Gastrointestinal Foreign Bodies Research Articles

Foreign Body-Related Extremity Trauma in Children: A Single-Center Experience.

The extremity foreign body in a child has propensity of getting missed or mistaken diagnosis. We report our experience of extremity foreign body trauma in order to increase awareness of this disease entity. The retrospective series of 24 retained foreign bodies was based on a 10-year chart review of emergency data (ICD code Z18). Patients with both upper and lower limb affections were included. Patients with ocular, otolaryngeal, tracheobronchial, gastrointestinal, and axial foreign bodies were excluded from the study. Male predominance (M:F = 20:4), young patient age (mean 6.8 years), variable lag period for consultation (range 3 h–8 years), and majority lower limb affection (58%; foot [7; 29%] and knee [5; 20.8%]) were some characteristics of extremity foreign bodies trauma. The foreign bodies reported were metallic needle (7; 29%), rubber band (3; 12.5%), pellets (3; 12.5%), bangle glass (2; 8%), glass pieces (2; 8%) “dhaga,” wooden twig, wooden thorn, ceramic earthen pot pieces, stapler pin, broomstick, and cracker piece in one case each (1; 4%). Postremoval, the wound healing was uneventful in all patients. Foreign body-related extremity trauma in children is a rare event. It has its own set of characteristics and differential diagnosis. Familiarity with the regional practices and customs is must to establish the circumstances/nature of the foreign body injury. The foreign body should preferably be removed in a well-equipped setting.

Examination of Gastrointestinal Foreign Body Removal

Examination of Gastrointestinal Foreign Body Removal

Endoscopic Management of Foreign Bodies in the Upper Gastrointestinal Tract: Single-Centre Experience

Introduction: Foreign body ingestion is a relatively common clinical problem. We report our clinical experiences in endoscopic management of upper gastrointestinal foreign bodies by endoscopy in a centre of northern Bangladesh. Methods: This retrospective study was conducted at Shaheed Ziaur Rahman College and Hospital, Bogura, Bangladesh, over a 2-year period. Patient characteristics, endoscopic findings, type of foreign body and its anatomical location, treatments and outcomes were analyzed. Results: We included 51 patients with foreign bodies in upper gastrointestinal tract. Most of them were found in esophagus (94.12%) predominately in lower esophagus (47.92%). Dysphagia (35.29%) and foreign body sensation (27.45%) were the most common complaints of foreign bodies impaction. Meat bolus (47.06%) and coins (29.41%) were the most common type of foreign bodies in adults and children, respectively. Patients were mostly affected (21.56%) during period of Eid -al - Adha (Islamic festival of sacrifice). Endoscopic foreign body removal was successful in 98.04% of cases, whereas surgery was required in only 1 patient. The most frequently used endoscopic accessory devices were retrieval forceps (38%) and Dormia basket (38%). Associated pathology were reported in 12 (24.53%) patients. Conclusion: Our experiences with foreign bodies impaction emphasize the importance of endoscopic approach and removal is simple and safe when performed by skilled hands. So, endoscopic interventions can increase the chance of successful removal of foreign bodies and reduction of the need of surgery.

Analysis of Radiopaque Gastrointestinal Foreign Bodies Expelled by Spontaneous Passage in Children: A 15-Year Single-Center Study.

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.

Isolated hepatic actinomycosis mimicking hepatocellular carcinoma: Case report and review

Actinomyces are a rare cause of the intra-abdominal infection that results in chronic suppurative and infectious granulomatous disease. The liver is involved in 15% of cases with abdominal infection and comprises 5% of all cases. Major risk factors include previous surgery, abdominal trauma, gastrointestinal foreign body, gut lesions, and immunosuppression. Due to the insidious course of the disease, symptoms arise several months after onset of the disease. The diagnosis of liver actinomycosis relies on clinical manifestations and imaging findings. Thus, it is often misdiagnosed as a primary liver cancer or metastatic tumor. Here we describe a case of isolated hepatic actinomycosis that mimicked a hepatocellular carcinoma with pretreatment and posttreatment magnetic resonance imaging findings. The patient was cured with long-term antibiotherapy.

