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Yu M, Li K, Zhou S, Wang H, Le M, Li C, Liu D, Tan Y. Endoscopic Removal of Sharp-Pointed Foreign Bodies with Both Sides Embedded into the Duodenal Wall in Adults: A Retrospective Cohort Study. Int J Gen Med 2021; 14:9361-9369. [PMID: 34908865 PMCID: PMC8664340 DOI: 10.2147/ijgm.s338643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/04/2021] [Indexed: 12/18/2022] Open
Abstract
Purpose Sharp-pointed FBs with both sides embedded in the duodenal wall are rare. Compared with smooth edged FBs, sharp objects are more likely to be associated with significant adverse events, when penetrating the wall of the digestive tract. The clinical features of patients who experienced sharp-pointed FBs embedded in both sides of the duodenum were retrospectively analyzed, as were the efficacy and safety of endoscopic removal of these FBs. Patients and Methods This retrospective study included 21 adults with both sides of sharp-pointed FBs embedded into the duodenal wall who were admitted to the Second Xiangya Hospital in China between January 1, 1996, and May 31, 2021. Data associated with the endoscopic removal of these FBs were collected from the electronic medical record system (EMRS) of the hospital. Results The incidence rate of duodenal total FBs and FBs embedded in both sides was 8.87% and 1.03%, respectively. The success rate of endoscopic treatment was 100.00% in 124 patients without embedded duodenal FBs and 97.14% in 35 patients with one side embedded duodenal FBs. Of the 21 patients with FBs embedded in both sides of the duodenal wall, endoscopic removal was successful in 85.71% of patients, whereas 14.29% required surgery. FBs removed from these patients included toothpicks in 12; needles in 3; jujube pits in 2; and a chopstick, dentures, fish bones, and chicken bones in one each. Most of these 21 FBs were located in the bulb and descending duodenum, followed by the third part of duodenum. Conclusion Sharp-edged FBs with both sides embedded in the duodenal wall are rare. Endoscopic removal may be considered as a feasible, safe, and effective method of removing sharp-pointed FBs with both sides embedded in the duodenal wall. And if endoscopic removal is unsuccessful, surgical management can be a secondary option.
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Affiliation(s)
- Meihong Yu
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People's Republic of China.,Research Center of Digestive Disease, Central South University, Changsha, Hunan, 410011, People's Republic of China
| | - Kaixuan Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China
| | - Shishuang Zhou
- Department of Nursing Administration, Army Military Medical University, Chongqing, 400038, People's Republic of China
| | - Hanyu Wang
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People's Republic of China.,Research Center of Digestive Disease, Central South University, Changsha, Hunan, 410011, People's Republic of China
| | - Meixian Le
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People's Republic of China.,Research Center of Digestive Disease, Central South University, Changsha, Hunan, 410011, People's Republic of China
| | - Chen Li
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People's Republic of China.,Research Center of Digestive Disease, Central South University, Changsha, Hunan, 410011, People's Republic of China
| | - Deliang Liu
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People's Republic of China.,Research Center of Digestive Disease, Central South University, Changsha, Hunan, 410011, People's Republic of China
| | - Yuyong Tan
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People's Republic of China.,Research Center of Digestive Disease, Central South University, Changsha, Hunan, 410011, People's Republic of China
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2
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Hou R, Zhou H, Hu K, Ding Y, Yang X, Xu G, Xue P, Shan C, Jia S, Ma Y. Thorough documentation of the accidental aspiration and ingestion of foreign objects during dental procedure is necessary: review and analysis of 617 cases. Head Face Med 2016; 12:23. [PMID: 27449659 PMCID: PMC4957346 DOI: 10.1186/s13005-016-0120-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 07/12/2016] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES To review the cases of accidental aspiration and ingestion of foreign objects during dental procedure, and to emphasize the importance of thorough documentation of the accidents. METHODS A comprehensive search on (dental procedure/treatment/practice), (aspiration/inhalation), and (ingestion/swallow) was performed for all years before 1st October 2014 available. The statistic analysis was made on the variables including journals and reported year, patients' age, gender, general conditions, dental procedure and location for procedure, foreign objects, site of involvement, possible causes, anesthesia during procedure and treatment, symptoms, treatment time and treatment modality, follow-up, and so on. RESULTS A total of 617 cases reported by 45 articles from 37 kinds of journals were included and analyzed. Most reports made detailed record. While some important variables were recorded incompletely, including patient's general conditions, location for procedure, clinical experience of the involving dentists, tooth position of procedure, possible causes, and anesthesia during procedure and treatment for the accident. CONCLUSIONS Aspiration and ingestion of foreign objects are rare and risky complication during dental procedure. Each accident should have thorough documentation so as to provide enough information for the treatment and prevention.
