than survey radiography.

Gastric foreign body

Gastric foreign body

Hématémèse chez un enfant de 11 mois : un mode de révélation rare d'un corps étranger intragastrique

Ingestion of foreign body has often no consequence. We report on a case in an 11-month-old girl who was referred for mild hematemesis and anorexia. Upper digestive tract endoscopy found a small metallic foreign body in the gastric antrum. After its removal, all symptoms disappeared. It is usually recommended to remove foreign bodies by endoscopy when they are in esophageal position, or are more than 3 to 5 cm long, or have a shape that may hurt the gut mucosa. Although rare, a gastric foreign body should be searched for in face of an upper gastrointestinal bleeding in an infant.

Minimally Invasive Management of Gastrointestinal Foreign Bodies

Purpose: Laparoscopy can be utilized for diagnostic exploration as well as for management of abdominal conditions. Therapeutic laparoscopic management of gastrointestinal foreign bodies (FB), especially in the pediatric population, has not been reported extensively. Methods: Since March 2001, three children have undergone laparoscopic management of gastrointestinal foreign bodies. Clinical cases and surgical approaches were reviewed. Results: All three patients were successfully managed laparoscopically. The mean operative time was ninety minutes. Patient 1 presented with an 18-month history of symptoms consistent with intermittent small bowel obstruction. A coin was visualized on the abdominal films. At laparoscopy, a jejunal web was identified. Web resection with coin removal was performed. Patient 2 underwent computed tomography scanning of the abdomen and pelvis for abdominal pain, and a mass suspicious for a FB was seen near the falciform ligament. At laparoscopy, the transverse colon was adhered to the abdominal wall. Laparoscopic colon resection was performed after identification of a colonic perforation due to a toothpick. A gastric FB was incidentally discovered in patient 3 during laparoscopic Nissen fundoplication for gastroesophageal reflux disease. The FB, a coin, was laparoscopically manipulated into the distal esophagus where a Foley catheter was used to remove it, through the mouth. Conclusions: Laparoscopy can be a valuable tool in the management of gastrointestinal foreign bodies. The combination of short operative times and hospitalization warrants its consideration when a gastrointestinal FB does not pass.

A case of a foreign body need a device to retrieve

A 20-year-old female patient with mental disease intentionally swallowed a pair of nail clippers and was treated at our hospital. Abdominal X-ray showed the clippers in stomach and endoscopy was performed. The clippers were located in the body of the stomach. A gastric mucosal lesion with mild redness and hemorrhaging was observed. We were unable to grasp the nail clippers using grasping forceps, snare forceps or basket forceps. We therefore switched to a 2-channel endoscope. First, we inserted a guide wire through the hole in the handle of the clippers with a cannula used in ERCP. We then grasped the guide wire using the biopsy forceps, which were extended from the channel for forceps, and pulled the guide wire towards the channel for forceps. With the clippers suspended from the guide wire we removed the fiberoptic scope. Because an overtube was used, we were able to retrieve the nail clippers without damaging the esophagus or oral cavity. We have occasionally encountered cases of esophageal and gastric foreign bodies. It is important to utilize safe procedures for foreignbody removal in order to minimize damage to the intestinal mucosa.

Modification of a latex glove for the safe endoscopic removal of a sharp gastric foreign body

The endoscopic removal of sharp foreign objects from the upper GI tract is a challenge. A latex protector hood (Ballard Medical Products, Draper, Utah) exists as a commercially available device for retrieving sharp objects. The following is a case report of the safe removal of a sharp foreign object by a similar technique using a modification of a widely available latex orthopedic glove (Maxxus, Arlington, Tex.).

