Predictors of Outcomes in Endoscopies for Foreign Body Ingestion: A Cross-Sectional Study

Non-interventional outcomes of adult foreign body ingestions

INTRODUCTION

Foreign body ingestions are a common problem in the emergency department. Patients often undergo invasive interventions that require significant resources. Current recommendations based on limited studies, are to attempt endoscopic removal of objects that are sharp or greater than 2.5 cm at or above the proximal duodenum. We hypothesized that many small and sharp objects will pass spontaneously without complication.

METHODS

We performed a retrospective study of all foreign bodies ingested by adults that were not removed initially by endoscopy over five years. We recorded foreign body size, shape and location, radiographic results, interventions performed, and demographic data. Regression analysis was used to determine any significant associations with the outcome of late intervention.

RESULTS

117 patients with 171 encounters met inclusion criteria with an average age of 33 years. 74 % of patients had a known psychiatric history. The most common foreign body was a razorblade. Fifteen patients had late intervention with twelve endoscopies and three exploratory laparotomies. 87 % of these late interventions were for failure to progress determined by the treatment team. There were no small bowel obstructions. One patient had a recto-sigmoid perforation from a pencil. Analysis indicates that size and sharpness were not significant risk factors for later intervention.

CONCLUSION

Our study indicates that small objects, even sharp foreign bodies including razorblades, can pass spontaneously without intervention. If larger, future studies show the same conclusion, there should be a reconsideration of current guidelines.

Hepatic abscess caused by foreign body ingestion: A case report

Introduction

Liver abscess is a common clinical condition caused by bacterial, fungal or parasitic infections, usually due to immunosuppression. In contrast, secondary liver abscesses are caused by specific factors such as foreign bodies, tumours, or appendicitis.

Methods

We admitted a patient with secondary liver abscess and found an intrahepatic foreign body after interventional drainage. Initially, a foreign body of medical origin was suspected, but after a multidisciplinary consultation, it was determined to be caused by a foodborne foreign body. Laparoscopic surgery was then chosen as the treatment.

Result

The liver abscess was caused by an alimentary foreign body, and the intrahepatic foreign body was identified as a fish bone measuring approximately 2.5 cm in length.

Discussion

Upon diagnosing either primary or secondary liver abscess, aggressive treatment of the abscess focus is essential. However, in cases of secondary liver abscess, addressing and removing the underlying cause is necessary for complete resolution. For patients with a previously healthy liver, comprehensive history-taking is crucial, and imaging studies play a significant role in diagnosis and treatment. Clinicians and radiologists should be vigilant for the possibility of foreign bodies, tumours, or unexpected intra-abdominal inflammation, regardless of the patient's history. When dealing with food-borne foreign bodies, endoscopic intervention should be considered first, followed by laparoscopy, and as a last resort, open surgery.

Conclusion

The diagnosis and treatment of liver abscess in clinical practice require a complete medical history and thorough imaging examinations. Ultrasound, as the initial imaging modality, allows real-time and dynamic observation of lesions. It is essential for ultrasonologists to consider the possibility of foreign body-induced liver abscess when diagnosing patients with liver abscess.

Predicting Factors of Clinical Outcomes in Patients Hospitalized after Esophageal Foreign Body or Caustic Injuries: The Experience of a Tertiary Center

Ingestion of foreign bodies (IFB) and ingestion of caustic agents are frequent non-hemorrhagic causes of endoscopic urgencies, with the potential for severe complications. This study aimed to evaluate the predicting factors of the clinical outcomes of patients hospitalized as a result of IFB or ingestion of caustics (IC). This was a retrospective single-center study of patients admitted for IFB or IC between 2000 and 2019 at a tertiary center. Demographic and clinical data, as well as preliminary exams, were evaluated. Also, variables of the clinical outcomes, including the length of stay (LS) and other inpatient complications, were assessed. Sixty-six patients were included (44 IFB and 22 IC). The median LS was 7 days, with no differences between the groups (p = 0.07). The values of C-reactive protein (CRP) upon admission correlated with the LS in the IFB group (p < 0.01) but not with that of those admitted after IC. In the IFB patients, a diagnosis of perforation on both an endoscopy (p = 0.02) and CT scan (p < 0.01) was correlated with the LS. The Zargar classification was not correlated with the LS in the IC patients (p = 0.36). However, it was correlated with antibiotics, nosocomial pneumonia and an increased need for intensive care treatment. CT assessment of the severity of the caustic lesions did not correlate with the LS. In patients admitted for IFB, CRP values may help stratify the probability of complications. In patients admitted due to IC, the Zargar classification may help to predict inpatient complications, but it does not correlate with the LS.

