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Chen S, Ying S, Xian C, Li Y, Jiang W. Removal of an embedded gastric fishbone by traction-assisted endoscopic full-thickness resection. Endoscopy 2024; 56:E232-E233. [PMID: 38458241 PMCID: PMC10923630 DOI: 10.1055/a-2268-5934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Affiliation(s)
- Shuzhen Chen
- Department of Gastroenterology and Hepatology, Guangzhou Digestive Disease Center, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Songsong Ying
- Department of Gastroenterology and Hepatology, Guangzhou Digestive Disease Center, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Cailian Xian
- Department of Gastroenterology and Hepatology, Guangzhou Digestive Disease Center, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Yongqiang Li
- Department of Gastroenterology and Hepatology, Guangzhou Digestive Disease Center, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Wenyan Jiang
- Department of Ultrasound, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
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2
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Shi C, Raza S, Tieniber A, Chau P, Fogt F. Ingested foreign bodies mimicking inflammatory bowel disease. J Clin Pathol 2024:jcp-2024-209531. [PMID: 38839087 DOI: 10.1136/jcp-2024-209531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 05/20/2024] [Indexed: 06/07/2024]
Affiliation(s)
- Chenxu Shi
- Department Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Shariq Raza
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Andrew Tieniber
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Pak Chau
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Franz Fogt
- Department Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Hoey P, Ryan K, McDonald C, Brown NJ, Boon K, Grimpen F, Appleyard M. Repeated intentional foreign body ingestion, what can be done? Emerg Med Australas 2024. [PMID: 38837326 DOI: 10.1111/1742-6723.14451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 02/02/2024] [Accepted: 05/21/2024] [Indexed: 06/07/2024]
Abstract
Repeated intentional foreign body ingestion (RIFBI) in patients with Emotionally Unstable Personality Disorder (EUPD) is a common clinical presentation to the emergency department. The relationship between repeated foreign body ingestion and a co-existent personality disorder diagnosis is complex, making it challenging to manage. Our institution implemented a novel interdisciplinary model of care for RIFBI as a way of improving health outcomes in this cohort of patients. Our observations following the model of care are presented herein. We encourage other health networks to adopt this model of care for managing RIBFI in EUPD.
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Affiliation(s)
- Paris Hoey
- Department of Gastroenterology and Hepatology, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Kimberley Ryan
- Department of Gastroenterology and Hepatology, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Clancy McDonald
- Emergency & Trauma Centre, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Nathan J Brown
- Emergency & Trauma Centre, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Kym Boon
- Consultant Liaison Psychiatry, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Florian Grimpen
- Department of Gastroenterology and Hepatology, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Mark Appleyard
- Department of Gastroenterology and Hepatology, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
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4
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Wei P, Song H, Ren Y. Ingestion of a diamond ring in a child. Asian J Surg 2024; 47:2841-2842. [PMID: 38378411 DOI: 10.1016/j.asjsur.2024.02.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/02/2024] [Indexed: 02/22/2024] Open
Affiliation(s)
- Penghui Wei
- Department of Anesthesiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Haicheng Song
- Department of Heart Center, Women and Children's Hospital, Qingdao University, Qingdao, China
| | - Yueyi Ren
- Department of Heart Center, Women and Children's Hospital, Qingdao University, Qingdao, China.
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Su W, Jiang Q, Yang X, Wang Y, Hu J, Gao P, Hu H, Zhou P, Lin S. The safety and efficacy of endoscopic submucosal fenestration in the treatment of completely embedded upper gastrointestinal foreign body. Surg Endosc 2024:10.1007/s00464-024-10899-4. [PMID: 38811429 DOI: 10.1007/s00464-024-10899-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 05/02/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Upper gastrointestinal foreign body ingestion is a common digestive tract emergency, of which completely embedded ones were challenging for most endoscopists. We aim to evaluate the efficacy and safety of endoscopic submucosal fenestration in the treatment of completely embedded upper gastrointestinal foreign bodies. METHODS From December 2018 to December 2021, 19 patients with completely embedded upper gastrointestinal foreign bodies who underwent endoscopic submucosal fenestration in Zhongshan Hospital, Fudan University were included. The safety, efficacy, and outcome were retrospectively reviewed. RESULTS Among the 19 patients, 15 foreign bodies were embedded in the esophagus, 3 located in the gastric wall, and 1 located in the duodenal bulb. The foreign bodies were successfully managed in 12 cases, and 7 failed after attempts of repeated exploration. Two cases confirmed completely traversing into the mediastinum were successfully removed after transfer to surgery. One case had retrieval of a foreign body in a half-year examination. Till now, 3 failed patients had great relief of symptoms and only one patient claimed occasional thoracodynia. Of note, there were neither serious adverse events, nor long-term complications during the follow-up. CONCLUSION In disposing of foreign bodies completely embedded in the upper gastrointestinal tract, ESF is a safe and effective alternative to surgery.
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Affiliation(s)
- Wei Su
- Zhongshan Hospital Fudan University Endoscopy Center, Shanghai, 200032, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, 200032, China
| | - Qi Jiang
- Zhongshan Hospital Fudan University Endoscopy Center, Shanghai, 200032, China
- Endoscopic Center, Zhongshan Hospital (Xiamen Branch), Fudan University, Xiamen, 361015, China
| | - Xia Yang
- Zhongshan Hospital Fudan University Endoscopy Center, Shanghai, 200032, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, 200032, China
| | - Yun Wang
- Zhongshan Hospital Fudan University Endoscopy Center, Shanghai, 200032, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, 200032, China
| | - Jianwei Hu
- Zhongshan Hospital Fudan University Endoscopy Center, Shanghai, 200032, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, 200032, China
| | - Pingting Gao
- Zhongshan Hospital Fudan University Endoscopy Center, Shanghai, 200032, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, 200032, China
| | - Hao Hu
- Zhongshan Hospital Fudan University Endoscopy Center, Shanghai, 200032, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, 200032, China
| | - Pinghong Zhou
- Zhongshan Hospital Fudan University Endoscopy Center, Shanghai, 200032, China.
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, 200032, China.
| | - Shengli Lin
- Zhongshan Hospital Fudan University Endoscopy Center, Shanghai, 200032, China.
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, 200032, China.
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Tola GG, Tesso BA, Moges TG, Abebe DM. An extraluminal migration of a gastrointestinal foreign body to the anterior abdominal wall: A rare case report. Int J Surg Case Rep 2024; 120:109794. [PMID: 38796941 DOI: 10.1016/j.ijscr.2024.109794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 05/16/2024] [Accepted: 05/21/2024] [Indexed: 05/29/2024] Open
Abstract
INTRODUCTION Ingested foreign bodies fail to pass spontaneously through the gastrointestinal tract in about 20 % of the cases and result in complications in about 1 % of the cases. One of the complications is the migration of the foreign body to the adjacent structure. CASE PRESENTATION A 25-year-old female lady presented to our hospital with a 15-cm-long coilable and insulated electrical wire foreign body in her abdomen, which extended from the descending colon to the right upper quadrant abdominal wall. Intra-abdominally, the object was located in the general peritoneum without penetrating the bowel or vascular structure. It was complicated by an abdominal wall abscess without any collection in the general peritoneum. The foreign body was then successfully retracted from the abdomen through a right upper quadrant incision without any complications thereafter. CLINICAL DISCUSSION The uncomplicated passage of foreign bodies through the gastrointestinal tract largely depends on the types of objects. Sharp, elongated objects are more likely to be arrested in the bowel commonly at the point of acute angulation and narrowing. The stacked foreign body may then result in different complications, including penetration and migration of the object. Migration of an insulated electrical wire to the anterior abdominal wall, which we encountered, is extremely rare and can pose a difficulty and dilemma in deciding on management options. CONCLUSION For an externally accessible, migrated intra-abdominal foreign body that does not result in peritonitis and is confirmed to be located out of the bowel, an exploratory laparotomy could be avoided.
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Affiliation(s)
- Gutu Ganati Tola
- Department of Surgery, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia.
| | - Birhanu Abdisa Tesso
- Department of Surgery, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Tadesse Girma Moges
- Department of Surgery, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Dabessa Mosissa Abebe
- Department of Surgery, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
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Pokharel S, KC S, Lamichhane S, Pokharel M, Sah RP, Yadav SK, Bhusal A, Poudel S, Shah SK, Pokharel M. Asymptomatic spontaneous expulsion of a long foreign body through the gastrointestinal tract - a curious case report. Radiol Case Rep 2024; 19:1940-1944. [PMID: 38449486 PMCID: PMC10915782 DOI: 10.1016/j.radcr.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
Foreign body ingestion and its natural elimination are common in children. However, this is uncommon for long foreign bodies. Here, we report the spontaneous removal of an ingested pencil in an asymptomatic child. To our knowledge, this is the first case report of asymptomatic spontaneous elimination of a normally-sized ingested pencil. A 7-year-old male child presented with a history of ingestion of a pencil 4 hours back, without any complaints. Immediate abdominal radiography revealed a pencil in the stomach with an estimated length of approximately 10 cm and no signs of complications. He was conservatively treated under a semi-solid diet, presumably due to lack of available endoscopic option. Subsequently, he passed the pencil in stool within 24 hours of ingestion. He was asymptomatic and playful during the course and at discharge. Conservative management of a quickly moving long foreign body initially located below the esophagus in an asymptomatic child is possible with the help of imaging guidance, particularly in settings lacking an endoscopy. Although, this should not be considered a norm. However, this suggests that the treatment of ingested foreign bodies must be individualized. Thus, multiple factors related to the child and the foreign body must be assessed before committing to invasive procedures like laparotomy. Similarly, plain X-rays can be helpful even for radiolucent foreign bodies, for diagnosis and ruling out complications. All of these are vital in underdeveloped countries, where endoscopy and computed tomography facilities might be either lacking or unaffordable by patients.
