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Wu L, Chen XY, Ji D, Zhang ZG, Mao XP. Foreign body-intestinal canal angle guides management of ingested foreign bodies in the lower gastrointestinal tract. Abdom Radiol (NY) 2024:10.1007/s00261-024-04404-7. [PMID: 38829394 DOI: 10.1007/s00261-024-04404-7] [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: 04/15/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Determining whether prompt surgery is required for patient with ingested foreign bodies is clinically important. PURPOSE To evaluate the potential value of computed tomography (CT) in guiding the selection of surgical treatment for patients with ingested foreign bodies in the lower gastrointestinal tract. METHODS Between January 2014 and December 2023, we analyzed the data of 58 patients (median age: 65.4 years; range, 31-96 years) with ingested foreign bodies in the lower gastrointestinal tract who underwent CT examinations. Patients were treated either conservatively (35 cases) or surgically (23 cases). The angle between the long axis of the foreign body and the intestinal canal (FB-IC angle) was measured. CT findings and clinical variables were evaluated to identify potential indicators for surgical treatment through univariate and multivariate logistic regression analyses. RESULTS Univariate analysis revealed the FB-IC angle (P = 0.002), presence of free peritoneal gas (P = 0.002), white blood cell count (P = 0.018), and neutrophil count (P = 0.007) as significant factors associated with surgical treatment. Multivariate analysis demonstrated that the FB-IC angle (odds ratio, 1.033; P = 0.045) and the presence of free peritoneal gas (odds ratio, 41.335; P = 0.002) are independent indicators for surgical management. The FB-IC angle showed an area under the receiver operating characteristic curve of 0.755, with a cutoff value of 51.25 degrees. CONCLUSION The FB-IC angle and presence of free peritoneal gas serve as potential predictive imaging markers for surgical intervention.
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Affiliation(s)
- Lei Wu
- Department of Radiology, The Affiliated Zhangjiagang TCM Hospital of Yangzhou University, No. 77 Changan Road, Zhangjiagang, 215600, Jiangsu, China
| | - Xiao-Yu Chen
- Department of Radiology, The Affiliated Zhangjiagang TCM Hospital of Yangzhou University, No. 77 Changan Road, Zhangjiagang, 215600, Jiangsu, China
| | - Dan Ji
- Department of Radiology, The Affiliated Zhangjiagang TCM Hospital of Yangzhou University, No. 77 Changan Road, Zhangjiagang, 215600, Jiangsu, China
| | - Zhi-Guo Zhang
- Department of Radiology, The Affiliated Zhangjiagang TCM Hospital of Yangzhou University, No. 77 Changan Road, Zhangjiagang, 215600, Jiangsu, China
| | - Xu-Ping Mao
- Department of Radiology, The Affiliated Zhangjiagang TCM Hospital of Yangzhou University, No. 77 Changan Road, Zhangjiagang, 215600, Jiangsu, China.
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2
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Canakci H, Akbas MU, Arslan E, Tulaci KG, Yazici H. A Rare Laryngeal Foreign Body Case: Postcricoid Total Dental Prosthesis. Laryngoscope 2024; 134:2331-2334. [PMID: 37916852 DOI: 10.1002/lary.31151] [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: 07/19/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 11/03/2023]
Abstract
In this case report, 60-year-old patient who aspirated total dental prosthesis into the postcricoid region was presented with patient's history, clinical findings, radiologic examinations and surgical treatment with comparison of literature data. To our literature knowledge, this is the first total dental prosthesis detected in postcricoid region. This was unusual because it did not cause any respiratory disorders such as laryngospasm and asphyxia, although it led to mucosal abrasions in a wide area of esophageus. Laryngoscope, 134:2331-2334, 2024.