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Affiliation(s)
- Rui Hou
- />Department of Oral Surgery, State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, School of Stomatology, The Fourth Military Medical University, Xi’an City, Shaanxi Province 710032 China
| | - Hongzhi Zhou
- />Department of Oral Surgery, State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, School of Stomatology, The Fourth Military Medical University, Xi’an City, Shaanxi Province 710032 China
| | - Kaijin Hu
- />Department of Oral Surgery, State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, School of Stomatology, The Fourth Military Medical University, Xi’an City, Shaanxi Province 710032 China
| | - Yuxiang Ding
- />Department of Oral Surgery, State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, School of Stomatology, The Fourth Military Medical University, Xi’an City, Shaanxi Province 710032 China
| | - Xia Yang
- />Department of Oral Surgery, State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, School of Stomatology, The Fourth Military Medical University, Xi’an City, Shaanxi Province 710032 China
| | - Guangjie Xu
- />Department of Oral Surgery, State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, School of Stomatology, The Fourth Military Medical University, Xi’an City, Shaanxi Province 710032 China
| | - Peng Xue
- />Department of Oral Surgery, State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, School of Stomatology, The Fourth Military Medical University, Xi’an City, Shaanxi Province 710032 China
| | - Chun Shan
- />Department of Oral Surgery, State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, School of Stomatology, The Fourth Military Medical University, Xi’an City, Shaanxi Province 710032 China
| | - Sen Jia
- />Department of Oral Surgery, State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, School of Stomatology, The Fourth Military Medical University, Xi’an City, Shaanxi Province 710032 China
| | - Yuanyuan Ma
- />Department of Stomatology, Research Institute of Surgery & Daping Hospital, The Third Military Medical University, Chongqing City, 400042 China
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Sarwa P, Dahiya RS, Anand S, Gogna S, Gupta D, Arora B. A curious case of foreign body induced jejunal obstruction and perforation. Int J Surg Case Rep 2014; 5:617-9. [PMID: 25105776 PMCID: PMC4201021 DOI: 10.1016/j.ijscr.2013.12.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 12/20/2013] [Accepted: 12/24/2013] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Accidental and unnoticed ingestion of foreign bodies are not very uncommon. Most of such foreign bodies pass through gastrointestinal tract uneventfully and only on rare instances cause obstruction and/or perforation. PRESENTATION OF CASE We are reporting a case in which a 45 yr old male presented to accident and emergency department of our institute with complaints of pain abdomen, greenish vomiting, abdominal distension, fever and non passage of flatus and stool following alcoholic binge 15 days back. On presentation tachycardia, hypotension, generalised abdominal tenderness and guarding were present. After initial resuscitation and investigation diagnosis of perforation peritonitis was made and emergency exploratory lapratomy was done and a single perforation with plastic foreign body protruding through it was found in jejunum 5 cm distal to duodeno-jejunal junction. DISCUSSION The majority of ingested FBs that reach the stomach pass uneventfully through the gastrointestinal tract. The majority of cases occur in children. Only 1% of patient of patients requires surgical intervention depending upon nature, size and shape of the foreign body. CONCLUSION Present case report intends to draw the attention towards possibility of intestinal obstruction and perforation by a single plastic foreign body. High index of suspicion is needed as this foreign body is not even radio-opaque and cannot be picked up in X-ray investigations. Also with increasing use of such plastic materials there are increased chances of such incidents.
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Affiliation(s)
- Pushpendra Sarwa
- Department of General Surgery, Pt. B.D.S. Post Graduate Institute of Medical Sciences, University of Health Sciences, Rohtak, India.