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Affiliation(s)
- Sushan Pokharel
- Department of Pediatric Surgery Division, Department of General Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Suraj KC
- Department of Pediatric Surgery Division, Department of General Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Samiksha Lamichhane
- Department of Radiodiagnosis and Imaging, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Mohir Pokharel
- Department of General Surgery, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
| | - Rajesh P. Sah
- Department of Pediatric Surgery Division, Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Sanjaya K. Yadav
- Department of Pediatric Surgery Division, Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Amrit Bhusal
- Department of Radiodiagnosis and Imaging, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Sishir Poudel
- Department of Pediatric Surgery Division, Department of General Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Siddhartha K. Shah
- Department of Pediatric Surgery Division, Department of General Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Moneec Pokharel
- Birat Medical College and Teaching Hospital, Biratnagar, Nepal
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Redd WD, McCallen JD, Xue Z, Kiran A, Barlowe TS, Reed CC, Eluri S, Dellon ES. Association between time from esophageal food impaction to endoscopy and adverse events. Gastrointest Endosc 2024; 99:525-536.e3. [PMID: 37951280 PMCID: PMC10954388 DOI: 10.1016/j.gie.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/20/2023] [Accepted: 11/07/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND AND AIMS Guidelines recommend emergent or urgent EGD for esophageal food impaction (EFI), but data on how time to EGD impacts the risk of adverse events remain limited. We determined whether EFI-to-EGD time was associated with adverse events. METHODS In this retrospective cohort study of patients with endoscopically confirmed EFI, adverse events were classified as esophageal (mucosal tear, bleeding, perforation) or extraesophageal (aspiration, respiratory compromise, hypotension, arrhythmia). Esophageal perforation and extraesophageal adverse events requiring intensive care unit admission were classified as serious adverse events. Baseline characteristics, event details, and procedural details were compared between patients with and without adverse events. Multivariable logistic regression was performed to assess for an association between EFI-to-EGD time and adverse events. RESULTS Of 188 patients with EFI, 22 (12%) had any adverse event and 2 (1%) had a serious adverse event. Patients with adverse events were older and more likely to have an esophageal motility disorder, to tolerate secretions at presentation, and to have a higher American Society of Anesthesiologists score. EFI-to-EGD time was similar in those with and without adverse events. On multivariable analysis, EFI-to-EGD time was not associated with adverse events (odds ratio, 1.00 [95% confidence interval, .97-1.04] for 1-hour increments; odds ratio, 1.03 [95% confidence interval, .86-1.24] for 6-hour increments). Results were similar after stratifying by eosinophilic esophagitis status and after adjusting for possible confounders. CONCLUSIONS Because the time from EFI to EGD is not associated with adverse events, emergent EGD for EFI may be unnecessary, and other considerations may determine EGD timing.
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Affiliation(s)
- Walker D. Redd
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Justin D. McCallen
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Zeyun Xue
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Akshatha Kiran
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Trevor S. Barlowe
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Craig C. Reed
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Swathi Eluri
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Evan S. Dellon
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC
- Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine; University of North Carolina School of Medicine, Chapel Hill, NC
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Philibert-Rosas S, Podolsky Rapoport I. Endoscopic Management of a Long-Duration Esophageal Food Impaction: A Case Report. Cureus 2024; 16:e58829. [PMID: 38784321 PMCID: PMC11114089 DOI: 10.7759/cureus.58829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 05/25/2024] Open
Abstract
Foreign object ingestion (FOI) is a potentially life-threatening pathology that affects all ages, from children to older adults. The classification includes true FOI and esophageal food impaction (EFI), and each presents unique challenges. Endoscopic intervention is often required to prevent complications. Flexible endoscopes are the preferred management tool, ensuring a high success rate and safety. The following text presents a case of a 48-year-old male with a 5-day undiagnosed esophageal food impaction and the approach taken.
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10
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Chen Z, Yin M, Xia P, Han X, Zhu H. Nomogram for Predicting the Risk of Complications after Endoscopic Foreign Body Removal from the Adult Upper Gastrointestinal Tract. Dig Dis Sci 2024; 69:1361-1371. [PMID: 38418681 DOI: 10.1007/s10620-024-08343-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/05/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Ingested foreign bodies may become impacted in the upper gastrointestinal tract, requiring endoscopic removal. AIMS To establish and validate a nomogram to determine the risk of complications following endoscopic foreign body removal. METHODS We retrospectively analyzed the data of 1510 adult patients who underwent endoscopic removal of ingested foreign bodies between January 2019 and December 2022. All participants were randomly allocated in a 7:3 ratio to the training (n = 1057) and validation (n = 453) cohorts. A nomogram for the development of major complications associated with endoscopic foreign body removal was established based on risk factors identified by logistic regression analysis. RESULTS Four independent risk factors for the development of major complications were identified by multivariate regression analysis: older age, impaction time > 24 h, type of foreign body (animal bones and jujube pits), and number of pressure points exerted on the digestive tract wall (one and ≥ two). The nomogram constructed using these factors showed favorable discriminatory values, with an area under the curve of 0.76 (95% confidence interval, 0.73-0.78) in the training cohort and 0.74 (95% confidence interval, 0.72-0.76) in the validation cohort. CONCLUSIONS Older patients who ingested bones or jujube pits with more pressure points exerted on the digestive tract wall more than 24 h earlier should be considered most at risk of major complications after endoscopic removal of foreign bodies. The nomogram established in this study can be conveniently used to assess patients and develop treatment plans for the management of foreign body ingestion.
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Affiliation(s)
- Zhe Chen
- Department of Gastroenterology, Affiliated Hospital of Nantong University, Nantong, 226000, China
| | - Minhao Yin
- Department of Gastroenterology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210000, Jiangsu Province, China
| | - Peichen Xia
- Department of Gastroenterology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210000, Jiangsu Province, China
| | - Xu Han
- Department of Gastroenterology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210000, Jiangsu Province, China
| | - Hong Zhu
- Department of Gastroenterology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210000, Jiangsu Province, China.
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Lambe G, Dempsey P, Bolger M, Bolster F. Self-harm, suicide and brain death: the role of the radiologist. Clin Radiol 2024; 79:239-249. [PMID: 38341342 DOI: 10.1016/j.crad.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 02/12/2024]
Abstract
Suicide is a leading cause of death worldwide and takes many forms, which include hanging, jumping from a height, sharp force trauma, ingestion/poisoning, drowning, and firearm injuries. Self-harm and suicide are associated with particular injuries and patterns of injury. Many of these patterns are apparent on imaging. Self-harm or suicidal intent may be overlooked initially in such cases, particularly when the patient is unconscious or uncooperative. Correct identification of these findings by the radiologist will allow a patient's management to be tailored accordingly and may prevent future suicide attempts. The initial role of the radiologists in these cases is to identify life-threatening injuries that require urgent medical attention. The radiologist can add value by drawing attention to associated injuries, which may have been missed on initial clinical assessment. In many cases of self-harm and suicide, imaging is more reliable than clinical assessment. The radiologist may be able to provide important prognostic information that allows clinicians to manage expectations and plan appropriately. Furthermore, some imaging studies will provide essential forensic information. Unfortunately, many cases of attempted suicide will end in brain death. The radiologist may have a role in these cases in identifying evidence of hypoxic-ischaemic brain injury, confirming a diagnosis of brain death through judicious use of ancillary tests and, finally, in donor screening for organ transplantation. A review is presented to illustrate the imaging features of self-harm, suicide, and brain death, and to highlight the important role of the radiologist in these cases.
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Affiliation(s)
- G Lambe
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
| | - P Dempsey
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - M Bolger
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - F Bolster
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
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12
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Bhumi S, Mago S, Mavilia-Scranton MG, Birk JW, Rezaizadeh H. Esophageal Button Battery Retrieval: Time-In May Not Be Everything. Cureus 2024; 16:e58327. [PMID: 38752048 PMCID: PMC11094668 DOI: 10.7759/cureus.58327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 05/18/2024] Open
Abstract
The management of ingested foreign bodies is a challenging task because each case is unique with multiple varying factors including a patient's age, anatomical considerations, clinical presentation, and the type and location of the foreign body ingested. Additionally, concern over complications associated with button battery ingestion typically drives management decisions. The common practice is the urgent retrieval of the foreign body within two to six hours of presentation. An unusual case is presented here that demonstrated significantly delayed endoscopic removal of an ingested button battery without complication, avoiding the many risks associated with any emergent endoscopic procedure. However, this practice is a case-by-case decision because there is a lack of literature to guide the current management.
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Affiliation(s)
- Sriya Bhumi
- Gastroenterology and Hepatology, New York Presbyterian, Queens, USA
| | - Sheena Mago
- Gastroenterology and Hepatology, Allegheny Health Network, Pittsburgh, USA
| | | | - John W Birk
- Gastroenterology and Hepatology, University of Connecticut Health, Farmington, USA
| | - Houman Rezaizadeh
- Gastroenterology and Hepatology, University of Connecticut Health, Farmington, USA
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13
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Rustemov D, Bilal R, Tukinov R, Nekessov A, Dzhenalaev D, Ermeshev E, Mukhamedov Z, Mustafinov D, Utebaliev R, Sakuov Z, Kaliev B. Case Report: Unique management strategy for rare case of esophageal foreign body. Front Surg 2024; 11:1370876. [PMID: 38505410 PMCID: PMC10948502 DOI: 10.3389/fsurg.2024.1370876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/20/2024] [Indexed: 03/21/2024] Open
Abstract
Background Foreign bodies that enter the esophagus can cause serious complications that may require extensive surgical intervention, including open surgery. The treatment method depends on the location, size, configuration, and number of foreign bodies in the esophagus, but to date, the best method to remove foreign bodies from the esophagus remains uncertain. Foreign bodies which can damage the walls of esophagus varies from bones and bone fragments, to metallic objects and batteries. In this article, we present a rare case of a "fish bone" penetrating through the esophagus walls and directly punctured the aorta, forming a post-traumatic saccular pseudoaneurysm of the descending thoracic aorta, which was successfully treated with endovascular stent placement to the aorta and with endoscopic foreign body removal. Case summary We reported a case of a 16-year-old male with a 6-day history of chest pain after consuming fish. As result of immediate test in regional hospital using oral flexible esophagogastroduodenoscopy abnormalities were not reported. Due to persistence of beforementioned symptoms, a fiberoptic esophagogastroduodenoscopy was performed 3 days later, revealing a 1.5-2.0 cm long altered area with contact bleeding 33.0 cm from the incisors, but no visualization of any foreign body. Computed tomography revealed a fish bone that had completely passed through walls of the esophagus and punctured the aortic wall, forming an aneurysm. Patient was urgently hospitalized by air ambulance to our hospital for high-specialized medical intervention after 6 days. After the endovascular placement of a stent graft, the fish bone was successfully removed by endoscopic intervention. 12 months follow up showed no abnormalities. Conclusion Endoscopic removal of foreign bodies in the esophagus and extracting a foreign body after thoracic endovascular aortic stent may be a feasible option for some cases.
