Combined laparoscopic and endoscopic approach for the management of two ingested sewing needles: one migrated into the liver and one stuck in the duodenum

Endoscopic management of gastric perforation secondary to chicken bone: A report of 2 cases

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The majority of ingested foreign bodies pass through the gastrointestinal tract harmlessly.

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Ingested foreign bodies can cause significant complications like bowel obstruction, bleeding, abscess formation, migration to other organs, and perforation.

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In selected cases, endoscopic management is more cost-effective, minimally invasive, has less post-operative complications, and leads to a more expeditious recovery.

Introduction

Ingested foreign bodies (IFB) can uncommonly cause perforation of the gastrointestinal tract. The traditional management is surgical exploration via laparotomy or laparoscopy, although endoscopic options are now gaining prominence.

Presentation of case

We present two patients with almost identical clinical presentations of post-prandial abdominal pain and anorexia. On examination they were haemodynamically stable with localised epigastric tenderness. Both patients underwent CT scan of the abdomen, with one scan revealing a foreign body in the stomach penetrating the full thickness of the gastric wall with the tip lying extraluminally. They subsequently underwent endoscopy where a chicken bone was found perforating the wall of the stomach. This was removed via snare and endoscopic clips were used to close the site of perforation.

Discussion

The majority of ingested foreign bodies pass through the gastrointestinal tract harmlessly. However some IFBs can cause significant complications like bowel obstruction, bleeding, abscess formation, migration to other organs, and in our case perforation. The diagnosis may be delayed due to an insidious clinical presentation especially if the patient does not recall ingesting anything untoward. Our patients managed to avoid surgery by undergoing successful endoscopic therapy.

Conclusion

In selected cases, endoscopic management is more cost-effective, minimally invasive, has less post-operative complications, and leads to a more expeditious recovery. Therefore, the role of therapeutic endoscopy for gastric perforations secondary to foreign bodies should always be considered.

Laparoscopic management of enterohepatic migrated fish bone mimicking liver neoplasm: A case report and literature review

RATIONALE

Accidental ingestion of a foreign body is common in daily life. But the hepatic migration of perforated foreign body is rather rare.

PATIENT CONCERNS

A 37-year-old man presented with a history of vague epigastric discomfort for about 2 months.

DIAGNOSIS

A diagnosis of the foreign body induced hepatic inflammatory mass was made based on abdominal computed tomographic scan and upper gastrointestinal endoscopy.

INTERVENTIONS

The patient underwent laparoscopic laparotomy. During the operation, inflammatory signs were seen in the lesser omentum and segment 3 of liver. B- Ultrasound guided excision of the mass (in segment 3) was performed. Dissecting the specimen revealed a fish bone measuring 1.7 cm in length.

OUTCOMES

The patient recovered uneventfully and was discharged on day 5 after surgery.

LESSONS

This study shows the usefulness of endoscopy for final diagnosis and treatment in foreign body ingestion. Early diagnosis and decisive treatment in time are lifesaving for patients with this potentially lethal condition.

Foreign Body Penetration through Jejunal Loops Causing Renal Artery Thrombosis and Renal Infarct

Foreign body ingestion is common, although perforation after ingestion is rare. We report a case of an ingested sharp wooden stick that perforated the proximal jejunum toward the renal vasculature, causing segmental renal artery thrombosis and renal infarct. The patient presented with severe abdominal pain and vomiting. A computed tomography scan revealed a linear opacity corresponding to the foreign body. The wooden stick was removed endoscopically through deep-push enteroscopy with a rat-tooth forceps. We report this unique case of perforation by a foreign body through the proximal jejunum to the left kidney, which was managed endoscopically.

Laparoscopic management of complicated foreign body ingestion: a case series

This study aims to demonstrate the safety and feasibility of laparoscopic management of complicated foreign body (FB) ingestion in a series of 5 patients. We present the merits of a minimally-invasive approach in this clinical setting from our series as well as published case reports. FB ingestion is occasionally complicated by abscess formation or perforation, requiring surgical intervention. Anecdotal reports of such cases managed by laparoscopic surgery have alluded to its merits over the conventional approach of open surgery. Over an 18-month period, 5 of 256 patients with FB ingestion at our unit were managed by laparoscopic surgery. Clinical and operative data were collected for this study. In all 5 cases, patients could not recall their FB ingestion and had normal plain radiographs. The diagnosis was made on a computed tomography (CT) scan. Laparoscopy was successfully employed to retrieve all FBs (fish bones), deroof abscesses, and primarily repair gastrointestinal perforations. The mean operative time was 69 minutes (55-85), utilizing 2 to 4 noncamera ports. There was no operative mortality and patients were discharged on average postoperative day (POD) 5 (2-8). Laparoscopic surgery is safe and feasible in small-diameter, complicated FB ingestion requiring surgical intervention and should be considered in similar patients.