| | - Ranbir Singh Dahiya
- Department of General Surgery, Pt. B.D.S. Post Graduate Institute of Medical Sciences, University of Health Sciences, Rohtak, India
| | - Samir Anand
- Department of General Surgery, Pt. B.D.S. Post Graduate Institute of Medical Sciences, University of Health Sciences, Rohtak, India
| | - Sekhar Gogna
- Department of General Surgery, Pt. B.D.S. Post Graduate Institute of Medical Sciences, University of Health Sciences, Rohtak, India
| | - Deepanshu Gupta
- Department of General Surgery, Pt. B.D.S. Post Graduate Institute of Medical Sciences, University of Health Sciences, Rohtak, India
| | - Bhavinder Arora
- Department of General Surgery, Pt. B.D.S. Post Graduate Institute of Medical Sciences, University of Health Sciences, Rohtak, India
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Yilmaz M, Akbulut S, Ozdemir F, Gozeneli O, Baskiran A, Yilmaz S. A swallowed dental prosthesis causing duodenal obstruction in a patient with schizophrenia: Description of a new technique. Int J Surg Case Rep 2012; 3:308-10. [PMID: 22543279 PMCID: PMC3356528 DOI: 10.1016/j.ijscr.2012.03.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Revised: 03/12/2012] [Accepted: 03/30/2012] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Foreign body ingestion has been a fundamental subject in the area of emergency surgery. The problem is encountered across all age groups; however, it is more common in the pediatric age group. Foreign body ingestion is rare in adults and usually occurs accidentally or in those with psychiatric problems, behavioral disorders, emotional disturbance, mental retardation, or impaired judgment caused by alcohol use. PRESENTATION OF CASE A 33-year-old Caucasian man with chronic schizophrenia was admitted to the emergency department with signs of upper gastrointestinal discomfort as a result of ingestion of a lower dental prosthesis. An abdominal X-ray showed the swallowed dental prosthesis in front of the vertebral column. A technique comprising gastrotomy and duodenal kocherization was used to remove the dental prosthesis; the prosthesis could not be removed endoscopically due to its fixed position on the duodenal wall. DISCUSSION Surgery of the duodenum is difficult and carries high mortality and morbidity. Therefore, endoscopy should be the first choice for patients in whom a foreign object is demonstrated to be fixed in the duodenum. In cases where endoscopic extraction fails, surgery should be considered. During surgery, foreign bodies should be removed, paying meticulous attention not to harm the integrity of the duodenum. CONCLUSION The technique presented in this study was performed successfully without any injury to the duodenum.
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Affiliation(s)
- Mehmet Yilmaz
- Department of Surgery, Inonu University Faculty of Medicine, Division of Liver Transplantation, 44280 Malatya, Turkey
| | - Sami Akbulut
- Department of Surgery, Diyarbakir Education and Research Hospital, 21400 Diyarbakir, Turkey
- Corresponding author. Tel.: +90 412 2580050; fax: +90 412 2580052.
| | - Fatih Ozdemir
- Department of Surgery, Inonu University Faculty of Medicine, Division of Liver Transplantation, 44280 Malatya, Turkey
| | - Orhan Gozeneli
- Department of Surgery, Inonu University Faculty of Medicine, Division of Liver Transplantation, 44280 Malatya, Turkey
| | - Adil Baskiran
- Department of Surgery, Inonu University Faculty of Medicine, Division of Liver Transplantation, 44280 Malatya, Turkey
| | - Sezai Yilmaz
- Department of Surgery, Inonu University Faculty of Medicine, Division of Liver Transplantation, 44280 Malatya, Turkey
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Saitua F, Acosta S, Soto G, Herrera P, Tapia D. To remove or not remove...asymptomatic sewing needle within hepatic right lobe in an infant. Pediatr Emerg Care 2009; 25:463-4. [PMID: 19606004 DOI: 10.1097/pec.0b013e3181ab7940] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The ingestion or accidental insertion of foreign bodies is extremely rare before 6 months of age. We report the case of a 3-month-old infant with a sewing needle into the right hepatic lobe, without symptoms. The extraction was performed through laparotomy. The issue is revisited, and the decision making tree is discussed.
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6
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Akçam M, Koçkar C, Tola HT, Duman L, Gündüz M. Endoscopic removal of an ingested pin migrated into the liver and affixed by its head to the duodenum. Gastrointest Endosc 2009; 69:382-4. [PMID: 18565527 DOI: 10.1016/j.gie.2008.03.1084] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Accepted: 03/17/2008] [Indexed: 02/08/2023]
Affiliation(s)
- Mustafa Akçam
- Department of Pediatrics, Division of Pediatric Gastroenterology Hepatology and Nutrition, Suleyman Demirel University Medical School, Isparta, Turkey
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7
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Duodeno-sigmoid fistula due to ingested metallic wire. J Emerg Med 2007; 34:83-4. [PMID: 17936536 DOI: 10.1016/j.jemermed.2007.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2006] [Revised: 11/15/2006] [Accepted: 02/17/2007] [Indexed: 11/21/2022]
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8
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Yalçin S, Karnak I, Ciftci AO, Senocak ME, Tanyel FC, Büyükpamukçu N. Foreign body ingestion in children: an analysis of pediatric surgical practice. Pediatr Surg Int 2007; 23:755-61. [PMID: 17569061 DOI: 10.1007/s00383-007-1958-y] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2007] [Indexed: 02/08/2023]
Abstract