Combined endoscopic and laparoscopic approach to remove a sharp gastric foreign body

GI foreign bodies are common and potentially fatal problems with 1500 deaths per year in the United States.1 Although most foreign bodies will pass spontaneously, 10% to 20% require endoscopy and 1% to 14% require surgery for removal.1-5 Objects wider than 2 cm or longer than 5 cm often remain in the stomach or proximal duodenum.6 Smaller sharp or pointed objects can pass into the intestine where they may perforate in 15% to 35% of cases.7

Gastric Foreign Body

To the Editor: A 64-yr-old male physician, with a postaortic valve replacement with a mechanical valve, performed at another facility in 1994, was recently admitted to our facility with increasing fatigue. The patient was anemic (hematocrit 19%) and had an international normalized ratio more than 4 times normal. The anemia and coagulopathy were corrected. Endoscopic evaluation for a presumed upper gastrointestinal bleed revealed small erosive lesions near the gastroesophageal junction (perhaps the etiology of the patient's decreased hematocrit) and, notably, a large tubular foreign body in the stomach. The gasteroenterologist's initial attempts to remove the foreign body with the patient under sedation were unsuccessful. In fact, the patient became somnolent and apneic and required endotracheal intubation and resuscitation by the anesthesia team. The following day, the patient was brought to the operating room for a second endoscopic attempt to remove the foreign body. General endotracheal anesthesia was administered without difficulty. However, multiple endoscopic attempts by the gasteroenterologist-including using a laser to cut the foreign body into smaller fragments-proved unsuccessful. Subsequently, the surgical team performed a gastrotomy, and the foreign body, an esophageal stethoscope, was removed intact. On examination, the stethoscope was found to have completely solidified in the shape of a Figure eight(Figure 1). The presence of the stethoscope in the stomach is most likely explained by its inadvertent advancement during the insertion of a transesophageal echo during the 1994 aortic valve replacement. We strongly believe that it is imperative to attach one's ear piece and/or the temperature probe once the esophageal stethoscope is in place. If this had been done, the above mishaps would most likely have been prevented.Figure 1It is unclear whether the foreign body itself caused the anemia, but our colleague certainly suffered unnecessary pain, inconvenience, and the risks associated with general anesthesia and surgery. We present this case as a warning to clinicians to make sure that the esophageal stethoscope is removed prior to the insertion of a transesophageal echo. Michael Brook, MD Paul S. Chard, PhD John G. Brock-Utne, MD, PhD Department of Anesthesia; Stanford University School of Medicine; Stanford, CA 94305-5115

当科における咽頭,食道,気管・気管支異物の統計

Eighty-one cases of pharyngeal, esophageal, or tracheo-bronchial foreign bodies which required hospitalization during the past 10 years were statistically analyzed. The results were as follows:1) Five cases of pharyngeal foreign bodies (male: 4, female: 1), fifty-one cases of esophageal foreign bodies (male: 37, female: 23), four cases of gastric foreign bodies and 21cases of tracheo-bronchial foreign bodies (male: 12, female: 9) were treated in our hospital.2) Forty patients (52%) were under 9 years of age.3) The foreign bodies included coins (19 cases ), P. T. P (press through pack) (15 cases), dentures (10 cases) and others.

Intestinal obstruction due to phytobezoar in childhood

Phytobezoar is a gastric or small-intestinal foreign body of vegetable origin. Morphologic, diagnostic, and surgical aspects of this condition in adults have been sufficiently described in the recent literature; however, it is almost unknown in childhood. We present our experience with five children operated upon for intestinal obstruction due to a phytobezoar. Pathophysiology, diagnosis, and treatment are discussed on the basis of our cases and those in the literature. One of our patients had previously undergone a vagotomy with pyloroplasty for hemorrhagic gastritis. The incidence of phytobezoar may increase in the future because of the tendency to add a pyloroplasty to the surgical treatment of gastroesophageal reflux in children.

誤えんしたスーパーボールにより消化管通過障害を起こした犬の３症例

Three dogs accidentally ingesting superball, radiolucent elastic ball, were successfully treated by gastrotomy and intensive cares. All dogs ingesting the superballs had shown severe vomiting, and two of them were in dangerous condition by severe dehydration and electrolyte imbalance at admission. Furthermore, the dog of case 1 showed mild renal insufficiency and unconsciousness. Radiography revealed severe gastric dilation in the dog of case 2 that suggested complete obstruction of the pylorus by the ingested superball.Foreign bodies were not conclusively diagnosed by plain radiography, however, their presence was demonstrated on positive contrast films. The superballs were located at the pyloric portion of the stomach in 2 cases (cases 1 and 2), and at the corpus of the stomach in a case (case 3) . These findings suggests that the superball accidentally ingested by the dog may have the risk to obstruct the pylorus and cause severe dehydration and electrolyte imbalance seen in these cases. After the intensive cares mainly with intravenous electrolyte solution therapy, the gastric foreign bodies were removed by gastrotomy. The general condition of the affected dogs recovered soon after the operation.