Rapunzel Syndrome—Gossypol Trichobezoar Case Report and Review of Literature

Gossypol trichobezoar consists of a compact interwoven mass of hair along with cotton fibers occupying the gastrointestinal tract. When the bezoar extends past the duodenum, it is referred to as Rapunzel syndrome. Trichobezoars are found mostly in females and they may be associated with psychiatric conditions such as trichotillomania and trichophagia. We present a case of a 15-year-old female child presented to our surgical outpatient clinic with palpable mobile epigastric lump and dyspeptic symptoms with early satiety. Imaging studies revealed presence of gastrointestinal foreign body with entangled appearance extending up to ileum. Endoscopy revealed presence of trichobezoar in the stomach extending into the duodenum. The patient underwent laparotomy and anterior oblique gastrotomy, and retrieval of gossypol trichobezoar was done, measuring 102 cm and weighing 500 g. Trichobezoars should be considered as a differential diagnosis in young female patients with epigastric mass. Majority of these patients have an underlying psychiatric disorder. Psychiatric evaluation and counseling is essential to prevent recurrence of the problem.

Endoscopic management of foreign bodies in the upper gastrointestinal tract: An analysis of 846 cases in China.

Foreign body ingestion is a relatively common occurrence, which may lead to morbidity and mortality. The aim of the present study was to report the experience of management of upper gastrointestinal foreign bodies by endoscopy in a large center. All patients who presented at the Department of Gastroenterology at Nanfang Hospital (Guangzhou, China) with complaints regarding upper gastrointestinal (GI) foreign body ingestion from December 1987 to December 2013. Hospital medical charts and endoscopic records were examined to evaluate etiology, treatment, and outcomes for these patients. A total of 846 patients were enrolled in the present study, from which foreign bodies were detected in 737 (87.1%) patients via X-ray or endoscopy. The objects most frequently ingested were bones (n=395, 53.6%). The detected foreign bodies were predominantly located in the cervical esophagus (n=325, 44.1%). Endoscopic foreign body extraction was successful in 92.5% of cases, whereas surgery was required in 6 patients. The most frequently used endoscopic accessory devices were retrieval forceps (n=480, 65.1%). The complication rate was 6.9%, including mucosal laceration (n=10) and others, all of which were managed conservatively. Associated GI diseases were reported in 74 (10.0%) patients, including postesophagectomy (n=34) and others. In conclusion, the endoscopic procedure was safe and effective for the removal of foreign bodies from the upper gastrointestinal tract, with a high success rate and low complication rate.

Evaluation of the reasons for and outcomes of gastrointestinal tract surgery in pet pigs: 11 cases (2004-2015).

OBJECTIVE To evaluate the reasons for and outcomes of gastrointestinal tract surgery in pet pigs. DESIGN Retrospective case series. ANIMALS 11 pigs. PROCEDURES The medical record database of a teaching hospital was searched to identify pet pigs that underwent at least 1 celiotomy because of a possible gastrointestinal tract obstruction between 2004 and 2015. For each pig, information extracted from the medical record included history; signalment; clinical signs; physical examination, diagnostic imaging, and diagnostic test results; perioperative management; surgical diagnosis, duration, and procedures performed; postoperative complications; and outcome. Descriptive data were generated. RESULTS 11 pet pigs underwent 12 celiotomies during the study period. Five pigs with intestinal obstructions caused by foreign bodies survived to hospital discharge. Four pigs were euthanized during surgery: 2 because of extensive adhesions that prevented correction of an intestinal obstruction, 1 because of a perforated spiral colon, and 1 because of neoplasia. One pig with a fecal impaction in the spiral colon died during anesthetic recovery. A diagnosis was not achieved for 1 pig, which was euthanized after surgery because of a deteriorating clinical condition. For the pig that underwent 2 celiotomies, the first procedure was an enterotomy for removal of a foreign body, and the second was an intestinal bypass of a stricture caused by adhesions at the previous enterotomy site. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated prognosis was good for pet pigs following surgical removal of gastrointestinal foreign bodies; however, the presence or development of intra-abdominal adhesions appeared to adversely affect prognosis.