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Affiliation(s)
- Hasan Canakci
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Balikesir University, Balıkesir, Turkey
| | - Mustafa U Akbas
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Balikesir University, Balıkesir, Turkey
| | - Erhan Arslan
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Balikesir University, Balıkesir, Turkey
| | - Kamil G Tulaci
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Balikesir University, Balıkesir, Turkey
| | - Hasmet Yazici
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Balikesir University, Balıkesir, Turkey
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3
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Ma L, Liu Z, Wang Y, Wang T, Sun G, Wang L, Fan K, Liu J, Ma L, Qin W, Hu J, Cai M, Zhang G, Li Q, Zhou P. Endoscopic management of duodenal perforation caused by foreign bodies in adults: A retrospective study. United European Gastroenterol J 2024; 12:390-398. [PMID: 38159037 PMCID: PMC11017768 DOI: 10.1002/ueg2.12505] [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: 07/24/2023] [Accepted: 10/12/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND AIMS Duodenal perforation caused by foreign bodies (FBs) is very rare but is an urgent emergency that traditionally requires surgical intervention. Several case reports have reported the successful endoscopic removal of duodenal perforating FBs. Here we aimed to evaluate the safety and efficacy of endoscopic management of duodenal perforating FBs in adults. METHODS Between October 2004 and October 2022, 12,851 patients with endoscopically diagnosed gastrointestinal FBs from four tertiary hospitals in China were retrospectively reviewed. Patients were enrolled if they were endoscopically and/or radiographically diagnosed with duodenal perforating FBs. RESULTS The incidence of duodenal total FBs and perforating FBs was 1.9% and 0.3%, respectively. Thirty-four patients were enrolled. Endoscopic removal was achieved in 25 patients (73.5%), and nine patients (26.5%) received surgery. For the endoscopic group, most perforating FBs were located in the duodenal bulb (36.0%) and descending part (28.0%). The adverse events included 3 mucosal injuries and 1 localized peritonitis. All patients were cured after conventional treatment. In the surgical group, most FBs were lodged in the descending part (55.6%). One patient developed localized peritonitis and one patient died of multiple organ failure. The significant features of FBs requiring surgery included FB over 10 cm, both sides perforation, multiple perforating FBs and massive pus overflow. CONCLUSION Endoscopic removal of duodenal perforating FBs is safe and effective, and can be the first choice of treatment for experienced endoscopists. Surgical intervention may be required for patients with FBs over 10 cm, both sides perforation, multiple perforating FBs, or severe infections.
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Affiliation(s)
- Li‐Yun Ma
- Endoscopy Center and Endoscopy Research InstituteZhongshan HospitalFudan UniversityShanghaiChina
| | - Zu‐Qiang Liu
- Endoscopy Center and Endoscopy Research InstituteZhongshan HospitalFudan UniversityShanghaiChina
| | - Ye Wang
- Department of GastroenterologyTianjin First Central HospitalTianjinChina
| | - Tao Wang
- Department of GastroenterologyTianjin Medical University General HospitalTianjinChina
| | - Guang‐bin Sun
- Department of GastroenterologyTianjin Fifth Central HospitalTianjinChina
| | - Li Wang
- Endoscopy Center and Endoscopy Research InstituteZhongshan HospitalFudan UniversityShanghaiChina
| | - Ke‐Yang Fan
- Endoscopy Center and Endoscopy Research InstituteZhongshan HospitalFudan UniversityShanghaiChina
| | - Jing‐Zheng Liu
- Endoscopy Center and Endoscopy Research InstituteZhongshan HospitalFudan UniversityShanghaiChina
| | - Li‐Li Ma
- Endoscopy Center and Endoscopy Research InstituteZhongshan HospitalFudan UniversityShanghaiChina
| | - Wen‐Zheng Qin
- Endoscopy Center and Endoscopy Research InstituteZhongshan HospitalFudan UniversityShanghaiChina
| | - Jian‐Wei Hu
- Endoscopy Center and Endoscopy Research InstituteZhongshan HospitalFudan UniversityShanghaiChina
| | - Ming‐Yan Cai
- Endoscopy Center and Endoscopy Research InstituteZhongshan HospitalFudan UniversityShanghaiChina
| | - Guo‐Liang Zhang
- Department of GastroenterologyTianjin First Central HospitalTianjinChina
| | - Quan‐Lin Li