Endoscopic failure for foreign body ingestion and food bolus impaction in the upper gastrointestinal tract: an updated analysis in a European tertiary care hospital

OBJECTIVE

Harmfulness of foreign body ingestion and food bolus impaction (FBIs) varies according to geographical area, population, habits, and diet. Therefore, studies may not draw generalizable conclusions. Furthermore, data regarding FBIs management in Europe are limited and outdated. This study aimed to analyze the endoscopic management and outcomes of FBIs in an Italian tertiary care hospital to identify risk factors for endoscopic failure.

METHODS

We retrospectively reviewed patients who underwent upper gastrointestinal endoscopy for FBIs between 2007 and 2017. Baseline, clinical, FBIs, and endoscopic characteristics and outcomes were collected and reported using descriptive statistics and logistic regression analyses.

RESULTS

Of the 381 endoscopies for FBIs, 288 (75.5%) were emergent endoscopy and 135 (35,4%) included underlying upper gastrointestinal conditions. The study population included 44 pediatric patients (11.5%), 54 prisoners (15.8%), and 283 adults (74.2%). The most common type and location of FBIs were food boluses (52.9%) and upper esophagus (36.5%), respectively. While eight patients (2.1%) developed major adverse events requiring hospital admission, the remainder (97.9%) were discharged after observation. No mortality occurred. Endoscopic success was achieved in 263 of 286 (91.9%) verified FBIs endoscopies. Endoscopic failure (8.04%) was associated with age, bone, disk battery, intentional ingestion, razor blade, prisoners, and stomach in the univariate analysis. Multivariate logistic regression revealed that intentional ingestion was associated with endoscopic failure (odds ratio: 7.31; 95% confidence interval = 2.06-25.99; P  = 0.002).

CONCLUSION

Endoscopy for FBIs is safe and successful, with low hospital admission rate in children, prisoners, and adults. Intentional ingestion is a risk factor of endoscopic failure.

When Meals Turn Into a Medical Mystery: A Case Report of Sigmoid Colon Impaction by a Chicken Bone

The presence of foreign objects in the digestive system can lead to various complications within the gastrointestinal (GI) tract. In certain cases, ingesting foreign objects can pose a significant dilemma for surgical teams, primarily because they can lead to blockages or punctures in the upper or lower sections of the GI tract. On occasion, foreign objects located in the lower regions of the digestive tract, such as the colon and rectum, might have entered via the anal pathway, thereby carrying the potential risk of causing perforations in the rectum or sigmoid colon. The other complications encompass the creation of abscesses, blockages in the bowel, fistula, and bleeding. Although these issues associated with foreign objects can arise in a healthy bowel, they can pose challenges in diagnosis when occurring in a bowel that is already affected by inflammation, constrictions, or malignancy. We present a unique case report of a 72-year-old female who presented to the emergency department with left lower quadrant pain associated with nausea and vomiting. Following a detailed clinical evaluation and radiographic imaging, a chicken bone was identified as the culprit, causing an unusual impaction in the sigmoid colon. The patient's medical history revealed no prior GI complications, making this case particularly noteworthy. Timely identification and precise diagnosis of complications arising from foreign bodies are essential to efficiently handle and prevent unfavorable consequences.

Decision-To-Scope Score: A novel tool with excellent accuracy in predicting foreign bodies in the esophagus

INTRODUCTION

Foreign body (FB) ingestion is a common indication for urgent esophagogastroduodenoscopy (EGD). Nevertheless, most pass spontaneously through the gastrointestinal (GI) tract. Differently from GI bleeding, there is no validated score aiming to identify "low-risk" patients in suspected FB ingestion. We aimed to create a score able to discriminate patients who are candidates to emergent EGD in this scenario.

METHODS

Retrospective study of consecutive patients admitted for suspected FB in the upper GI tract between 2016 and 2021. The evaluated outcome was endoscopic confirmation of FB in the esophagus. Variables significantly associated with the outcome on multivariate analysis were computed into a score predicting endoscopic confirmation.