Gastrointestinal foreign bodies with concurrent intussusception and its surgical management in a Malinois dog

A 6-month-old female Malinois dog was presented with a history of vomiting, anorexia, and abdominal discomfort. During the abdominal examination, several foreign bodies were palpated in the stomach. Abdominal radiographs revealed radiolucent linear foreign bodies in the stomach. The physical examination and radiographic findings were suggestive of pyloric obstruction. Diagnosis of jejunal intussusception was made during the exploratory celiotomy. The manual reduction of intussusception and removal of the foreign bodies in the stomach and small intestine were performed at surgery. The recovery was uneventful and the dog had no further clinical signs 4 months post-operatively.

Gastrointestinal Disease in Cats and Dogs with Gastrointestinal Foreign Bodies

Gastrointestinal Disease in Cats and Dogs with Gastrointestinal Foreign Bodies

Sa1207 A Retrospective Analysis of Upper Gastrointestinal Foreign Body Ingestion Among Adults: Initial Presentation, Diagnosis, Intervention and Outcome

Sa1207 A Retrospective Analysis of Upper Gastrointestinal Foreign Body Ingestion Among Adults: Initial Presentation, Diagnosis, Intervention and Outcome

This too shall pass: A study of ingested sharp foreign bodies.

Gastrointestinal foreign body (GFB) ingestion is a common problem and often results in surgical consultation. Current literature is limited to case reports and fails to provide data regarding the management of sharp GFB ingestion. We hypothesized that patients who ingest sharp objects rarely have perforation or obstruction requiring surgical intervention. Patients presenting with GFBs from January 2005 to December 2015 at a level 1 trauma center with an acute care surgery program were retrospectively reviewed. Exclusion criteria were leaving without being seen, noningested GFB, unknown or blunt GFB, or if the GFB was not found on imaging. Data collected included patient demographics, length of stay, imaging, and interventions that were performed. During the study period, there were 1,164 patients with 1,245 hospital visits for GFBs; 995 visits were excluded, resulting in 169 sharp GFB ingestion patients with 192 visits included in our study. The average age was 31. Sixty-five percent were men, and 41% were incarcerated. The average length of stay was 3 days, which was longer in patients with psychiatric holds and consultations. Of the 169 patients, 116 (69%) had no intervention and did not return for complications. Fifty-five endoscopies were performed with GFB removal in 30 cases. Seven patients (4%) underwent surgery, five of which had peritonitis. When evaluating the total study cohort, 134 (79%) of the patients had no procedure or a negative procedure. Patients requiring surgery had significantly larger objects (6 ± 3 cm) than those who had endoscopy (3 ± 2 cm) or no procedure (2 ± 1 cm). Surgical intervention occurred in only seven (4%) patients with sharp GFB ingestions, and 79% of the patients required no intervention. Barring an acute abdomen or esophageal sharp GFBs, patients can be discharged with return precautions, admitted for necessary psychiatric care, or returned to custody for patients seeking secondary gain. Upper gastrointestinal larger GFBs should be removed endoscopically when possible. Therapeutic/care management study, level V.