- Endoscopy Center and Endoscopy Research InstituteZhongshan HospitalFudan UniversityShanghaiChina
- Shanghai Collaborative Innovation Center of EndoscopyShanghaiChina
| | - Ping‐Hong Zhou
- Endoscopy Center and Endoscopy Research InstituteZhongshan HospitalFudan UniversityShanghaiChina
- Shanghai Collaborative Innovation Center of EndoscopyShanghaiChina
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4
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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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5
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Chen J. Vascular covered stent and video-assisted thoracoscopic surgery for Aortoesophageal fistula caused by esophageal fishbone: a case report. J Cardiothorac Surg 2024; 19:112. [PMID: 38461352 PMCID: PMC10924337 DOI: 10.1186/s13019-024-02610-4] [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: 07/26/2023] [Accepted: 03/05/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND Aortoesophageal fistula (AEF) is a rare condition characterized by communication between the aorta and esophagus. AEF caused by an esophageal foreign body is even rare, and there is currently no recommended standard treatment protocol. We report a case of delayed aortic rupture after the endoscopic removal of a fish bone, which was successfully treated with a combined approach of vascular stenting and thoracic surgery. CASE PRESENTATION A 33-year-old man presented to the hospital after experiencing chest discomfort for 3 days following the accidental ingestion of a fish bone. Under endoscopic guidance, the fish bone was successfully removed, and the patient was subsequently admitted for medical therapy. On the fourth postoperative day, the patient suddenly developed hematemesis, and chest computed tomography angiography revealed the presence of an AEF. This necessitated urgent intervention; hence, thoracic surgery was performed and a vascular-covered stent was placed. Following the surgical procedure, the patient received active medical treatment, recovered well, and was successfully discharged from the hospital. CONCLUSIONS In patients with esophageal perforation caused by foreign bodies, hospitalization for observation, computed tomography angiography examination, early use of antibiotics, and careful assessment of aortic damage are advised. Thoracic endovascular aortic repair and esophageal rupture repair may have benefits for the treatment of AEF.
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Affiliation(s)
- Jianfeng Chen
- Department of Anesthesiology, West China Hospital, Sichuan University, No 37 Guoxue Alley, Wuhou District, Chengdu City, Sichuan Province, PR China.
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6
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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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7
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Martins D, Vaz-Pereira R, Ferreira C, Costa P, Pinto-de-Sousa J. Apple Core Unveiled: Malignant Colonic Obstruction Revealing an Unknown Rectosigmoid Neoplasm With Foreign Body Impaction. Cureus 2024; 16:e51536. [PMID: 38304657 PMCID: PMC10834070 DOI: 10.7759/cureus.51536] [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: 01/02/2024] [Indexed: 02/03/2024] Open
Abstract
This case report highlights a rare clinical scenario of a 46-year-old male presenting with constipation and fecaloid vomiting due to an impacted chicken bone within an unidentified rectosigmoid neoplasm, leading to acute malignant colonic obstruction. Emergent exploratory laparotomy revealed an impacted chicken bone lodged in a previously unknown rectosigmoid tumor. An anatomopathological examination revealed a mucinous adenocarcinoma with clear margins and one pericolic metastatic lymph node. The postoperative period was uneventful, and the patient was proposed for adjuvant chemotherapy. The abrupt onset of symptoms allowed for an early diagnosis, emphasizing the unexpected association between foreign body impaction and incidental malignant obstruction. This case underscores the complexity of managing foreign body ingestion in the gastrointestinal tract and emphasizes the crucial role of diagnostic imaging in surgical planning. Furthermore, it draws attention to the potential occurrence of colorectal cancer in younger individuals, emphasizing the necessity for clinical vigilance and screening strategies beyond conventional age recommendations.