Successful endoscopic management of gastric perforation caused by ingesting a sharp chicken bone

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We discuss a case of gastric perforation caused by a sharp chicken bone ingestion.

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Early diagnosis lead to successful minimally invasive management using an endoscopic approach.

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High degree of suspicion is important in diagnosing foreign body related gastrointestinal complications as the clinical presentation can be elusive.

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Early diagnosis can allow the utilization of less invasive therapeutic interventions, subsequently leading to faster recovery.

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In the right context, therapeutic endoscopy can help to avoid more aggressive surgical interventions.

Introduction

Gastrointestinal perforation related to foreign body ingestion is uncommon. Surgical interventions aiming at removal of the offending agent and restoration of bowel continuity are sought when perforations occur.

Presentation of case A 68 year old male presented with epigastric abdominal pain and anorexia for 2 days. On examination, he was febrile and had localized epigastric tenderness. Laboratory investigations revealed marked leucocytosis with no other abnormalities. Computed tomography revealed the presence of a foreign body penetrating through the full thickness of the gastric wall with its tip lying adjacent to the pancreatic head. Endoscopic trial to extract the foreign body was successfully carried out. The gastric defect was sealed by applying an endoscopic metallic clip.

Discussion

Gastric perforations secondary to foreign body ingestion usually follow an elusive clinical course and are rarely diagnosed early in its course. Early diagnosis allows for the utilization of minimally invasive management. Unfortunately, Most reported cases were diagnosed after intra-abdominal processes, such as abscesses, have ensued.

Conclusion

This case illustrates the importance of early diagnosis of foreign body related gastrointestinal perforations and emphasizes the role of therapeutic endoscopy.

Foreign body retained in liver long after gauze packing

This case report describes a foreign body retained in the liver long after perihepatic gauze packing. A 64-year-old female patient had suffered a rib fracture and liver rupture during a traffic accident in 1973. She discovered a mass in her right hypochondrium. Her hepatic ultrasonography showed a round mass (20.3 cm × 17.3 cm × 16.0 cm in size) with fluid echogenicity in the right lobe of her liver, and a hepatic cystic-solid mass (19.7 cm × 18.5 cm × 15.6 cm in size) was identified in an abdominal computerized tomography scan. Several pieces of gauze were extracted, and brown pus from the hepatic mass was suctioned during her exploratory laparotomy. Histology documented gauze remnants with necrotic material inclusions and fibrotic capsules. To our knowledge, this patient’s case represents the longest time for which a foreign body has been retained in the liver. In addition, we conducted a comprehensive literature review of foreign bodies retained in the liver. Foreign bodies may be introduced into the liver via penetrating trauma, surgical procedures or the ingestion of foreign bodies (which then migrate from the gut). Thus, they can be classified into the following three categories: penetrating, medical and migrated foreign bodies. The details of the case are thoroughly described.

A sewing needle in the liver: 6 years later

A 27-year-old male patient was admitted for renal colic. In the radiographic findings of his kidney-ureter-bladder, a 6-cm-long sewing needle was detected in the right upper abdominal region. The needle displayed a direction toward the diaphragm, and the center of the needle had a radiolucent discontinuity. He refused to be operated. No complication was observed during the 6-year follow-up. Foreign bodies in the liver are generally recommended to be removed. This case is the first one in the literature with a needle in the liver remaining for 6 years without a change of location or causing a complication.

A sewing needle in liver: a case report and review of the literature

Introduction

Hepatic foreign bodies are quite rare. A sewing needle as a hepatic foreign body in an old woman is very rare and the managements have been varied.

Case presentation

An old woman was incidentally found to have a sewing needle in her liver on abdominal X-ray. The sewing needle was kept stable in her liver after two years of follow-up. Eleven cases of sewing needle in the liver were reviewed.

Conclusion

Sewing needle as a foreign body in the liver is rare. In general, the sewing needle should be removed through laparotomy or laparoscopy, but a stable and uncomplicated sewing needle in the liver need not be removed.