Experience of management of gastrointestinal magnet foreign bodies in children

Experience of management of gastrointestinal magnet foreign bodies in children

Cost varies with procedure type in pediatric GI foreign bodies

Background/purposeIn pediatric cases of ingested foreign bodies, gastrointestinal foreign bodies (GIFB) have distinct factors contributing to longer and more costly hospitalizations. MethodsPatients admitted with ingested foreign bodies were identified in the Kids' Inpatient Database (1997–2009). ResultsOverall, 7480 cases were identified. Patients were most commonly <5years of age (44%), male (54%), and Caucasian (57%). A total of 2506 procedures were performed, GI surgical procedures (57%) most frequently, followed by GI endoscopy (24%), esophagoscopy (11%), and bronchoscopy – in cases of inhaled objects (9%). On multivariate analysis, length of stay increased when cases were associated with intestinal obstruction (OR=1.7), esophageal perforation (OR=40.0), intestinal perforation (OR=4.4), exploratory laparotomy (OR=1.9), and gastric (OR=2.9), small bowel (OR=1.5), or colon surgery (OR=2.5), all p<0.02. Higher total charges (TC) were associated with intestinal obstruction (OR=2.0), endoscopy of esophagus (OR=1.8), stomach (OR=2.1), or colon (OR=3.3), and exploratory laparotomy (OR=3.6) or surgery of stomach (OR=5.6), small bowel (OR=6.4), or colon (OR=3.4), all p<0.001. ConclusionsSurgical or endoscopic procedures are performed in approximately one third of GIFB cases. Associated psychiatric disorder or self-inflicted injury is seen in more than 20% of GIFB patients. Resource utilization is determined heavily by associated diagnoses and treatment procedures.

Preliminary study on attitudes, opinions and knowledge of Italian veterinarians with regard to abdominal visceral pain in dogs

ObjectiveTo determine the attitudes, opinions and knowledge of Italian veterinarians regarding abdominal visceral pain in canine practice. Study designProspective online survey. MethodsAn online questionnaire was created on a Google Form spreadsheet and the weblink was circulated to Italian veterinarians on several mailing lists. The questionnaire, which was available between November 2012 and July 2013, comprised 18 closed, semi-closed and open questions divided into five sections (aetiology, recognition and assessment, drug choices for canine visceral pain, general knowledge about pain management and desire for further education, and demographic information). ResultsA total of 527 responses to the questionnaire were completed. Pancreatitis (19%), gastroenteritis (17%) and gastrointestinal obstructions or foreign bodies (9%) were highlighted as the most frequent causes of abdominal visceral pain. Posture, gait and movement changes (32%) and physiological changes (31%) were commonly quoted for pain recognition and assessment. Most respondents (74%) did not use pain scoring systems. Pancreatitis and peritonitis were considered the most painful abdominal conditions. Opioids (40%), nonsteroidal anti-inflammatory drugs (21%) and tramadol (20%) were cited as drugs for the management of visceral pain. A large percentage of respondents (97%) believed that their knowledge regarding pain management required improvement. There is practitioner interest for more continuing education in the subject. Most respondents were women (66%), aged between 25 and 40 years (57%). Internal medicine (56%), surgery (34%) and anaesthesiology (29%) were the main three speciality areas of interest in this study. Conclusions and clinical relevanceThis online survey represents the opinion of a small number of Italian veterinarians regarding the assessment and treatment of canine abdominal visceral pain. The results show that Italian veterinarians are aware of the main causes and clinical signs of canine visceral pain. Pain-scoring systems are not often used for the recognition and assessment of pain; however, according to these veterinarians, visceral pain is commonly diagnosed.

Gastrointestinal Foreign Bodies- Five Year Experience at Tertiary Care Center of Northeren India

Aims and Objectives: The aim was to determine various causes of foreign body ingestion at a tertiary care center of Northeren India. Background: The majority of foreign body ingestions occur in children between the ages of six months and three years. Fortunately, most foreign bodies that reach the gastrointestinal tract pass spontaneously. Only 10 to 20 percent will require endoscopic removal, and less than 1 percent requires surgical intervention. Although mortality from foreign body ingestion is extremely low, deaths have been reported. Coins are the most common foreign bodies ingested by children. Ingestion of multiple foreign objects and repeated episodes are uncommon occurrences and usually occur in children with developmental delay.