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Affiliation(s)
- Dastan Rustemov
- Clinical Academic Department of Pediatric Surgery, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
| | - Ruslan Bilal
- Department of Medicine, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Ruslan Tukinov
- Clinical Academic Department of Radiology and Nuclear Medicine, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
| | - Adilzhan Nekessov
- Clinical Academic Department of Pediatric Surgery, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
| | - Damir Dzhenalaev
- Clinical Academic Department of Pediatric Surgery, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
| | - Erbulat Ermeshev
- Clinical Academic Department of Radiology and Nuclear Medicine, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
| | - Zarip Mukhamedov
- Clinical Academic Department of Pediatric Surgery, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
| | - Dulat Mustafinov
- Clinical Academic Department of Pediatric Surgery, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
| | - Ruslan Utebaliev
- Resuscitation and Intensive Care Unit, Clinical Academic Department Pediatric Anesthesiology, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
| | - Zhenis Sakuov
- Resuscitation and Intensive Care Unit, Clinical Academic Department Pediatric Anesthesiology, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
| | - Baurzhan Kaliev
- Clinical Academic Department of Radiology and Nuclear Medicine, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
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14
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Sbeit W, Basheer M, Shahin A, Makanovitsky D, Khoury T. Predictors of spontaneous passage of ingested foreign bodies in adults: twelve years of experience. Surg Endosc 2024; 38:1533-1540. [PMID: 38272975 DOI: 10.1007/s00464-023-10657-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/22/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Foreign body ingestion in adults is commonly encountered in clinical practice. The therapeutic approach of whether to follow-up or extract is often controversial. AIM We aimed to explore predictors for spontaneous passage of ingested foreign bodies by focusing on foreign body type, length, and location of impaction. METHODS We performed a 12-year retrospective single-center study. Logistic regression analysis was done to identify predictors of spontaneous passage. RESULTS Overall, 365 patients with foreign body ingestion were included. The rate of spontaneous passage was 53.7% in general, while the spontaneous passage rate was 47.9% in food impaction, 44.3% in sharp objects, 88.7% in blunt objects and only 22.2% in long blunt objects (> 6 cm). On regression analysis, esophageal location was associated with a higher impaction rate and lower spontaneous passage vs. stomach and small and large intestine (OR 0.15, 95% CI 0.07-0.31, OR 0.18, 95% CI 0.09-0.37 and OR 0.02, 95% CI 0.003-0.14), respectively. Performing Receiver operating characteristics (ROC) analysis found that the maximal length above which the foreign body will fail to pass spontaneously was 3.5 cm in the stomach and 3 cm in the small intestine, with area under the curve (AUC) of 0.8509 in stomach and 0.8073 in small intestine. CONCLUSION Endoscopic removal was needed for all esophageal foreign bodies, and all foreign bodies more than 3.5 cm above the duodenum. Spontaneous passage of ingested foreign body in a selected cohort of patients depends on foreign body type, location, and length.
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Affiliation(s)
- Wisam Sbeit
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Maamoun Basheer
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Amir Shahin
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Denis Makanovitsky
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Tawfik Khoury
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel.
- Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.
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15
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Watanabe A, Nakamatsu D, Nishida T, Fujii Y, Osugi N, Matsumoto K, Yamamoto M, Fukui K. Endoscopic Removal and Conservative Treatment of a Small Bowel Perforation Caused by a Toothpick: A Case Report. Cureus 2024; 16:e57254. [PMID: 38686238 PMCID: PMC11057516 DOI: 10.7759/cureus.57254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2024] [Indexed: 05/02/2024] Open
Abstract
This case report describes a unique instance of small bowel perforation in a 49-year-old woman caused by an ingested toothpick. Initially suspected of colonic diverticulitis, a final diagnosis of small bowel perforation was made later, and the toothpick was successfully removed via endoscopy. This case emphasizes the need to consider foreign body ingestion in the differential diagnosis of abdominal pain and demonstrates the feasibility of conservative endoscopic approaches in similar cases.
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Affiliation(s)
- Asuka Watanabe
- Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, JPN
| | - Dai Nakamatsu
- Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, JPN
| | - Tsutomu Nishida
- Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, JPN
| | - Yoshifumi Fujii
- Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, JPN
| | - Naoto Osugi
- Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, JPN
| | - Kengo Matsumoto
- Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, JPN
| | | | - Koji Fukui
- Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, JPN
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16
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Luo DH, Fang LN, Mao XL, Ye LP, Wang J. Endoscopic Submucosal Excavation of Submucosal Foreign Bodies in the Sigmoid Colon. Dig Dis Sci 2024; 69:650-652. [PMID: 38190071 DOI: 10.1007/s10620-023-08227-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/28/2023] [Indexed: 01/09/2024]
Affiliation(s)
- Ding-Hai Luo
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Li-Na Fang
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Xin-Li Mao
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Li-Ping Ye
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Jun Wang
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China.
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17
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Syamal MN. Adult Esophageal Foreign Bodies. Otolaryngol Clin North Am 2024:S0030-6665(24)00003-3. [PMID: 38350826 DOI: 10.1016/j.otc.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
This manuscript reviews and outlines the necessary tools to efficiently assess and manage an adult patient where an esophageal foreign body is suspected. It reviews the vulnerable populations and relevant diagnostics and provides a triage diagram to aid in timely intervention. Management with esophagoscopy is reviewed as well as potential complications that may arise. Lastly, to illustrate the concepts of this section, a case study is presented to highlight the salient points.
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Affiliation(s)
- Mausumi N Syamal
- Laryngology, Department of Otorhinolaryngology, Division of Laryngology, Rush University Medical Center, 1611 West Harrison Street, Suite 550, Chicago, IL 60612, USA.
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18
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Tong CW, Alhayo S, Chu F. Incidental Finding of a Fish Bone Perforation in the Pylorus Mimicking Acute Cholecystitis. Cureus 2024; 16:e54596. [PMID: 38384865 PMCID: PMC10880048 DOI: 10.7759/cureus.54596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 02/23/2024] Open
Abstract
We present a case of a 43-year-old man with Crohn's disease who presented with epigastric and right upper quadrant abdominal pain, initially suspected to be acute cholecystitis or a Crohn's flare-up. CT revealed a curvilinear, hyperdense foreign body adjacent to the duodenum, concerning micro-perforation. Endoscopic examination confirmed findings of a 3 cm fish bone lodged in the pylorus. Endoscopic extraction was successful without significant mucosal damage, and the patient recovered well postoperatively. This case highlights the rarity of pyloric perforation secondary to fish bone ingestion and highlights the importance of considering this diagnosis in patients presenting with unexplained acute abdominal pain, as prompt recognition and intervention are essential for favorable outcomes.
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Affiliation(s)
- Chai Wei Tong
- Department of Surgery, St. George Hospital, Sydney, AUS
- Faculty of Medicine and Health, University of New South Wales, Sydney, AUS
| | - Sam Alhayo
- Department of Upper Gastrointestinal Surgery, St. George Hospital, Sydney, AUS
- Department of Upper Gastrointestinal Surgery, University of New South Wales, St. George and Sutherland Clinical School, Sydney, AUS
| | - Francis Chu
- Department of Upper Gastrointestinal Surgery, St. George Hospital, Sydney, AUS
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19
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Sum SCM, Hort A, Tsakanov S. A unique operative approach to a retained gastrointestinal foreign body. ANZ J Surg 2024; 94:250-251. [PMID: 37803489 DOI: 10.1111/ans.18712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/16/2023] [Accepted: 09/19/2023] [Indexed: 10/08/2023]
Affiliation(s)
| | - Amy Hort
- Department of Surgery, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Sergei Tsakanov
- General Surgery Auburn Hospital and Canterbury Hospital, Sydney, New South Wales, Australia
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20
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Chen H, Zeng Y. Letter to the Editor: Hepatic Abscess Caused by the Migration of a Fish Bone. Surg Infect (Larchmt) 2024; 25:79-80. [PMID: 38153971 DOI: 10.1089/sur.2023.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023] Open
Affiliation(s)
- Hao Chen
- Department of Liver Surgery and Laboratory of Liver Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Zeng
- Department of Liver Surgery and Laboratory of Liver Surgery, West China Hospital, Sichuan University, Chengdu, China
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21
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Schulte K, Wolf HW. Occurrence of multiple fistulas decades after ingestion and neglect of numerous thermometers: a case report. Surg Case Rep 2024; 10:4. [PMID: 38165519 PMCID: PMC10761639 DOI: 10.1186/s40792-023-01801-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/24/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Ingestion of thermometers is a very rare occurrence and associated with penetrations of hollow organs. An event decades ago can lead to the development of fistulas. CASE PRESENTATION We present a case of a 62-year-old male who swallowed multiple thermometers with a length of up to 22 cm over a period of 40 years. Diagnostic imaging presented a retroperitoneal abscess due to a duodenal perforation of the longest thermometer as well as multiple other thermometers stuck in the small intestine. After all thermometers were removed and the abscess drained, the patient showed a clinical deterioration. In further operations we found a duodeno-sigmoid fistula and a gastro-thoracal fistula, which were not visible in the initial operations and imaging. CONCLUSION We recommend an active search for fistulas especially in the case of long-foregone ingestion.
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Affiliation(s)
- Katrin Schulte
- General and Visceral Surgery, Cantonal Hospital Aarau, Tellstrasse 25, 5001, Aarau, Switzerland.
| | - Henning Wendelin Wolf
- General and Visceral Surgery, Cantonal Hospital Aarau, Tellstrasse 25, 5001, Aarau, Switzerland
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22
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Terkelsen JH, Hollænder M, Bredal K, Nielsen SM, Thomsen KVK, Baggerman A, Ofverlind E, Koc AM, Pakes H, Mahdi MB, Larsen SØ, Gonzalez VP, Riis J, Frandsen LT, Melgaard D, Krarup AL. A retrospective cohort study on oesophageal food bolus obstruction in the North Denmark region in 2021-two thirds were never diagnosed with a cause. BMC Gastroenterol 2024; 24:3. [PMID: 38166672 PMCID: PMC10759704 DOI: 10.1186/s12876-023-03077-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Food bolus obstruction (FBO) leading to hospital treatment is often associated with eosinophilic oesophagitis (EoE), stenosis, or oesophageal cancer (1). Danish national guidelines recommend that patients with FBO undergo a diagnostic upper endoscopy within two weeks of presentation to exclude possible malignancy, and histological evaluation of eight biopsies (2, 3). AIMS The aims of this study were to (1) report the incidence and describe the causes and treatment of FBO in the North Denmark Region (NDR), (2) determine the proportion of patients who underwent upper endoscopy and biopsy according to regional and national guidelines, and (3) identify International Classification of Diseases 10th Revision (ICD-10) diagnosis and procedure codes applied to the hospital visits due to FBO in the NDR. METHODS Among all acute hospital visits in the NDR in 2021, all visits with ICD-10 codes possibly reflecting FBO, as well as a random sample of 14,400 visits with unspecific ICD-10 codes (R and Z codes), were screened manually for possible FBO. Diagnosis, follow-up, and treatment of all patients with FBO were recorded. RESULTS The median patient age was 66.0 (Q1-Q3: 49.8-81.0) years, and half of the patients had experienced FBO before. Two thirds of patients (66.0%) were never diagnosed with a cause of FBO, followed by 17.3% with EoE. 30% of patients did not undergo upper endoscopy within two weeks of the hospital visit, and 50.7% were never biopsied in the oesophagus. Of 1886 hospital visits with registry ICD-10 codes that possibly reflected FBO, 8.4% were due to FBO, while FBO was present in 0.028% of the random sample of unspecific ICD-10 codes. CONCLUSIONS Most hospitalized FBO patients in the NDR in 2021 were never diagnosed with a cause. In these patients there is a high risk of overlooked EoE or upper gastrointestinal cancers. The area needs immediate focus and changed routines to improve treatment and prevent new FBO.