RESULTS

We included 228 patients. From these, 97 (42.5%) had a confirmed FB in EGD. Time since ingestion <6 h (OR = 4.0; P = 0.042), absence of any meal after FB ingestion (OR = 7.1; P = 0.005), dysphagia (OR = 11.8; P < 0.001), odynophagia (OR = 4.6; P = 0.004), and drooling (OR = 15.1; P < 0.001) were independent predictors of confirmed FB. These variables were used to compute a FB predicting score-the Decision-To-Scope (DTS) Score: time since ingestion <6 h (+1 point), absence of meals (+2 points), dysphagia (+3 points), odynophagia (+1 point), and drooling (+4 points). DTS-Score had excellent accuracy to predict the outcome (AUC = 0.953; 95%CI = 0.928-0.977; P < 0.001). The optimal cutoff to identify low-risk patients was a score ≤5 (sensitivity 85.0% and specificity 94.7%).

CONCLUSIONS

More than half of the suspected FB were not confirmed by EGD. The DTS-Score presented excellent accuracy at stratifying patients' risk and may contribute to the decision to perform emergent EGD in suspected FB ingestion.

Accidental ingestion of an endodontic file: A case report and literary review

Ingestion and aspiration can be accidental or intentional events in both adults and children. Approximately 1500 people in the United States die from ingestion of foreign bodies annually. Patients with cognitive disabilities, neurological disorders, elderly age or incarcerated patients carry the highest risk of intentional and/or accidental ingestion of foreign objects. Although uncommon, ingestion of foreign objects during dental procedures can be potentially life-threatening and increased awareness is important. Sharp objects ingested from dental procedures can cause impaction, obstruction, hemorrhage, or perforation and may need endoscopic or surgical intervention. Herein we report a case of a 22-year-old male, who underwent routine dental cleaning and accidentally ingested an endodontic file, retrieved from the ascending colon endoscopically without complications.

Do not open wide; accidentally swallowed dental mold causing bowel obstruction. A case report

Foreign body ingestion is a common condition in daily practice; fortunately, most cases do not require endoscopic or surgical treatment, as most foreign bodies pass through the intestine without injuring it. Although mainly seen in children, adults can also be affected, especially in accidental situations and suicide attempts. Therefore, the clinical history and the environment in which the event occurred are essential for a rapid diagnosis. This can be even more challenging as most adult patients are rarely aware of ingestion. Therefore, a high index of suspicion is necessary. Therapy will depend on the foreign body’s size, shape and material; treatment should not be delayed if complications are detected. We present a case of a 34-year-old man who accidentally swallowed the mold of his teeth while undergoing a dental procedure. Subsequently, he presented with an intestinal obstruction that required surgery. Fortunately, he made a full recovery.

Emergent Endoscopy for Esophageal Foreign Body Removal: The Impact of Location

Background

Timely intervention is essential for the successful removal of ingested foreign bodies. Emergent endoscopy (EGD) is usually performed in the emergency department (ED), operating room (OR), intensive care unit (ICU), or endoscopy suite. However, because the endoscopy suite is not always available, this study investigated the impact of location outside of the endoscopy suite on the successful removal of ingested foreign bodies and other patient outcomes.

Methodology

We reviewed charts of patients who underwent EGD for foreign body removal at an academic quaternary center between January 01, 2012, and December 31, 2020. We defined successful EGD as retrieval of the foreign body at the first attempt and not requiring subsequent endoscopy or surgical intervention. We performed descriptive and inferential statistical analyses and conducted classification and regression trees to compare endoscopy procedure length (EPL) and hospital length of stay (HLOS) between different locations.

Results

We analyzed 77 patients, of whom 13 (17%) underwent endoscopy in the ICU, 46 (60%) in the OR, and 18 (23%) in the ED. Endoscopic removal failed in four (5%) patients. Endoscopy length was significantly shorter in the OR (67 (48-122) minutes) versus the ICU (158 (95-166) minutes, P = 0.004) and the ED (111 (92-155) minutes, P = 0.009). Time to procedure was similar if the procedure was performed in the ED (278 minutes), the ICU (331 minutes), or the OR (378 minutes). The median (interquartile range) of HLOS for the OR group (0.87 (0.54-2.03) days) was significantly shorter than the ICU group (2.26 (1.47-6.91) days, P = 0.007).