Upper gastrointestinal tract foreign body in children India

Background: Foreign body ingestion is a common problem all over the world with 80% of the case reported in children. Most swallowed foreign bodies pass harmlessly through the gastrointestinal (GI) tract. Evaluation of foreign body in upper GI tract in children. The design of this study was retrospective case study. Study conducted Mata Gujari medical college, Kishanganj, Bihar, India from January 2005 to January 2016. Methods: Between January 2005 to January 2016 the record of all children of age group 5-16 were analyzed at Mata Gujari medical college, Kishanganj, Bihar with a final diagnosis of foreign body in upper GI tract. Data were analyzed with respect to demographic data, presenting symptoms, investigations, management and outcome. Age below 5 year and 16 year were excluded from the study. Results: Total seventy patients were identified (38 boy and 32 girl). Age ranges from 5 year to 16 year. Fifty three patients (75.7%) presented within 24 hours. Thirteen patients (18.6%) had underlying predisposing factors. The most common FB found in 30 patients (42.8%) was coin. The most common symptoms were drooling of saliva in 42 patients (60%) followed by vomiting (51.4%) in 36 patients. Follow up ranges from one week to six months and all were recovered without any sequelae. Conclusions: Foreign body ingestion is common problem in children and usually an accidental event. Long retained FB is associated with higher incidence of complications.

内視鏡的に摘出し得た魚骨による消化管穿通の2例

Fish bones are the leading type of gastrointestinal foreign body in Japan, and most require surgical removal. We describe the endoscopic removal of fish bones from the gastrointestinal tracts of two patients. Case 1 : A 70-year-old man presented with pain in the left lower abdomen. A 3-cm linear, high-density foreign body was identified by CT in the sigmoid colon. A fish bone was removed by colonoscopy. Case 2 : A 49-year-old woman was referred to our institution with upper abdominal pain. A linear, high-density structure was identified by CT in the proximal jejunum, and a fish bone was removed using single balloon endoscopy. This is the first report of removal of fish bones from the small intestine by balloon assisted endoscopy. We emphasize that clinicians should be aware of the characteristic imaging features of fish bones : they are usually linear and have high density on CT images. Endoscopic removal and laparotomy should be considered as the first and second approaches, respectively, for removing fish bones from the gastrointestinal tract.

Gastrointestinal foreign bodies: delayed presentations and associated complications

Two cases of canine gastrointestinal foreign bodies presented to a charity hospital (RSPCA Greater Manchester Animal Hospital) due to owners being unable to afford private veterinary care are described. The cases are outlined for comparison and discussion, focusing on the clinical presentation, diagnosis and treatment, and relating some of the difficulties encountered.

Upper gastro intestinal foreign bodies in pediatrics patients

Abstract Aim: Analyzeexperience with presentation, diagnosis and management of accidental ingested upper digestive tract foreign bodies in children. Materials: A prospective study of 60 pediatric patients from July 2009 to July 2014 with history of accidental ingested upper gastro intestinal foreign bodies. All patients were studied for age, gender, complaints, duration, site of impaction, type and complications. Radiological investigations were taken according to the case. Direct laryngoscopy and Magill forceps or flexible esophagoscopy has been used for retrieval of foreign bodies. Result: Sixty cases were analyzed age between 6 months to 13 years. Male 42 and female 18. Age group 6 months to 6 years constitutes 85%. Thirty six (60%) patients arrived to hospital within 24 hours. Difficultly in swallowing (70%) was the most frequent symptom. Most foreign bodies were coin in the upper esophagus (70%). Preexisting esophageal disease was present in 20%. Out of 60 patients twenty four (40%) FB retrieved using Magill forceps and rest with Flexible esophagoscopy (60%). Foreign bodies were successfully removed without major complication in all cases. Mucosal erosions were seen in four patients after extraction. All patients except 4 were discharged within 24 hours after the procedure. Conclusion: Children between 6 month to 6 years is the commonest age group affected. Magill forceps with the aid of a direct laryngoscope is a safe and effective method for proximal esophageal foreign body removal. But flexible esophagoscopy remains the safest method of upper digestive tract foreign body extraction.