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Affiliation(s)
| | - Martin Hollænder
- School of Medicine and Health, Aalborg University, Aalborg, Denmark
| | - Kasper Bredal
- School of Medicine and Health, Aalborg University, Aalborg, Denmark
| | | | - Kristoffer Vittrup Koed Thomsen
- Department of Emergency Medicine and Trauma Center, Aalborg University Hospital, Hobrovej 18-22, DK-9000, Aalborg, Denmark
- School of Medicine and Health, Aalborg University, Aalborg, Denmark
| | - Amanda Baggerman
- Department of Emergency Medicine and Trauma Center, Aalborg University Hospital, Hobrovej 18-22, DK-9000, Aalborg, Denmark
| | - Emilia Ofverlind
- School of Medicine and Health, Aalborg University, Aalborg, Denmark
| | - Alptug Mertcan Koc
- Department of Emergency Medicine and Trauma Center, Aalborg University Hospital, Hobrovej 18-22, DK-9000, Aalborg, Denmark
| | - Hannah Pakes
- Department of Emergency Medicine and Trauma Center, Aalborg University Hospital, Hobrovej 18-22, DK-9000, Aalborg, Denmark
| | - Marco Bassam Mahdi
- Department of Emergency Medicine and Trauma Center, Aalborg University Hospital, Hobrovej 18-22, DK-9000, Aalborg, Denmark
- School of Medicine and Health, Aalborg University, Aalborg, Denmark
| | - Sanne Ørnfeldt Larsen
- Department of Emergency Medicine and Trauma Center, Aalborg University Hospital, Hobrovej 18-22, DK-9000, Aalborg, Denmark
| | - Vanessa Parra Gonzalez
- Department of Emergency Medicine and Trauma Center, Aalborg University Hospital, Hobrovej 18-22, DK-9000, Aalborg, Denmark
- School of Medicine and Health, Aalborg University, Aalborg, Denmark
| | - Johannes Riis
- Department of Emergency Medicine and Trauma Center, Aalborg University Hospital, Hobrovej 18-22, DK-9000, Aalborg, Denmark
| | - Line Tegtmeier Frandsen
- Department of Emergency Medicine and Trauma Center, Aalborg University Hospital, Hobrovej 18-22, DK-9000, Aalborg, Denmark
- Department of Gastroenterology, North Denmark Regional Hospital, Hjørring, Denmark
| | - Dorte Melgaard
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
- Faculty of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Anne Lund Krarup
- Department of Emergency Medicine and Trauma Center, Aalborg University Hospital, Hobrovej 18-22, DK-9000, Aalborg, Denmark.
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.
- Faculty of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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23
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de Benito Sanz M, Tejedor-Tejada J, Mangas-Sanjuan C, Santa EDL, Cebrian I, Talegón R, Sánchez-Ocaña R, Pérez-Pariente JM, Pérez-Miranda M, García-Alonso FJ. Double-Blind Multicenter Randomized Clinical Trial Comparing Glucagon vs Placebo in the Resolution of Alimentary Esophageal Impaction. Am J Gastroenterol 2024; 119:87-96. [PMID: 37734342 DOI: 10.14309/ajg.0000000000002511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/03/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION The aim of this study was to compare the effectiveness of glucagon vs placebo in resolving esophageal foreign body impaction (EFBI), as well as the length of the procedure and adverse events. METHODS This was a multicenter, randomized, double-blind trial involving consecutive patients diagnosed with alimentary EFBI. Participants were randomized to receive either 1 mg of intravenous glucagon or placebo. All patients underwent upper endoscopy, and adverse events were assessed through a protocolized telephonic interview 7 days later. RESULTS The study included 72 subjects in the glucagon group and 68 in the placebo group. The foreign body was not identified in 23.6% of subjects in the glucagon group and 20.6% of subjects in the placebo group (difference 3%, 95% confidence interval -10.7% to 16.8%, P = 0.67). The median time required to remove the foreign body was similar in both groups 4 minutes (range 2-10) in the glucagon group and 3.5 minutes (range 2-7) in the placebo group (difference 0.5 minutes, 95% confidence interval -1.3 to 2.3; P = 0.59). The most common adverse event reported in both groups was mild pharyngeal pain. DISCUSSION Glucagon is no more effective than placebo in resolving EFBI or shortening the time required to remove the foreign body (EUDRA-CT number 2019-004920-40).
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Affiliation(s)
- Marina de Benito Sanz
- Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
| | | | | | - Eva de la Santa
- Department of Gastroenterology, Hospital de Ciudad Real, Ciudad Real, Spain
| | - Irene Cebrian
- Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Raquel Talegón
- Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Ramón Sánchez-Ocaña
- Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
| | | | - Manuel Pérez-Miranda
- Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
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24
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Salman Önemli C. TWENTY CYLINDRICAL BATTERIES PROGRESSING IN THE ABDOMEN OF AN ADULT PATIENT. Gastroenterol Nurs 2024; 47:63-66. [PMID: 38150622 DOI: 10.1097/sga.0000000000000751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/01/2023] [Indexed: 12/29/2023] Open
Affiliation(s)
- Canan Salman Önemli
- Canan Salman Önemli, MD, is an anesthesiology and reanimation specialist, Department of Anesthesiology and Reanimation, University of Health Sciences Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
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25
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Haider M, Saeed A, Zijlstra M, Wenzke K, Tommolino E. The Gastric Obstruction Due to Orbeez Beads Ingestion: A Case Report With Esophagogastroduodenoscopy Findings. Cureus 2024; 16:e51857. [PMID: 38327938 PMCID: PMC10848886 DOI: 10.7759/cureus.51857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 02/09/2024] Open
Abstract
Ingestion of non-food entities poses a critical risk, particularly in children and young adults. Mostly foreign bodies can safely pass through the gastrointestinal tract if they traverse the pylorus; however, ingestion of Orbeez beads can present as a unique challenge. Orbeez beads have the potential to absorb water and can expand in the stomach and small intestine, and can result in complications including constipation, intestinal obstruction, perforation, and peritonitis. Timely diagnosis and management are crucial to improve patient outcomes. We present a case of a 19-year-old male who ingested Orbeez beads and presented with nausea, vomiting, and abdominal pain. A non-contrast CT scan of the abdomen confirmed the foreign bodies. Fifty to seventy beads were successfully removed via esophagogastroduodenoscopy (EGD) without any complications, and the patient is currently doing well.
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Affiliation(s)
- Marjan Haider
- Internal Medicine, St. Joseph Mercy Ann Arbor Hospital, Ann Arbor, USA
| | - Aamir Saeed
- Internal Medicine, Merit Health Wesley Hospital, Hattiesburg, USA
| | - Michael Zijlstra
- Gastroenterology and Hepatology, Trinity Health Ann Arbor Hospital, Ann Arbor, USA
| | - Kevin Wenzke
- Gastroenterology and Hepatology, Trinity Health Ann Arbor Hospital, Ann Arbor, USA
| | - Emily Tommolino
- Gastroenterology and Hepatology, Trinity Health Ann Arbor Hospital, Ann Arbor, USA
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26
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Shehata M, Abdelrahman Dafalla H, Singh Y. Successful Retrieval of 35 Razors From the Stomach via Upper Gastrointestinal (GI) Endoscopy: A Case Report. Cureus 2024; 16:e52856. [PMID: 38268993 PMCID: PMC10807475 DOI: 10.7759/cureus.52856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 01/26/2024] Open
Abstract
Adult ingestion of foreign bodies in the digestive system is a common clinical challenge, often involving mentally impaired individuals, criminals, and drug dealers or occurring accidentally. Encounters with multiple sharp foreign bodies are infrequent and pose significant risks, including gastrointestinal (GI) bleeding, perforation, internal fistulas, and infection. The choice between endoscopy and emergency surgery for removal is contentious, with the less invasive endoscopy typically favored as the first line of management, depending on the foreign body's location and endoscopic accessibility. The current literature on the treatment of numerous sharp foreign bodies is sparse. This case report illustrates the successful endoscopic removal of a large quantity of sharp foreign bodies (35 half blades) from the upper GI tract, utilizing various extraction tools. It also aims to contribute to the existing literature regarding management strategies for ingested sharp foreign bodies. A comprehensive account is provided of the clinical presentation, imaging studies, consultations, and endoscopic procedures performed, culminating in the patient's safe discharge from our facility.
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Affiliation(s)
- Mostafa Shehata
- Gastroenterology, Sheikh Shakhbout Medical City, Abu Dhabi, ARE
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27
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Liao Y, Ma Y, Chao F, Wang Y, Zhao Z, Ren J. A 37-Year-Old Schizophrenic Woman With Abdominal Pain. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2023; 16:11795476231219076. [PMID: 38106620 PMCID: PMC10725092 DOI: 10.1177/11795476231219076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 11/21/2023] [Indexed: 12/19/2023]
Abstract
Introduction Internal fistula across the posterior wall of stomach and the transverse colon caused by foreign bodies in the alimentary tract presents an extremely rare medical entity. Presentation of case We report an aschizophrenia female patient with onset of internal fistula across the posterior wall of stomach and the transverse colon triggered by swallowed magnetic metal beads. The patient was admitted to the emergency room of Northern Jiangsu People's Hospital because of acute right lower abdominal pain. Emergency routine abdominal CT scan revealed acute appendicitis and a set of foreign body in digestive tract. Discussion The foreign body in the stomach was removed by open surgery after tentative Endoscopic foreign body removal and laparoscopic appendectomy and exploration. In the process of exploring the gastric wall, it was found that one of magnet beads was embedded in the posterior wall of stomach and adhered to part of the transverse colon. After separation, it was found that an internal fistula was formed across the posterior wall of stomach and the transverse colon. As the patient ate only a small amount of food within 2 days, and the intestines were in good condition, we performed partial transverse colectomy, end-to-side anastomosis and gastric wall repair. Conclusion This case shows that for long-term foreign bodies in the digestive tract, we should be beware of the onset of gastrointestinal perforation. Moreover, perforation caused by the force acting on a blunt foreign body often results in atypical imaging findings, and the diagnosis of perforation cannot be clearly determined by imaging findings such as the presence of free gas downstream of the diaphragm. This poses new challenges for clear diagnosis and treatment.