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Affiliation(s)
- Daniela Martins
- General Surgery, Centro Hospitalar de Trás-Os-Montes e Alto Douro, Vila Real, PRT
- General Surgery, Clinical Academic Centre Trás-Os-Montes e Alto Douro, Vila Real, PRT
| | - Ricardo Vaz-Pereira
- General Surgery, Centro Hospitalar de Trás-Os-Montes e Alto Douro, Vila Real, PRT
| | - Cátia Ferreira
- General Surgery, Centro Hospitalar de Trás-Os-Montes e Alto Douro, Vila Real, PRT
| | - Pedro Costa
- General Surgery, Centro Hospitalar de Trás-Os-Montes e Alto Douro, Vila Real, PRT
| | - João Pinto-de-Sousa
- General Surgery, Centro Hospitalar de Trás-Os-Montes e Alto Douro, Vila Real, PRT
- General Surgery, Clinical Academic Centre Trás-Os-Montes e Alto Douro, Vila Real, PRT
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8
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Flacks NH, Steen CJ, Kong JC. Dental hygiene and gut health: a surgical case of a misplaced dental drill bur. ANZ J Surg 2023; 93:3012-3013. [PMID: 37654123 DOI: 10.1111/ans.18681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/02/2023]
Affiliation(s)
| | | | - Joseph C Kong
- Department of Surgery, Cabrini Hospital, Melbourne, Australia
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9
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Evans NS, Aronowitz P, Albertson TE. Coin-Shaped Opacities in the Stomach. JAMA 2023; 330:2016-2017. [PMID: 37902730 DOI: 10.1001/jama.2023.19032] [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: 10/31/2023]
Abstract
On day 7 after hospital admission, a patient with end-stage kidney disease prescribed sevelamer, hydrocodone-acetaminophen, hydromorphone, and chewable lanthanum tablets developed intermittent apneic episodes, bilateral rhonchi, and responsiveness to verbal commands only with deep painful stimulus; a chest radiograph showed 4 radio-opaque coin-shaped opacities in the stomach. What is the diagnosis and what would you do next?
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Affiliation(s)
| | - Paul Aronowitz
- Department of Medicine, UC Davis Medical Center, Sacramento, California
| | - Timothy E Albertson
- Division of Pulmonary Critical Care Medicine, UC Davis, Sacramento, California
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10
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Ghazanfar H, Qasim A, Shin D, Sun H, Ihimoyan A. When Meals Turn Into a Medical Mystery: A Case Report of Sigmoid Colon Impaction by a Chicken Bone. Cureus 2023; 15:e45955. [PMID: 37900480 PMCID: PMC10599981 DOI: 10.7759/cureus.45955] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
The presence of foreign objects in the digestive system can lead to various complications within the gastrointestinal (GI) tract. In certain cases, ingesting foreign objects can pose a significant dilemma for surgical teams, primarily because they can lead to blockages or punctures in the upper or lower sections of the GI tract. On occasion, foreign objects located in the lower regions of the digestive tract, such as the colon and rectum, might have entered via the anal pathway, thereby carrying the potential risk of causing perforations in the rectum or sigmoid colon. The other complications encompass the creation of abscesses, blockages in the bowel, fistula, and bleeding. Although these issues associated with foreign objects can arise in a healthy bowel, they can pose challenges in diagnosis when occurring in a bowel that is already affected by inflammation, constrictions, or malignancy. We present a unique case report of a 72-year-old female who presented to the emergency department with left lower quadrant pain associated with nausea and vomiting. Following a detailed clinical evaluation and radiographic imaging, a chicken bone was identified as the culprit, causing an unusual impaction in the sigmoid colon. The patient's medical history revealed no prior GI complications, making this case particularly noteworthy. Timely identification and precise diagnosis of complications arising from foreign bodies are essential to efficiently handle and prevent unfavorable consequences.