Ingestion of a foreign body (FB) is a prevalent condition among children. The type of FB varies according to the feeding habits and sociocultural features of communities. The management modality differs also between disciplines due to use of conventional techniques. We aimed to picture the general characteristics of FB ingestion and treatment alternatives, to mention the indications of open surgery in an advanced pediatric surgical center. The records of patients who were hospitalized for FB ingestion between 1973 and May 2005 were evaluated retrospectively. One hundred and twelve patients were enrolled into the study. The mean age was 2.27 +/- 2.84 years with a M/F ratio of 59/53. The history was suggestive of ingestion in 92% of patients. The age did not differ significantly whether the history was positive or negative (3.6 years vs. 4.8 years and P = 0.19). Most common presenting symptom was vomiting (28.6%). The duration of symptoms was longer in patients with negative history (median 47.7 h vs. 28.1 h and P < 0.002). Physical examination was normal in 89.3% of cases. Most common localization of the FB shown in plain X-ray was the esophagus (67%). Esophagography revealed nonopaque FB in the esophagus in 4.4%. X-ray was normal in 6.3% of the patients. The age of patient did not determine the localization of FB on admission (P = 0.436). Endoscopic removal was attempted in 75% and was successful in 68% of patients in which FB was extracted by using laryngoscope and Magill forceps (12%), rigid esophagoscope with FB forceps (51%), and flexible endoscope with FB forceps (5%). FB could not be found in 32% of patients at initial rigid esophagoscopy or flexible endoscopy. FB was eliminated spontaneously (n = 19) or extracted surgically (n = 8). Follow-up was preferred in 21% of patients on initial admission. FB proceeded uneventfully in 15 patients or was extracted by flexible endoscopy or surgery in one and eight patients, respectively. Surgery was performed in 4% on admission. Surgery or endoscopy were essentially required in cases whose follow-up period exceeded 4 days when compared with patients who eliminated FB spontaneously within 4 days, independent to the location of FB. The metallic objects were the frequently ingested FBs (83.8%) in which the safety pins (SPs) (n = 53) and coins (n = 25) were the most frequent. The type of FB did not affect the FB localization on admission (P = 0.38). The duration of hospitalization was longer in patients with delayed admission; 2.46 +/- 3.51, 3.80 +/- 8.17, and 5.72 +/- 4.24 days for the admissions within first, second-fifth days, and sixth or later days after ingestion, respectively (P = 0.000). Pediatric surgery has the largest spectrum of duty in the treatment of FB ingestion in children. Negative history, normal physical examination findings and absence of symptoms do not exclude the possibility of FB ingestion. Presentation with isolated respiratory symptoms is an enigma that can lead to misdiagnoses. The mode of management should be selected according to the patient's condition, surgeon's experience, and available technical equipment as well as the location and type of ingested FB. Especially, SPs should be treated by experienced surgeons. Simple extraction techniques and both rigid and flexible endoscopies with appropriate forceps as well as surgery can be used for the extraction of FBs lodged in the alimentary tract. Surgery can be expected especially in asymptomatic cases that have been followed up for more than 4 days irrespective of the location of FB.
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Affiliation(s)
- Sule Yalçin
- Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, 06100 Ankara, Turkey
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Prasad TRS, Low Y, Tan CE, Jacobsen AS. Swallowed Foreign Bodies in Children: Report of Four Unusual Cases. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2006. [DOI: 10.47102/annals-acadmedsg.v35n1p49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Introduction: Although a majority of ingested foreign bodies (FBs) pass down the gastrointestinal tract spontaneously, those that are sharp, pointed or large in size need removal to avert serious complications. We highlight the urgent need and utility of endoscopic accessories and technical artistry in safe retrieval of FBs in children.
Clinical Picture: Four children had accidentally swallowed a nail, metallic dumbbell, open safety pin and a cushion pin respectively. They were symptom-free and the abdominal plain radiographs revealed foreign body in the stomach in all the cases.
Treatment: Oesophago-gastro-duodenoscopy (OGD) was done in all the patients and could retrieve the nail, metallic dumbbell and open safety pin successfully using a Dormia basket, a polypectomy snare and a pair of rat-tooth forceps respectively. The cushion pin had migrated to the duodeno-jejunal junction within 4 hours of ingestion and necessitated open duodenotomy and retrieval.
Outcome: All patients did well after the procedure with no complications.
Conclusions: Swallowed FBs with pointed or sharp ends or large enough to cross the pylorus and duodenal sweep need removal and in the majority of the cases they can be retrieved by OGD. Sharp or pointed FBs that have crossed the second part of the duodenum necessitate urgent laparotomy for retrieval to prevent complications.
Key words: Complications, Ingestion, Treatment
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Affiliation(s)
| | - Y Low
- KK Women’s and Children’s Hospital, Singapore
| | - CE Tan
- KK Women’s and Children’s Hospital, Singapore
| | - AS Jacobsen
- KK Women’s and Children’s Hospital, Singapore
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