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Affiliation(s)
- Yiqun Liao
- Department of Clinical Medical college, The Yangzhou School of Clinical Medicine, Dalian Medical University, Dalian, China
| | - Yue Ma
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Northern Jiangsu People’s Hospital Affiliated to Medical School of Nanjing University, Yangzhou, China
| | - Fei Chao
- Department of Anesthesiology, Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou, China
| | - Yong Wang
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Ziming Zhao
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou, China
| | - Jun Ren
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
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28
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Tiebie EG, Baerends EP, Boeije T, Frankenmolen PG, Lameijer H, van den Berg W, van Stralen KJ, Ridderikhof ML, Bredenoord AJ. Efficacy of cola ingestion for oesophageal food bolus impaction: open label, multicentre, randomised controlled trial. BMJ 2023; 383:e077294. [PMID: 38081653 PMCID: PMC10711662 DOI: 10.1136/bmj-2023-077294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVE To determine the efficacy and safety of cola in resolving complete oesophageal food bolus impaction. DESIGN Open label, multicentre, randomised controlled trial. SETTING Emergency departments of five Dutch hospitals at the secondary and tertiary level, between 22 December 2019 and 16 June 2022. PARTICIPANTS 51 adults presenting with complete oesophageal food bolus impaction, defined as a sudden inability to pass saliva after consumption of foods. Patients who ingested meat that contained bones, and patients with an American Society of Anesthesiologists (ASA) physical status classification of IV or higher were excluded. INTERVENTIONS 28 patients in the intervention group were instructed to consume 25 mL cups of cola at intervals up to a maximum total volume of 200 mL. 23 patients in the control group awaited spontaneous passage. In either group, if complete resolution of symptoms did not occur, endoscopic removal was performed following current guidelines: within 6 hours for patients with complete obstruction, and within 24 hours for partial obstruction. In case of complete resolution of symptoms, elective diagnostic endoscopy was required. MAIN OUTCOME MEASURES Improvement of oesophageal food bolus obstruction as reported by patients (ie, aggregate of complete and partial passage), and evaluation of complete passage. The secondary outcome was any intervention related adverse event. RESULTS Cola did not have a meaningful effect on the improvement of food bolus obstruction (17/28 (61%) intervention v 14/23 (61%) control; odds ratio 1.00, 95% confidence interval 0.33 to 3.1; relative risk reduction 0.0, 95% confidence interval -0.55 to 0.36; P>0.99). Complete passage was reported more often in the intervention group but this difference was not significant (12/28 (43%) intervention v 8/23 (35%) control; odds ratio 1.4 (0.45 to 4.4); relative risk reduction -0.23 (-1.5 to 0.39); P=0.58). No severe adverse events occurred. However, six (21%) patients in the intervention group experienced temporary discomfort after drinking cola. CONCLUSIONS In this study, cola consumption did not lead to a higher rate of improvement of complete oesophageal food bolus impaction. Given the lack of adverse events in the treatment group and some events of resolution after treatment, cola might be considered as a first line treatment, but should not delay any planning of endoscopic management. TRIAL REGISTRATION Netherlands Trial Register (currently International Clinical Trial Registry Platform) NL8312.
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Affiliation(s)
- E G Tiebie
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam University Medical Centres, PO Box 22660, 1100 DD Amsterdam, Netherlands
- Department of Emergency Medicine, Spaarne Gasthuis, Haarlem, Netherlands
| | - E P Baerends
- Department of Emergency Medicine, Victoria Hospital, Wynberg, Cape Town, South Africa
| | - T Boeije
- Department of Emergency Medicine, Dijklander Hospital, Hoorn, Netherlands
| | - P G Frankenmolen
- Department of Emergency Medicine, OLVG hospital, Amsterdam, Netherlands
| | - H Lameijer
- Department of Emergency Medicine, Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
| | - W van den Berg
- Department of Emergency Medicine, Rode Kruis hospital, Beverwijk, Netherlands
| | - K J van Stralen
- Spaarne Gasthuis Academy, Spaarne Gasthuis, Haarlem, Netherlands
| | - M L Ridderikhof
- Department of Emergency Medicine, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - A J Bredenoord
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam University Medical Centres, PO Box 22660, 1100 DD Amsterdam, Netherlands
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Heise J, Kreysel C, Blank M, Euler P, Melchior I, Johnen M, Planker M, Ballauff A, Czypull M, Frieling T. [Bolus obstruction within the esophagus - an analysis over 5 years]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:1603-1607. [PMID: 36990446 DOI: 10.1055/a-2029-6468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
BACKGROUND The removal of bolus impaction within the esophagus is an indication for emergency endoscopy. The current guideline of the European Society of Gastrointestinal Endoscopy (ESGE) recommends gently pushing the bolus into the stomach. This view is discerned by many endoscopists because of the increased risk of complications. In addition, the use of an endoscopic cap for bolus removal is not mentioned. MATERIAL AND METHODS In a retrospective analysis from 2017 to 2021 we investigated 66 adults and 11 children with acute bolus impaction within the esophagus. RESULTS Eosinophilic esophagitis, reflux esophagitic /peptic stenosis and Schatzki Ring caused 57.6%, esophageal and bronchial carcinoma 18%, esophageal motility disorders 4.5%, Zenkers diverticulum 1.5% and radiation esophagitis 1.5% of the bolus obstructions. The reason remained unclear in 16.7% of the cases. The spectrum was comparable in children with additional 2 cases with esophageal atresia and stenosis. The reason was unclear in 2 cases. Removal of bolus impaction was successful in 92.4% in adults and 100% in children. Bolus obstruction in adults was successfully removed solely by endoscopic cap in 57.6% and 75% in children. Pushing the bolus into the stomach without disintegration was possible in only 9% of cases. CONCLUSION Flexible endoscopy is an effective ermergency intervention for removal of bolus obstruction within the esophagus. Uncontrolled pushing the bolus into the stomach without view cannot be recommended. An endoscopic cap is a good extension for safe bolus removal.
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Affiliation(s)
- Jürgen Heise
- Medizinische Klinik II, HELIOS Klinikum Krefeld, Krefeld, Germany
| | | | - Michael Blank
- Medizinische Klinik II, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Philipp Euler
- Medizinische Klinik II, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Ilka Melchior
- Medizinische Klinik II, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Michaela Johnen
- Medizinische Klinik II, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Manfred Planker
- Medizinische Klinik II, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Antje Ballauff
- Zentrum für Kinder- und Jugendmedizin, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Martina Czypull
- Medizinische Klinik II, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Thomas Frieling
- Medizinische Klinik II, HELIOS Klinikum Krefeld, Krefeld, Germany
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30
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Zhao K, Zhong R, Li J, Fu X. Successful ultrasound-assisted endoscopic removal of a fishbone penetrating the full thickness of the antrum wall. Endoscopy 2023; 55:E492-E493. [PMID: 36894135 PMCID: PMC9998225 DOI: 10.1055/a-2025-0388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Affiliation(s)
- Kui Zhao
- Department of Gastroenterology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Rui Zhong
- Department of Gastroenterology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Jun Li
- Department of Gastroenterology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Xiangsheng Fu
- Department of Gastroenterology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
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31
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Kubota Y, Ban T, Takahama T, Sasoh S, Itoh T, Nakamura Y, Joh T. Endoscopic removal of a large ingested squeeze ball at the duodenojejunal flexure using multiple devices. Endoscopy 2023; 55:E670-E671. [PMID: 37100415 PMCID: PMC10132937 DOI: 10.1055/a-2058-8879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Affiliation(s)
- Yoshimasa Kubota
- Department of Gastroenterology and Hepatology, Gamagori City Hospital, Gamagori, Aichi, Japan
| | - Tesshin Ban
- Department of Gastroenterology and Hepatology, Gamagori City Hospital, Gamagori, Aichi, Japan
| | - Takuya Takahama
- Department of Gastroenterology and Hepatology, Gamagori City Hospital, Gamagori, Aichi, Japan
| | - Shun Sasoh
- Department of Gastroenterology and Hepatology, Gamagori City Hospital, Gamagori, Aichi, Japan
| | - Tsuyoshi Itoh
- Department of Gastrointestinal Surgery, Gamagori City Hospital, Gamagori, Aichi, Japan
| | - Yoshinori Nakamura
- Department of Gastrointestinal Surgery, Gamagori City Hospital, Gamagori, Aichi, Japan
| | - Takashi Joh
- Department of Gastroenterology and Hepatology, Gamagori City Hospital, Gamagori, Aichi, Japan
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32
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Tang Y, Wu Z, Deng X, Cheng Z, Zhong X. Removal of an impacted apricot pit from a scarring duodenal stenosis using endoscopic retrograde cholangiopancreatography (ERCP) stone extraction technique. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2023. [PMID: 37929959 DOI: 10.17235/reed.2023.10019/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
A 66-year-old man presented with repeated vomiting for 5 days. Initial gastroscopy showed gastric retention while computed tomography (CT) revealed a 1.8*1.1 cm, oval-shaped, high-density object in the duodenum. Considering his past medical history of a surgical repair for duodenal ulcer perforation 20 years ago, a diagnosis of foreign body (FB) impaction causing gastric outlet obstruction was established. After gastric lavage, a second gastroscopy was performed. A brownish round FB impacted upon scarring stenoses at the junction of the 1st and 2nd part of duodenum was visualized after advancement of the scope with effort through a deformed pylorus. Attempts to capture the FB using a polypectomy snare failed because the snare loop could not be advanced across the stenotic impaction site to allow adequate opening. A grasper was also ineffective due to the smooth surface of the FB. Then the ERCP stone extraction technique was applied. Directed by the adjustable tip of a sphincterotome which was introduced through the same gastroscope, a guidewire passed with little resistance over the impaction site for an adequate length. Subsequently, an extraction balloon was advanced through the guidewire with slight inflation to avoid injury to the stenotic duodenal wall and fully inflated in the distal lumen. Gradual balloon deflation and withdrawal applied simultaneously achieved successful removal of the BF, which was identified as an apricot pit. The patient resumed his diet of soft food immediately after the procedure without complaint of any discomfort.
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Affiliation(s)
- Yu Tang
- Gastroenterology, People's Hospital of Leshan, China
| | - Zhiyong Wu
- Internal Medicine, People's Hospital of Jiajiang
| | - Xuejie Deng
- Gastroenterology, People's Hospital of Leshan
| | - Zhengyu Cheng
- Gastroenterology, People's Hospital of Leshan, China
| | - Xianfei Zhong
- Gastroenterology, People's Hospital of Leshan, China
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Ma Y, Tian Y, Chen Y, Ran H, Pan T, Xiong X. Combination of gastroscopy and fibro‑bronchoscopy facilitates removal of incarcerated fish bone in the esophagus: A case report. Exp Ther Med 2023; 26:518. [PMID: 37854500 PMCID: PMC10580255 DOI: 10.3892/etm.2023.12217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/24/2023] [Indexed: 10/20/2023] Open
Abstract
Esophageal foreign body impaction is a notable clinical emergency. If the high-risk esophageal foreign bodies are not removed in time, life-threatening complications, such as perforation, infection and injury to the vessels, may occur. In the present study, the case of a patient experiencing a foreign body sensation in the throat after ingesting a fish bone by mistake is presented. A high risk of impending arterial puncture was confirmed using thoracic CT and thoracic aorta CT angiography scanning. The ends of the fish bone were first confirmed using a fibro-bronchoscopy light source passing through the bronchial and esophageal walls, before biopsy forceps were used to successively free the thoracic aorta and bronchial ends under gastroscopy. Finally, the fish bone was safely removed using a combination of gastroscopy and the rarely used fibro-bronchoscopy, and the patient recovered well after standard care. In certain cases of foreign bodies, it is necessary to use multiple strategies in a timely manner according to the type and location of the ingested foreign body.