Management of Smooth-Blunt Gastric Foreign Bodies in Asymptomatic Patients

Guidelines for management in the asymptomatic patient with a smooth-blunt gastric foreign body are not well established in the pediatric literature. Questionnaires were sent to pediatricians, family practitioners, pediatric gastroenterologists and pediatric surgeons with an over-all response rate of 62.2%. There was no agreement in regard to how long one should observe such patients before recommending intervention. There was no correlation of years of clinical experience and length of observation recommended either. Review of the pre-endoscopic literature revealed spontaneous evacuation in 93-99% of all types of foreign bodies in 1477 pediatric patients. An observation period of at least eight weeks should be strongly considered in an asymptomatic patient with a smooth-blunt gastric foreign body. Exceptions would include an anatomic abnormality of the gastric outlet, previous gastric outlet surgery as well as a possibly toxic object.

Aluminium intoxication in a dog

A two-year-old male Barsoi dog was presented after a two-week period of muscle twitching and convulsions during exercise, which worsened to a state of tetraparesis and coma. Removal of a gastric foreign body, containing aluminium, resolved the presenting signs. Parallel with this clinical recovery the elevated serum levels of aluminium decreased to values of two normal control dogs, suggesting that the neurological signs were due to A1 intoxication.

The Bee: an Unusual Gastric Foreign Body

The Bee: an Unusual Gastric Foreign Body

下いん頭・食道入口部ファイバースコープ検査の問題点 バルーン装着法の試み

It is very difficult to observe the postcricoid area of the hypopharynx and the upper end of the esophagus with a fiberscope because their lumens are usually closed. When the gastrointestinal fiberscope (GIF type P2, Olympus Co. Ltd.) and nasopharyngo-laryngofiberscope (ENF type LB, Olympus Co. Ltd.) were used in a case of hypopharyngeal (postcricoid) cancer for comparison, the ENF-LB is too slender to keep a favorable position for observation and insufficient to extend the postcricoid lumen. Therefore, it is not suitable for observation on these regions as compared with the GIF-P2. A small erosion in the postcricoid area of the hypopharynx after passage of fish bones could be diagnosed by mounting the hood on the GIF-P3. When the ENF-LB was simultaneously inserted through the nose while the gastrointestinal fiberscope (GIF type XQ10, Olympus Co. Ltd.) was being orally inserted, the pyriform sinus could be favorably observed because the hypopharynx cavity had been extended by the GIF.From the above-mentioned experiences, the balloon (Top Co. Ltd.) which had been used in the sclerotherapy of the esophageal varix was mounted on the end of the GIF-XQ10 in order to obtain an enough visual field by extending the lumen of the hypopharynx and the upper end of the esophagus. It was used successfully in diagnosing and treating the ectopic gastric mucosa and foreign body in the esophagus.

Pediatric gastrointestinal foreign body ingestions

One hundred twenty-five consecutive emergency department cases of pediatric gastrointestinal foreign body ingestions were analyzed retrospectively to tabulate data, identify high risk ingestions, and draw conclusions regarding the standard of care. Eleven patients (9%) were admitted for endoscopy or observation of high risk situations. Twenty patients (16%) were managed invasively, 19 with esophageal foreign bodies; 17 of 20 attempts at invasive management were successful. There was a 2% incidence of minor complications; no major complications (perforation, obstruction, bleeding, or mediastinal infection) or complications of invasive procedures were observed. High risk factors identified included the following: 1) the ingestion of rounded objects (esophageal impaction); 2) the presence of social, developmental, or psychiatric risk factors (29.6% incidence); and 3) esophageal disease (significantly associated with recurrent foreign bodies and frequent endoscopy or other surgical procedures). We conclude that, while asymptomatic gastric and intestinal foreign bodies can be managed with outpatient observation, hospitalization is indicated for endoscopic management and for symptom complexes suggestive of complication. Immediate endoscopy is recommended for removal of esophageal foreign bodies and for direct evaluation of the esophagus.