Endoscopic removal of a spoon from the stomach with a double-snare and balloon

A double-scope technique enabled a patient with an esophageal plastic fork foreign body to avoid surgery: a case report and review of the literature

Foreign body ingestion is a common problem, and endoscopic removal is often performed with ancillary equipment. However, long, sharp foreign bodies are much more difficult to remove endoscopically than other objects and require emergent surgery. A 68-year-old man with a history of distal gastrectomy accidentally swallowed a plastic fork. He complained of chest pain at the visit. The plastic fork was located between the thoracic esophagus and remnant stomach. Endoscopic removal of the plastic fork was considered difficult, and surgery was deemed necessary. However, we were able to avoid surgery to remove the object using two endoscopes with hoods and a polypectomy snare. The first endoscope covered the sharp edge with a hood, and the snare grasped the neck of the plastic fork. The second endoscope covered the remaining sharp tip. A single operator held the two endoscopes and the snare and pulled them out together. This new double-scope technique is simple and useful for removing long, sharp foreign bodies, such as forks, from the esophagus.

Endoscopic removal of a spoon from the stomach using a 2-channel endoscope

Video 1Endoscopic removal of a spoon from the stomach using a 2-channel scope, with simultaneous use of alligator forceps and an endoscopic snare.

Endoscopic Retrieval of Mis-Swallowed Table Spoon

Mis-swallowed foreign body is a common scenario for endoscopy intervention. Although a long object is rarely seen in our clinical setting, limited published articles could be found for proper retrieval. We hence report a 30-year-old female who mis-swallowed a long table spoon, which was retrieved by a snare from the duodenal second portion with conventional endoscopy.

Movement Disorder Associated With Foreign Body Ingestion

We present a case of recurrent bouts of irritability with arching, head extension, and lethargy in a previously healthy 10-month-old girl admitted to the PICU for acute onset of a movement disorder. The patient's vital signs and physical examination were unremarkable but recurrent bouts of abnormal movements persisted for the first 10 hours of admission in the PICU. Possible diagnoses, such as meningitis, status epilepticus, space occupying lesions, and toxic ingestions, were ruled out because of negative cerebrospinal fluid analysis, normal EEG, and negative results of other ancillary tests. On the second day of admission, an abdominal radiograph was obtained because intussusception was considered a probable diagnosis due to recurrent episodes of arching and lethargy. The abdominal radiograph revealed the presence of a 15-mm radiopaque foreign body in the right lower quadrant corresponding to the anatomic location of the ileocecal valve. The patient made an uneventful recovery after she spontaneously passed a 1.5 cm by 1 cm rock (15 mm) in her stool on the third day of admission. This case highlights the need for a high index of suspicion for unwitnessed ingestion of a foreign body in a previously healthy preschool child with sudden onset of a movement disorder.

Endoscopic removal of a tablespoon lodged within the duodenum

Here we report the case of a 34-year-old man who underwent endoscopic removal of a tablespoon from the stomach that was lodged within the duodenum. Removal required the use of a two-channel upper endoscope and polypectomy snares. Using the double-snare technique, the spoon was grasped at the proximal and distal parts of the handle. The double-snare was first pulled unsuccessfully and then pulled with simultaneous manual abdominal compression of the bulbus from the body surface. Compression was gently applied towards the stomach. As a result, the head of the spoon prolapsed from the bulbus, and was easily retracted from the stomach without any complications. In cases of foreign body lodging within the duodenum, the manual abdominal compression technique may help clinicians pull out the object and avoid surgery. The usefulness of manual compression is dependent on the foreign body’s sharpness and the location.

Application of imaging guidelines in patients with foreign body ingestion or inhalation: literature review

Ingestion, inhalation, and insertion of foreign bodies (FBs) are very common clinical occurrences. In any case, early diagnosis and prompt management are mandatory to avoid severe and life-threatening complications. Radiologists have an important role in revealing the presence, dimension, nature, and relationship with anatomical structures of a FB; selecting the most appropriate imaging modality; and enabling the best therapeutic choice. This review article focuses on the most frequent FBs ingested, inhaled, and inserted and presents the different tests and investigations to provide a correct radiological approach.

Travel of a mis-swallowed long spoon to the jejunum

Foreign-body ingestion is a relatively common presentation at emergency departments, but long metallic spoon swallowing is an infrequent occurrence. Unlike most cases of foreign-body ingestion, there have been no reported cases of long foreign bodies reaching the jejunum. We report a rare case of a coffee spoon that was swallowed accidentally and passed through the pylorus and duodenal loop and reached the jejunum, with no complications.

Simple endoscopic technique for retrieving a long foreign body from the stomach

BACKGROUND

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.

METHODS

We present a case of a young woman ingesting a spoon.

RESULTS

By using a single channel gastroscope, snare and altering the position of the operating table we were able to extract the long foreign body.

CONCLUSION

We describe an alternate, new technique that may help avoid a laparotomy in a patient presenting after ingestion of a retained gastric foreign body.

Pediatric foreign bodies and their management

Ingestion of foreign bodies is a common pediatric problem, with more than 100,000 cases occurring each year. The vast majority of pediatric ingestions are accidental; increasing incidence of intentional ingestions starts in the adolescent age group. In the United States, the most common pediatric foreign bodies ingested are coins, followed by a variety of other objects, including toys, toy parts, sharp objects, batteries, bones, and food. In adolescents and adults, meat or food impactions are the most common accidental foreign body ingestion. Esophageal pathology underlies most cases of food impaction. Management of foreign body ingestions varies based on the object ingested, its location, and the patient's age and size. Esophageal foreign bodies as a group require early intervention because of their potential to cause respiratory symptoms and complications, esophageal erosions, or even an aortoesophageal fistula. Ingested batteries that lodge in the esophagus require urgent endoscopic removal even in the asymptomatic patient due to the high risk of complications. Sharp foreign bodies increase the foreign body complication rate from less than 1% to 15% to 35%, except for straight pins, which usually follow a relatively benign course unless multiple pins are ingested. Magnets are increasingly ingested, due to their ubiquitous nature and the perception that they do not pose a risk. Ingestion of multiple magnets creates a significant risk of obstruction, perforation, and fistula development. Methods to deal with foreign bodies include the suture technique, the double snare technique, and the combined forceps/snare technique for long, large, and sharp foreign bodies, along with newer equipment, such as retrieval nets and a variety of specialized forceps.