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Affiliation(s)
- Yihan Ma
- Department of Gastroenterology, Chengdu First People's Hospital, Chengdu, Sichuan 610041, P.R. China
| | - Yong Tian
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610037, P.R. China
| | - Yao Chen
- Department of Gastroenterology, Chengdu First People's Hospital, Chengdu, Sichuan 610041, P.R. China
| | - Hongmei Ran
- Department of Gastroenterology, Chengdu First People's Hospital, Chengdu, Sichuan 610041, P.R. China
| | - Tao Pan
- Department of Gastroenterology, Chengdu First People's Hospital, Chengdu, Sichuan 610041, P.R. China
| | - Xing Xiong
- Department of Gastroenterology, Chengdu First People's Hospital, Chengdu, Sichuan 610041, P.R. China
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Joo DC, Lee MW, Hong SM, Baek DH, Lee BE, Kim GH, Song GA. A Gastric Magnetic Foreign Body Incidentally Detected Several Years after Ingestion. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2023; 82:198-201. [PMID: 37876260 DOI: 10.4166/kjg.2023.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/15/2023] [Accepted: 10/15/2023] [Indexed: 10/26/2023]
Abstract
Foreign body ingestion is commonly seen in children. However, occasionally it may also be seen among adults and is often associated with intellectual disability, psychiatric disorders, and alcoholism. Ingestion of a magnetic foreign body may cause complications such as gastrointestinal tract perforation, wherein emergency endoscopic removal of the foreign body is generally required. Here, we report a rare case of a 59-year-old male with an intellectual disability and psychiatric disorder in whom metallic objects in the stomach cavity were accidentally discovered during abdominal CT. Esophagogastroduodenoscopy revealed several metallic objects attached to two magnets, which had been ingested several years before and had remained in the stomach cavity. The magnets and metallic objects were safely removed endoscopically using rat-tooth forceps without complications.
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Affiliation(s)
- Dong Chan Joo
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Moon Won Lee
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Seung Min Hong
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Dong Hoon Baek
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Bong Eun Lee
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Geun Am Song
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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Ribeiro T, Mascarenhas Saraiva M, Afonso J, Brozzi L, Macedo G. Predicting Factors of Clinical Outcomes in Patients Hospitalized after Esophageal Foreign Body or Caustic Injuries: The Experience of a Tertiary Center. Diagnostics (Basel) 2023; 13:3304. [PMID: 37958198 PMCID: PMC10648504 DOI: 10.3390/diagnostics13213304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 11/15/2023] Open
Abstract
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.
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Affiliation(s)
- Tiago Ribeiro
- Department of Gastroenterology, Centro Hospitalar Universitário de São João, 4200-427 Porto, Portugal; (T.R.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
| | - Miguel Mascarenhas Saraiva
- Department of Gastroenterology, Centro Hospitalar Universitário de São João, 4200-427 Porto, Portugal; (T.R.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
- Department of Medicine, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal
| | - João Afonso
- Department of Gastroenterology, Centro Hospitalar Universitário de São João, 4200-427 Porto, Portugal; (T.R.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
| | - Lorenzo Brozzi
- Gastroenterology and Digestive Endoscopy Unit, Pancreas Institute, Department of Medicine, G.B. Rossi University Hospital, 37134 Verona, Italy;
| | - Guilherme Macedo
- Department of Gastroenterology, Centro Hospitalar Universitário de São João, 4200-427 Porto, Portugal; (T.R.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
- Department of Medicine, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal
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36
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Guo H, Hamilton P, Enns E, Gupta M, Andrews CN, Nasser Y, Bredenoord AJ, Dellon ES, Ma C. Postendoscopy Care for Patients Presenting With Esophageal Food Bolus Impaction: A Population-Based Multicenter Cohort Study. Am J Gastroenterol 2023; 118:1787-1796. [PMID: 37410911 DOI: 10.14309/ajg.0000000000002392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 06/08/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Esophageal food bolus impactions (FBI) are a common gastrointestinal emergency. Appropriate management includes not only index endoscopy for disimpaction but also medical follow-up and treatment for the underlying esophageal pathology. We evaluated the appropriateness of postendoscopy care for patients with FBI and assessed patient-related, physician-related, and system-related factors that may contribute to loss to follow-up. METHODS We conducted a retrospective, population-based, multicenter cohort study of all adult patients undergoing endoscopy for FBI in the Calgary Health Zone, Canada, from 2016 to 2018. Appropriate postendoscopy care was defined by a composite of a clinical or endoscopic follow-up visit, appropriate investigations (e.g., manometry), or therapy (e.g., proton-pump inhibitors or endoscopic dilation). Predictors of inappropriate care were assessed using multivariable logistic regression. RESULTS A total of 519 patients underwent endoscopy for FBI: 25.2% (131/519) did not receive appropriate postendoscopy care. Half of the patients (55.3%, 287/519) underwent follow-up endoscopy or attended clinic, and among this group, 22.3% (64/287) had a change in their initial diagnosis after follow-up, including 3 new cases of esophageal cancer. Patients in whom a suspected underlying esophageal pathology was not identified at the index endoscopy were 7-fold (adjusted odds ratio 7.28, 95% confidence interval 4.49-11.78, P < 0.001) more likely to receive inappropriate postendoscopy follow-up and treatment, even after adjusting for age, sex, rural residence, timing of endoscopy, weekend presentation, and endoscopic interventions. DISCUSSION One-quarter of patients presenting with an FBI do not receive appropriate postendoscopy care. This is strongly associated with failure to identify a potential underlying pathology at index presentation.
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Affiliation(s)
- Howard Guo
- Division of Internal Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Patrick Hamilton
- Division of Internal Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Edwin Enns
- Department of Medicine, Alberta Health Services, Calgary, Alberta, Canada
| | - Milli Gupta
- Division of Gastroenterology & Hepatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christopher N Andrews
- Division of Gastroenterology & Hepatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yasmin Nasser
- Division of Gastroenterology & Hepatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Albert J Bredenoord
- Department of Gastroenterology & Hepatology, Academic Medical Center, Amsterdam, the Netherlands
| | - Evan S Dellon
- Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing, Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Christopher Ma
- Department of Medicine, Alberta Health Services, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Karb D, DeLozier S, Raad D, Dumot J, Mok S. Effect of Delayed Endoscopy Protocol on Timing and Safety of Endoscopy for Foreign Body Ingestion and Esophageal Food Impaction. J Clin Gastroenterol 2023; 57:890-894. [PMID: 36730739 DOI: 10.1097/mcg.0000000000001789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 09/29/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Endoscopic procedures for foreign body ingestion (FBI) and esophageal food impactions (EFI) performed during on-call hours are associated with increased stress, risk, and cost. We implemented a Foreign Body Algorithm (FBA) designed to delay all but the most urgent endoscopy for EFI and FBI until regular working hours. METHODS Using endoscopy records from multiple academic and community hospitals within a large integrated health system in the United states, we identified esophagogastroduodenoscopy (EGD) performed for food impactions and foreign body ingestions occurring between May 2011 and February 2021. RESULTS We identified 479 EGDs performed for FBI and EFI. The introduction of the FBA was associated with a shorter length of stay (LOS) for overall cases (0.35 vs. 0.8 d P <0.001), day cases (0.16 vs. 1.0 d P <0.001), and night cases (0.40 vs. 0.6 d P =0.03). The introduction of the FBA did not change the rate of overall adverse events (AE) or night AE. AE from the entire cohort was rare (3%; 16 total). Of the AE, most were sedation related. The introduction of the FBA did not affect the overall rate of night cases or AE, but the rate of after-hours endoscopy for intentional ingestions decreased from 17.2% to 3.1% ( P =0.01). CONCLUSION This is one of the largest studies of esophageal impactions and foreign bodies in adults in the United States, and the first to examine the effects of a protocol designed to avoid after-hours endoscopy. These results suggest that postponing after-hours EGD until the daytime is not associated with adverse safety outcomes or increased LOS.
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Affiliation(s)
- Daniel Karb
- Division of Gastroenterology and Liver Disease
| | - Sara DeLozier
- Clinical Research Development Office, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, OH
| | - Dany Raad
- Division of Gastroenterology and Liver Disease
| | - John Dumot
- Division of Gastroenterology and Liver Disease
| | - Shaffer Mok
- Clinical Research Development Office, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, OH
- Division of Gastroenterology, Moffitt Cancer Center, Tampa, FL
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Higashi K, Koike Y, Sato Y, Yamashita S, Nagano Y, Shimura T, Kitajima T, Matsushita K, Yokota K, Amano K, Okugawa Y, Toiyama Y. Extraction of a metallic susceptor after accidental ingestion of the heated tobaccostick TEREA™: a case report. BMC Pediatr 2023; 23:452. [PMID: 37689624 PMCID: PMC10492281 DOI: 10.1186/s12887-023-04285-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/01/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Tobacco ingestion is widely known to cause nicotine toxicity, which may result in severe symptoms. Two heated tobacco sticks, called TEREA™ and SENTIA™, were launched in 2021 by Philip Morris International (New York, NY, USA), and their ingestion is associated with a risk of bowel injury because they contain a partially pointed metallic susceptor. However, this risk is not well known to the general public or healthcare providers. To increase awareness of this risk, we herein report a case involving extraction of a metallic susceptor after ingestion of the heated tobacco stick TEREA™. CASE PRESENTATION A 7-month-old girl presented to the emergency department of a nearby hospital because she was suspected to have accidentally swallowed heated tobacco. Although she presented with no symptoms related to nicotine poisoning, abdominal X-ray examination revealed a metal object in her stomach. According to a statement released by the Japan Poison Information Center, the TEREA™ heated tobacco stick contains a metallic susceptor with a rectangular shape and sharp corners. The patient was transferred to our department because of the risk of bowel injury, and upper gastrointestinal endoscopy was performed. No cigarettes were found by endoscopic observation; however, a metallic susceptor was located in the second part of the duodenum. We grasped it with biopsy forceps and carefully removed it using an endoscope with a cap attached to the tip. The post-endoscopic course was uneventful. CONCLUSIONS Some patients who ingest heated tobacco sticks might be exposed not only to the effects of nicotine but also to physical damage caused by a metallic susceptor. Infants and toddlers especially could swallow these sticks, therefore tobacco companies need to make the problem more public. Clinicians also should alert the problem, and pay attention to this risk in the clinical setting.
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Affiliation(s)
- Koki Higashi
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Yuhki Koike
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
| | - Yuki Sato
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Shinji Yamashita
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Yuka Nagano
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Tadanobu Shimura
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Takahito Kitajima
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Kohei Matsushita
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Kazuki Yokota
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Keishiro Amano
- Department of Pediatrics, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Yoshinaga Okugawa
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Yuji Toiyama
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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Niset A, Baert J, Dupriez F. Point-of-Care Ultrasound for the Diagnosis of Pediatric Foreign Body Ingestion: A Narrative Review and Illustrative Case Report. Pediatr Emerg Care 2023; 39:728-733. [PMID: 37339160 DOI: 10.1097/pec.0000000000002997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
PURPOSE Foreign body ingestion (FBI) is a frequent concern in emergency departments. Clinical guidelines recommend performing plain x-rays as the primary modality of diagnosis. Although point-of-care ultrasound (PoCUS) has increasingly been integrated into the daily practice of emergency medicine, it has been poorly investigated in the diagnostic approach for FBI.This review aims to highlight the current state of PoCUS use for pediatric FBI.The following research question was considered in this narrative review: Is PoCUS useful for FBI management? METHODS A literature search was conducted to identify articles reporting PoCUS use for the management of FBI. All articles were assessed for quality by 2 reviewers. MAIN RESULTS The 14 selected articles reported 52 FBI cases in which PoCUS successfully identified and located the ingested FB. Point-of-care ultrasound was used either as the primary imaging technique or after positive or negative x-ray findings. In 5 cases (9.6%), PoCUS was the only modality used for the diagnosis. Of these cases, 3 (60%) underwent a successful procedure to remove the FB and 2 (40%) received conservative treatment without complications. CONCLUSIONS This review suggests that PoCUS might be a reliable modality for the initial management of FBI. PoCUS can locate, identify, and evaluate the size of the FB in a wide range of materials and gastrointestinal locations. Point-of-care ultrasound could eventually become the go-to modality in the case of radiolucent FB, thus avoiding the use of radiation. Further studies are nevertheless required to validate PoCUS use for FBI management.