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Affiliation(s)
| | - Abeer Qasim
- Internal Medicine, BronxCare Health System, New York, USA
| | - Dongmin Shin
- Internal Medicine, BronxCare Health System, Bronx, USA
| | - Haozhe Sun
- Medicine/Internal Medicine, BronxCare Health System, Bronx, USA
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11
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Barrie J, Lobo DN. A pen in the liver. Radiol Case Rep 2022; 17:3992-3995. [PMID: 36032213 PMCID: PMC9403883 DOI: 10.1016/j.radcr.2022.07.096] [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: 07/08/2022] [Revised: 07/23/2022] [Accepted: 07/27/2022] [Indexed: 11/29/2022] Open
Abstract
A 24-year-old woman with anxiety, depression, and emotionally unstable personality disorder was referred to a tertiary center 2 weeks after ingesting multiple foreign bodies. She had undergone a laparoscopic cholecystectomy and a laparotomy for extraction of ingested foreign bodies several years ago. A sagittal CT scan view showed a ballpen and a hair clip in the stomach. A coronal view demonstrated that a second ballpen had penetrated the duodenal wall to enter the liver parenchyma. There was no free intraperitoneal air or fluid or evidence of abscess formation. At laparotomy, a toothbrush, a broken spoon and a ballpen were extracted from the stomach via an anterior gastrotomy. The duodenum was adherent to the liver but the second ballpen had migrated into the distal duodenum, with the tip in the proximal jejunum. This was extracted via an enterotomy and the fistula was not interfered with. The enterotomy and gastrotomy were closed with 3-0 polydioxanone sutures. The hair clip had passed spontaneously and was not detected on intraoperative fluoroscopy. She made an uneventful recovery and postoperative liver function tests remained in the normal range. This is only the fourth reported case of a pen fistulizing between the upper gastrointestinal tract and the liver.
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Affiliation(s)
- Jenifer Barrie
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - Dileep N. Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
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12
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Zanchetta M, Monti E, Latham L, Costa J, Marzorati A, Odeh M, Colombo EM, Ietto G, Inversini D, Iovino D, Maffioli MP, Festi LF, Carcano G. Dental Prosthesis in Esophagus: A Right Cervicotomic Approach. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081170. [PMID: 36013349 PMCID: PMC9409762 DOI: 10.3390/life12081170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022]
Abstract
Foreign body ingestion in the upper digestive tract is a relatively common emergency. Less than 1% have to be treated surgically. We report the case of a 68-year-old man who ingested a dental prosthesis, probably during a seizure, and thus unknowingly, and presented two days later to the emergency department complaining of a mild dysphagia. A chest radiograph showed the presence of a removable dental prosthesis in the upper esophageal tract. The patient was brought to the operating room where a multidisciplinary equipe was assembled. Two attempts of retrieval with a flexible and a rigid endoscope failed because the removable dental prosthesis was stuck in the right pyriform sinus. Therefore, the surgeon performed an uncommon right cervicotomy and retrieved the foreign body through a right-side esophagotomy. The surgical approach depends on the nature and location of the foreign body. Urgent treatment is required whenever the patient develops dyspnea or dysphagia because of the high risk of inhalation and asphyxia. Removal of any esophageal foreign body has to be performed within 12-24 h. Repeated attempts to retrieve large dental prosthesis using an endoscope may result in esophageal perforation therefore when such risk of complication is too high, a surgical approach becomes inevitable. In our opinion, surgery remains the extrema ratio after a failed endoscopic retrieval attempt but can be lifesaving despite high risk of complications.
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Affiliation(s)
- Matteo Zanchetta
- Dipartimento di Medicina e Chirurgia, Università degli Studi dell’Insubria, 21100 Varese, Italy; (E.M.); (J.C.); (G.I.); (D.I.); (M.P.M.); (G.C.)
- Correspondence:
| | - Elisa Monti
- Dipartimento di Medicina e Chirurgia, Università degli Studi dell’Insubria, 21100 Varese, Italy; (E.M.); (J.C.); (G.I.); (D.I.); (M.P.M.); (G.C.)
| | - Lorenzo Latham
- Chirurgia Generale d’Urgenza e Trapianti, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy; (L.L.); (A.M.); (M.O.); (E.M.C.); (D.I.); (L.F.F.)
| | - Jessica Costa
- Dipartimento di Medicina e Chirurgia, Università degli Studi dell’Insubria, 21100 Varese, Italy; (E.M.); (J.C.); (G.I.); (D.I.); (M.P.M.); (G.C.)
