Endoscopic foreign body retrieval from the caecum - A case report and push for intervention guidelines

Modern endoscopist’s toolbox: Innovations in foreign body removal

Foreign body ingestion is a common gastrointestinal emergency, particularly in children, who account for 80% of cases. While most ingested objects pass spontaneously, around 20% require medical intervention. In adults, incidents often occur accidentally during meals, leading to impactions, especially in individuals with underlying esophageal conditions. Endoscopy remains the gold standard for foreign body retrieval, with a success rate exceeding 95%. The type, shape, and location of the foreign body determine the clinical presentation and management approach. Sharp objects, batteries, and large items pose the highest risk of complications, including perforation, obstruction, and chemical injury. Prompt endoscopic removal is guided by established protocols, with emergent intervention required for complete esophageal obstruction and high-risk objects. Various retrieval devices, including forceps, snares, baskets, and overtubes, are used based on the nature of the foreign body. Technological advancements, such as artificial intelligence-assisted imaging and endoscopic ultrasound, are improving diagnostic precision and procedural outcomes. Despite these advances, foreign body ingestion can still lead to severe complications if not managed in a timely manner. Public awareness, preventive measures, and rapid medical response are essential in reducing morbidity and mortality associated with foreign body ingestion.

Endoscopic lavage for an infected pelvic hematoma in a patient with pelvic sepsis after anterior pelvic exenteration

Anastomotic leakage and subsequent pelvic sepsis are serious complications after surgery for pelvic malignancies, particularly challenging due to the large pelvic cavity dead space post-exenteration. We report a 47-year-old man treated for a severely infected pelvic hematoma and sepsis following anastomotic leakage after anterior pelvic exenteration. Post robot-assisted exenteration for locally advanced sigmoid colon cancer treated with neoadjuvant chemotherapy, a pelvic abscess from anastomotic dehiscence was identified. Initial CT-guided drainage and subsequent laparoscopic drainage were performed. On postoperative day 22, a bleeding left internal iliac pseudoaneurysm required embolization. Despite these efforts, the sepsis worsened due to an enlarged, infected hematoma. Endoscopic lavage, in collaboration with skilled endoscopists, successfully removed the hematoma, leading to an improved inflammatory response, and the patient was discharged. Endoscopic lavage proved to be the safest and most effective treatment for pelvic sepsis with an infected hematoma after various attempted interventions.