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Affiliation(s)
- Alexandre Niset
- From the Emergency Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Zhang M, Wan J, Zhou Q. Time trends and endoscopic management of foreign body ingestion in the upper GI tract: a retrospective analysis of 1,152 cases in China. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2023; 115:488-495. [PMID: 36896925 DOI: 10.17235/reed.2023.9426/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
OBJECTIVES foreign body ingestions are encountered in the clinical practice and sometimes require endoscopic management. However, time trends and epidemiology of these cases have not been fully clarified. Whether seasons and festivals have an effect on the occurrence has been poorly described. METHOD from 2009 to 2020, 1,152 consecutive foreign body ingestion cases were enrolled in our endoscopic center. Case records were reviewed for demographic data, foreign body type and location, outpatient or hospitalization, adverse events and dates. Annual time trends and seasonal variation were analyzed as well as the influence of Chinese legal festivals on the incidence. The impact of SARS-CoV-2 pandemic on the potential delay for clinical consultation of these cases was preliminarily explored. Clinical features of these cases were demonstrated. RESULTS the overall success rate was 99.7 % and the adverse events rate was 2.4 %. There was an uptrend in the annual frequency of food foreign body ingestion endoscopic extraction from 0.65 in 2009 to 8.86 in 2020 per 1,000 esophagogastroduodenoscopy patients (r = 0.902, p < 0.001). Furthermore, the frequency of endoscopic extraction significantly increased in winter (p < 0.001) and during Chinese New Year celebratory season (p = 0.003). The duration of hospitalization may be longer in the pandemic period (p = 0.0049). CONCLUSION considering the uptrend of the annual frequency of food related foreign body endoscopic extraction, the publicity about the danger of foreign body ingestion should be enhanced. Arrangement of endoscopic physicians and assistants during the high-incidence season should be emphasized.
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Affiliation(s)
- Miaoxin Zhang
- Gastroenterology, Tongji Hospital. Tongji Medical College, Huazhong University of Science and Technology, China
| | - Junchen Wan
- Gastroenterology, Tongji Hospital. Tongji Medical College, Huazhong University of Science and Technology, China
| | - Qi Zhou
- Gastroenterology, Tongji Hospital. Tongji Medical College, Huazhong University of Science and Technology, China
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Calini G, Ortolan N, Battistella C, Marino M, Bresadola V, Terrosu G. Endoscopic failure for foreign body ingestion and food bolus impaction in the upper gastrointestinal tract: an updated analysis in a European tertiary care hospital. Eur J Gastroenterol Hepatol 2023; 35:962-967. [PMID: 37395211 DOI: 10.1097/meg.0000000000002602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
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.
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Affiliation(s)
- Giacomo Calini
- Department of Surgery, University Hospital 'Santa Maria della Misericordia', University of Udine
| | | | - Claudio Battistella
- Department of Medical and Biological Sciences, Section of Statistics, University of Udine
| | - Marco Marino
- Gastroenterology and GI Endoscopy Unit, University Hospital of Udine, Udine, Italy
| | - Vittorio Bresadola
- Department of Surgery, University Hospital 'Santa Maria della Misericordia', University of Udine
| | - Giovanni Terrosu
- Department of Surgery, University Hospital 'Santa Maria della Misericordia', University of Udine
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Soni A, Roy R, Gupta Y. Esophageal Foreign Bodies in Pediatric Age Group with Different Durations of time from Ingestion to Effective Treatment. Indian J Otolaryngol Head Neck Surg 2023; 75:1421-1428. [PMID: 37636667 PMCID: PMC10447692 DOI: 10.1007/s12070-023-03578-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/07/2023] [Indexed: 08/29/2023] Open
Abstract
A foreign body(FB) is any object in a region it is not meant to be, where it can cause harm by its mere presence if immediate medical attention is not sought. Foreign body is particularly common in the pediatric population especially below 5 years of age and in whom prevalence was reported to vary between 57% and 80%. Endoscopic interventions are indicated when the foreign objects fail to pass spontaneously. The standard methods to remove these foreign bodies include push technique and retrieval methods using various endoscopic instruments. Study of 302 patients admitted with the final diagnosis of esophageal foreign body during January 2017 - April 2018, for sex, age, diagnosis on admission, estimated duration and site of impaction, type and number of foreign body removed. During the study period, 302 patients (169 males and 133 females) of different ages, maximum in the age group of 1-5 years i.e 197 cases were admitted with the diagnosis of esophageal foreign body. 11% of patients were less than 1 year of age & 23% were more than 5 years of age at the time of admission. Most of them presented to hospital within 24 hours of ingestion of foreign body i.e 85%. In this study all the children with suspected foreign body esophagus underwent Xray and FB was found in 300/302 i.e its diagnostic accuracy (sensitivity) is 98%. Rigid esophagoscopy was done in all 302 pts with 100% diagnostic accuracy. Different types of foreign bodies ingested most common being coin i.e in 91% patients followed by FB battery in 17 patients and safety pin in 6 patients. Majority of foreign bodies were located in the cricopharynx (198) followed by upper esophagus (67) and mid-esophagus (25) and only 10 cases involved the lower esophagus and spontaneous passage was found in 2 cases. The most common foreign bodies in children are coins and toys. Sharp foreign bodies are difficult to remove but need to be removed carefully at the earliest to prevent dreaded complications like - retropharyngeal abscess and mediastinitis. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-03578-8.
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Affiliation(s)
| | | | - Yamini Gupta
- Department of ENT, Mahatma Gandhi Memorial Medical college, Indore, Madhya Pradesh India
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Yadav A, Thakur R, Sasani A, Siddharth, Kiran U, Yadav A, Shah JH, Jearth V, Rana SS. Decision-to-scope score: a novel tool with excellent accuracy in predicting foreign bodies in the esophagus. J Gastroenterol Hepatol 2023; 38:1664. [PMID: 37490941 DOI: 10.1111/jgh.16306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/10/2023] [Indexed: 07/27/2023]
Affiliation(s)
- A Yadav
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - R Thakur
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - A Sasani
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - Siddharth
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - U Kiran
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - A Yadav
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - J H Shah
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - V Jearth
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - S S Rana
- Department of Gastroenterology, PGIMER, Chandigarh, India
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Sghaier A, Mraidha MH, Jarrar MS, Gaddour M, Elghali MA, Youssef S. An unusual etiology of acute intestinal occlusion: The swallowed missing dentures a case reports and literature review. Int J Surg Case Rep 2023; 110:108770. [PMID: 37660490 PMCID: PMC10510072 DOI: 10.1016/j.ijscr.2023.108770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 09/05/2023] Open
Abstract
INTRODUCTION Denture swallowing is an uncommon incident. However, it should be suspected in edentulous elderly patients who wear removable dentures which are poorly cared for and maintain. The existence of neuro-psychiatric disorders may contribute to the occurrence of this adverse event. CASE PRESENTATION We report the case of an 85-years-old woman admitted to emergency with acute intestinal occlusion. The investigations concluded that the bowel was obstructed by a foreign body blocked in the terminal ileum. There was a high suspicion that his dental prosthesis had been swallowed. Removal of the dental prosthesis was achieved surgically after laparotomy. DISCUSSION Foreign bodies in the esophagus could be responsible of a variety of symptoms, including dysphagia, airway obstruction and even perforation. In the gastrointestinal tract foreign bodies may be responsible of fewer specific symptoms, including abdominal pain, melena or perforation. The blockage will occur in anatomical strictures. At the most appropriate situations, removal should be performed through endoscopy, although in case of failure of procedure or complication, surgery will be unavoidable. CONCLUSION Ingestion of a dental or other foreign object is a clinical condition that is more common in pediatric populations, but is very rare in healthy individuals. Denture swallowing is insidious in itself and may lead to a complicated course, if not properly managed. Although most of these can be conservative, careful monitoring is necessary to avoid such adverse event.
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Affiliation(s)
- Asma Sghaier
- Hospital of Farhat Hached of Sousse, Tunisia; Faculty of Medicine of Sousse, University of Sousse, Tunisia; Department of general surgery, Tunisia.
| | - Mohamed Hédi Mraidha
- Hospital of Farhat Hached of Sousse, Tunisia; Faculty of Medicine of Sousse, University of Sousse, Tunisia; Department of general surgery, Tunisia
| | - Mohamed Salah Jarrar
- Hospital of Farhat Hached of Sousse, Tunisia; Faculty of Medicine of Sousse, University of Sousse, Tunisia; Departement of anatomy, Tunisia
| | - Mariem Gaddour
- Faculty of Medicine of Sousse, University of Sousse, Tunisia; Hospital of Sahloul, Tunisia; Departement of physical medicine and functional rehabilitation, Tunisia
| | - Mohamed Amine Elghali
- Hospital of Farhat Hached of Sousse, Tunisia; Faculty of Medicine of Sousse, University of Sousse, Tunisia; Department of general surgery, Tunisia
| | - Sabri Youssef
- Hospital of Farhat Hached of Sousse, Tunisia; Faculty of Medicine of Sousse, University of Sousse, Tunisia; Department of general surgery, Tunisia
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Stojkovic S, Bjelakovic M, Stojkovic Lalosevic M, Stulic M, Pejic N, Radivojevic N, Stojkovic N, Martinov Nestorov J, Culafic D. Accidental Sewing Pin Ingestion by a Tailor: A Case Report and Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1566. [PMID: 37763686 PMCID: PMC10534428 DOI: 10.3390/medicina59091566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/17/2023] [Accepted: 08/26/2023] [Indexed: 09/29/2023]
Abstract
Foreign body ingestion is a frequently encountered emergency in healthcare institutions. It mostly affects pediatric populations, although it can also affect adults with developmental delays, those with psychiatric diseases, drug abusers, and prisoners. Endoscopy is a diagnostic and treatment method for suspected foreign body ingestion. In this article, we discuss a 45-year-old tailor who swallowed a sewing pin while at work. The abdominal X-ray showed a needle-shaped metal shadow in the stomach region. During an upper endoscopy, it was discovered that a sewing pin with a sharp edge was stuck in the pylorus. The sewing pin was extracted endoscopically, and the patient was discharged the same day in good condition. Since the estimated risk of complications of foreign body ingestion in the adult population is about 35%, and the most common complications include impaction, laceration, bleeding, or perforation of the gastrointestinal wall, endoscopic or surgical removal is necessary. This also emphasizes the importance of a careful endoscopic evaluation of some at-risk occupations for foreign body ingestion with or without gastrointestinal complaints.