| | - Alessandro Marzorati
- Chirurgia Generale d’Urgenza e Trapianti, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy; (L.L.); (A.M.); (M.O.); (E.M.C.); (D.I.); (L.F.F.)
| | - Murad Odeh
- Chirurgia Generale d’Urgenza e Trapianti, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy; (L.L.); (A.M.); (M.O.); (E.M.C.); (D.I.); (L.F.F.)
| | - Elisabetta Marta Colombo
- Chirurgia Generale d’Urgenza e Trapianti, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy; (L.L.); (A.M.); (M.O.); (E.M.C.); (D.I.); (L.F.F.)
| | - Giuseppe Ietto
- Dipartimento di Medicina e Chirurgia, Università degli Studi dell’Insubria, 21100 Varese, Italy; (E.M.); (J.C.); (G.I.); (D.I.); (M.P.M.); (G.C.)
- Chirurgia Generale d’Urgenza e Trapianti, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy; (L.L.); (A.M.); (M.O.); (E.M.C.); (D.I.); (L.F.F.)
| | - Davide Inversini
- Dipartimento di Medicina e Chirurgia, Università degli Studi dell’Insubria, 21100 Varese, Italy; (E.M.); (J.C.); (G.I.); (D.I.); (M.P.M.); (G.C.)
- Chirurgia Generale d’Urgenza e Trapianti, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy; (L.L.); (A.M.); (M.O.); (E.M.C.); (D.I.); (L.F.F.)
| | - Domenico Iovino
- Chirurgia Generale d’Urgenza e Trapianti, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy; (L.L.); (A.M.); (M.O.); (E.M.C.); (D.I.); (L.F.F.)
| | - Marco Paolo Maffioli
- Dipartimento di Medicina e Chirurgia, Università degli Studi dell’Insubria, 21100 Varese, Italy; (E.M.); (J.C.); (G.I.); (D.I.); (M.P.M.); (G.C.)
- Otorinolaringoiatria, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy
| | - Luigi Fiorenzo Festi
- Chirurgia Generale d’Urgenza e Trapianti, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy; (L.L.); (A.M.); (M.O.); (E.M.C.); (D.I.); (L.F.F.)
| | - Giulio Carcano
- Dipartimento di Medicina e Chirurgia, Università degli Studi dell’Insubria, 21100 Varese, Italy; (E.M.); (J.C.); (G.I.); (D.I.); (M.P.M.); (G.C.)
- Chirurgia Generale d’Urgenza e Trapianti, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy; (L.L.); (A.M.); (M.O.); (E.M.C.); (D.I.); (L.F.F.)
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Yi Z, Chen C, Tuo B, Li T, Liu X. An extremely dangerous case of acute massive upper gastrointestinal bleeding: a case report. BMC Gastroenterol 2022; 22:67. [PMID: 35168558 PMCID: PMC8845279 DOI: 10.1186/s12876-022-02138-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 02/03/2022] [Indexed: 11/16/2022] Open
Abstract
Background Upper gastrointestinal (GI) bleeding is a severe acute disease of gastroenterology department. Fish bone is the most common food-related foreign body. However, fish bone piercing the esophagus, causing the mediastinal abscess that corroded the left subclavian artery, resulting delayed but high-risk massive upper gastrointestinal bleeding is very rare. Case presentation We report a 54-year-old man who was diagnosed with delayed but high-risk massive upper GI bleeding that was the result of a fish bone piercing the esophagus, causing a mediastinal abscess that corroded the left subclavian artery. He was saved effectively by early and timely multidisciplinary collaboration. Conclusion A fish bone-caused mediastinal abscess that corrodes the left subclavian artery and induces delayed but high-risk massive upper GI bleeding is very rare. In addition to routine consideration of upper GI bleeding, medical history, endoscopy and CT are helpful for achieving a diagnosis. Importantly, early and timely multidisciplinary collaboration can effectively save critically ill patients.
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