Conclusions

While performing endoscopy for esophageal foreign body removal in the OR may be associated with a shorter EPL and HLOS, no location was inferior for overall outcomes. Further prospective and randomized studies are needed to confirm our findings.

Liver abscess in the caudate lobe caused by a fishbone and treated by laparoscopy: a case report

Background

Ingestion of fish bones leading to gastric perforation and inducing abscess formation in the caudate lobe of the liver is very rare.

Case presentation

A 67-year-old man presented to our hospital with a 2-day history of subxiphoid pain. There were no specific symptoms other than pain. Laboratory tests showed only an increase in the number and percentage of neutrophils. Contrast-enhanced Computerized tomography (CT) of the abdomen showed two linear dense opacities in the gastric cardia, one of which penetrated the stomach and was adjacent to the caudate lobe of the liver, with inflammatory changes in the caudate lobe. We finally diagnosed his condition as a caudate lobe abscess secondary to intestinal perforation caused by a fishbone based on the history and imaging findings. The patient underwent 3D laparoscopic partial caudate lobectomy, incision and drainage of the liver abscess, and fishbone removal. The procedure was successful and we removed the fishbone from the liver. The patient was discharged on the 9th postoperative day without other complications.

Conclusions

Liver abscess caused by foreign bodies requires multidisciplinary treatment. Especially when located in the caudate lobe, we must detect and remove the cause of the abscess as early as possible. Foreign bodies that perforate the gastrointestinal tract can penetrate to the liver and cause abscess formation, as in this case. When exploring the etiology of liver abscesses, we should investigate the general condition, including the whole gastrointestinal tract.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12893-021-01457-z.

A stomach like a utility room: Case report

Background

Foreign body (FB) ingestion is an emergency that is more common in children and adults with mental disorders. A wide array of FBs can be ingested, and most of them do not need to be treated. However, if the FB blocks the digestive tract or causes damage, it needs to be removed by endoscopy or even surgery.We describe here a stomach full of FBs, but these FBs did not cause serious damage.

Case presentation

A 9-year-old male child with mental retardation suffered abdominal pain after swallowing FBs. X-ray and computed tomography (CT) found a large number of FBs of different shapes. We tried to remove them under endoscopy but failed; we then changed to laparotomy and removed a large number of FBs. The patient started normal feeding on the 4th day and was discharged home.

Conclusions

FB ingestion is very common. Symptoms are used to determine whether further treatment, which is usually feasible, is required. However, for patients who cannot accurately describe the ingestion of FBs, such as children, patients with mental disorders, and patients who are inebriated, FBs should still be treated with caution, especially when the clinical symptoms and related examinations are not typical, and adequate plans should be made, as shown in this case. There may be unexpected discoveries.

Upper gastrointestinal foreign bodies in adults: A systematic review

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).

The removal of foreign body ingestion in the upper gastrointestinal tract: a retrospective study of 1,182 adult cases

Background

Foreign body (FB) ingestion in the gastrointestinal tract is a common and urgent problem observed in children and adults. However, there may be difficulty locating FBs and complications associated with their removal. This study aimed to identify risk factors and complications correlated to the presence and removal of FBs.

Methods

This 5-year retrospective study enrolled 1,311 patients between June 2014 and April 2019. Demographic and endoscopic data were collected, containing age, gender, types and location of FBs, duration of FB ingestion, accessory devices, endoscopic methods, and complications. Logistic regression analysis was applied to evaluate the predictive risk factors.

Results

Among 1,131 patients, FBs were found in 90.16% of cases. A major predictor for the presence of FB was a presentation of less than 24 hours (h). The types of FBs were jujube pits (36.72%) and fish bones (22.00%), and over 80% of the FBs were discovered in the esophagus. Complications were found in 239 cases (20.22%), of which hemorrhage (162/239, 67.78%) was the most frequent. Age ≥60, duration ≥24 h, and FBs ingested in the esophagus were considered as risk factors for developing complications.

Conclusions

In conclusion, the longer duration, age ≥60, and impaction in the esophagus were risk factors for developing complications following the ingestion of FBs. These factors should be considered when developing assessment and treatment plans in the management of FB ingestion.