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Affiliation(s)
- Stefan Stojkovic
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milica Bjelakovic
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Nis, 18000 Nis, Serbia
| | - Milica Stojkovic Lalosevic
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Milos Stulic
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Nina Pejic
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Nemanja Radivojevic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Nemanja Stojkovic
- Department of Cardiology, University Clinical Hospital Center “Dr. Dragisa Misovic-Dedinje”, 11000 Belgrade, Serbia
| | - Jelena Martinov Nestorov
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Djordje Culafic
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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Han JH, Cha RR, Kwak JY, Jeon H, Lee SS, Jung JJ, Cho JK, Kim HJ. Two Cases of Severe Complications Due to an Esophageal Fish Bone Foreign Body. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1504. [PMID: 37763623 PMCID: PMC10533137 DOI: 10.3390/medicina59091504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/08/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023]
Abstract
Cases of foreign body ingestion are encountered relatively often in clinical settings; however, serious complications are rare. In such cases, mediastinal abscess due to esophageal perforation can become a life-threatening complication. We encountered two cases of severe complications due to an esophageal fish bone foreign body. The first case was a 40-year-old male with an intramural esophageal abscess due to a fish bone after eating fish five days before visiting the hospital. The patient underwent surgical treatment, but the esophageal abscess did not improve; so, the abscess was drained through endoscopic mucosal dissection, and the abscess improved. In the second case, a 64-year-old male, who had eaten fish three days before visiting the hospital, had esophageal perforation by a fish bone, and abscess formation in the mediastinum and the lesser sac in the abdominal cavity were observed. Although surgical treatment was performed, the intra-abdominal abscess formation was not controlled; so, percutaneous drainage (PCD) was inserted, and the abscess improved. Both patients were discharged without any complications. Here, we report two cases that were improved through surgical treatments and additional treatments such as endoscopic dissection and PCD.
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Affiliation(s)
- Ji-Hee Han
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea; (J.-H.H.); (J.-Y.K.); (H.J.); (S.-S.L.); (H.J.K.)
| | - Ra-Ri Cha
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea; (J.-H.H.); (J.-Y.K.); (H.J.); (S.-S.L.); (H.J.K.)
| | - Ji-Yoon Kwak
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea; (J.-H.H.); (J.-Y.K.); (H.J.); (S.-S.L.); (H.J.K.)
| | - Hankyu Jeon
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea; (J.-H.H.); (J.-Y.K.); (H.J.); (S.-S.L.); (H.J.K.)
| | - Sang-Soo Lee
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea; (J.-H.H.); (J.-Y.K.); (H.J.); (S.-S.L.); (H.J.K.)
| | - Jae Jun Jung
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea;
| | - Jin Kyu Cho
- Department of General Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea;
| | - Hyun Jin Kim
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju 52828, Republic of Korea; (J.-H.H.); (J.-Y.K.); (H.J.); (S.-S.L.); (H.J.K.)
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Wu KA, Hsiao CJ, Lee CC, Su TH, Kao YH, Wu GC. Extraction of large foreign bodies from the airway by gastrointestinal endoscopy. Respir Med Case Rep 2023; 45:101907. [PMID: 37635732 PMCID: PMC10448197 DOI: 10.1016/j.rmcr.2023.101907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/29/2023] Open
Abstract
Foreign body aspiration is a worldwide health problem that often results in life-threatening complications. Although flexible bronchoscopy is a safe procedure for removal of foreign bodies, it is usually unsuccessful in removing large foreign bodies from the airway. Gastrointestinal (GI) endoscopy, which is frequently used to remove foreign bodies from the gastrointestinal tract, has not been reported for retrieval of airway foreign bodies. In this report, we described three successful cases of removal of large airway foreign bodies by GI endoscopy. To avoid rigid bronchoscopy, GI endoscopy can be considered if flexible bronchoscopy has failed to remove a large or heavy airway foreign body in adult patients.
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Affiliation(s)
- Kuo-An Wu
- Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
- Department of Life Sciences, National Central University, Jhongli, Taoyuan, 32001, Taiwan
| | - Chia-Jen Hsiao
- Division of Gastroenterology, New Taipei City Hospital, Taiwan
| | - Chu-Ching Lee
- Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
| | - Ting-Hsuan Su
- Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
| | - Yung-Hsi Kao
- Department of Life Sciences, National Central University, Jhongli, Taoyuan, 32001, Taiwan
| | - Geng-Chin Wu
- Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
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48
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Doya LJ, Mohammad MF, Mohammad A, Ibrahim A. Colonoscopy for foreign body retrieval in ileocecal valve: a rare case report. Oxf Med Case Reports 2023; 2023:omad088. [PMID: 37637366 PMCID: PMC10451108 DOI: 10.1093/omcr/omad088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/24/2023] [Accepted: 07/13/2023] [Indexed: 08/29/2023] Open
Abstract
Foreign body (FB) ingestion is a common emergency among the pediatric population. They usually pass spontaneously through the gastrointestinal (GI) tract. In rare cases, it may cause complications because of the impaction. That depends on the type of an FB, its location, the patient's age and the duration of impaction. Colonoscopy as management of FB ingestion in the ileocecal valve (IC) is rare in the medical literature review. Herein, we reported a case of an FB (thin needle-shaped FB 4 cm long) in the IC that was removed from the IC by colonoscopy. Although colonoscopic retrieval of impacted foreign bodies at the GI tract in children has been rarely reported in the literature review, it may be helpful in young children to avoid invasive surgical treatment.
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Affiliation(s)
- Leen J Doya
- Department of Pediatrics, Tishreen University Hospital, Latakia, Syria
| | | | - Aria Mohammad
- Department of Pediatrics, Tishreen University Hospital, Latakia, Syria
| | - Ali Ibrahim
- Department of Pediatrics, Tishreen University Hospital, Latakia, Syria
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Hardy JC, Ashcroft C, Kay C, Liane BJ, Horn C. Loose Screws: Removal of Foreign Bodies From the Lower Gastrointestinal Tract. Cureus 2023; 15:e43093. [PMID: 37554373 PMCID: PMC10406514 DOI: 10.7759/cureus.43093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 08/10/2023] Open
Abstract
While both the American Society for Gastrointestinal Endoscopy (ASGE) and the European Society of Gastrointestinal Endoscopy (ESGE) have released guidelines on the management of ingested foreign bodies in the upper gastrointestinal (GI) tract, neither has addressed indications or techniques for endoscopic removal of foreign bodies in the lower GI tract, perhaps due to the high likelihood of foreign body passage once the foreign body has reached the lower GI tract. We present the case of a 45-year-old woman presenting to the emergency department following the intentional ingestion of multiple screws and nails, complaining of acute abdominal pain and nausea. Imaging revealed four nails in the colon and two adjacent screws in the distal small bowel. In the absence of signs of acute obstruction or bowel perforation, she was admitted for expectant management but subsequently required endoscopic removal of two retained screws in the lower GI tract.
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Affiliation(s)
- John C Hardy
- Internal Medicine, Brooke Army Medical Center, San Antonio, USA
| | - Cody Ashcroft
- Internal Medicine, Brooke Army Medical Center, San Antonio, USA
| | - Carl Kay
- Gastroenterology, Brooke Army Medical Center, San Antonio, USA
| | - Billy-Joe Liane
- Gastroenterology, Brooke Army Medical Center, San Antonio, USA
| | - Christian Horn
- Gastroenterology, Brooke Army Medical Center, San Antonio, USA
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50
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Wong E, Smith M, Buchanan MA, Kudpaje A, Williamson A, Hedge PS, Hazan D, Idaire J, Smith MC, Sritharan N, Palme C, Riffat F. Smell-related quality of life changes after total laryngectomy: a multi-centre study. Eur Arch Otorhinolaryngol 2023; 280:3861-3866. [PMID: 37115324 PMCID: PMC10313529 DOI: 10.1007/s00405-023-07976-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE A total laryngectomy creates an alternate airway for gas exchange that bypasses the upper aerodigestive tract. The subsequent reduction in nasal airflow, and therefore, reduction in deposition of particles to the olfactory neuroepithelium leads to hyposmia or anosmia. The aim of this study was to assess the quality of life impairment conferred by anosmia following laryngectomy and identify any specific patient-related risk factors that are associated with poorer outcomes. METHODS Consecutive patients with a total laryngectomy presenting for review at three tertiary head and neck services (in Australia, the United Kingdom and India) over a 12-month period were recruited. Patient demographic and clinical data were collected, and each subject completed the validated assessment of self-reported olfactory functioning and olfaction-related quality of life questionnaire (ASOF). Dichotomous comparisons were performed using the student's unpaired t-test for continuous variables (SRP), a chi-squared test for categorical variables, and a Kendall's tau-b for ordinal variables (SOC) to assess for a correlation with poorer questionnaire scores. RESULTS A total of 66 laryngectomees (13.4% female; age 65.7 ± 8.6 years) were included in the study. The mean SRP score of the cohort was found to be 15.6 ± 7.4, while the mean ORQ score was noted to be 16.4 ± 8.1. No other specific risk factors associated with poorer quality of life were identified. CONCLUSION A significant quality of life detriment from hyposmia is conferred following laryngectomy. Further research to assess treatment options and the patient population that would best benefit from these interventions is required.
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Affiliation(s)
- Eugene Wong
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, University of Sydney, Camperdown, NSW, 2006, Australia.
- Department of Surgery, School of Medicine and Health Sciences, University of Sydney, Camperdown, Australia.
| | - Murray Smith
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, University of Sydney, Camperdown, NSW, 2006, Australia
| | | | - Akshay Kudpaje
- Department of Head and Neck Surgical Oncology, Cytecare Cancer Hospitals, Bangalore, India
| | - Andrew Williamson
- Department of ENT Surgery, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Prasanna Suresh Hedge
- Department of Head and Neck Surgical Oncology, Cytecare Cancer Hospitals, Bangalore, India
| | - Daniel Hazan
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Jordan Idaire
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Mark C Smith
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, University of Sydney, Camperdown, NSW, 2006, Australia
- Department of Surgery, School of Medicine and Health Sciences, University of Sydney, Camperdown, Australia
- Chris O'Brien Lifehouse, Camperdown, NSW, 2006, Australia
- Department of Otolaryngology, Head and Neck Surgery, Macquarie University Hospital, Macquarie Park, Australia
| | - Niranjan Sritharan
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, University of Sydney, Camperdown, NSW, 2006, Australia
- Department of Surgery, School of Medicine and Health Sciences, University of Sydney, Camperdown, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Carsten Palme
- Department of Surgery, School of Medicine and Health Sciences, University of Sydney, Camperdown, Australia
- Chris O'Brien Lifehouse, Camperdown, NSW, 2006, Australia
| | - Faruque Riffat
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, University of Sydney, Camperdown, NSW, 2006, Australia
- Department of Surgery, School of Medicine and Health Sciences, University of Sydney, Camperdown, Australia
- Chris O'Brien Lifehouse, Camperdown, NSW, 2006, Australia
- Department of Otolaryngology, Head and Neck Surgery, Macquarie University Hospital, Macquarie Park, Australia
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