A Case of Mysterious Impacted Duodenal Foreign Body Presenting with Halitosis

Endoscopic Removal of Sharp-Pointed Foreign Bodies with Both Sides Embedded into the Duodenal Wall in Adults: A Retrospective Cohort Study

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.

Hazards and Management of Wire Bristle ingestions: A Systematic Review

OBJECTIVE

Inadvertently ingested grill brush bristles can lodge in various locations and lead to a variety of injuries. They can also be difficult to identify and remove. Our primary objective was to perform a systematic review of cases reported in the literature, with analysis of trends in clinical presentation and success of diagnostic modalities and treatment approaches.

DATA SOURCES

Cases of reported grill brush bristle ingestion reported in PubMed, PubMed Central, and Google Scholar databases through April 30, 2021.

REVIEW METHODS

Databases were searched for the following terms: ("ingestion" OR "injury" OR "barbeque" OR "BBQ" OR "grill" OR "foreign body" OR "brush" AND "wire" OR "bristle"). Data were collected on patient demographics, clinical presentation, and treatment course. Statistical analysis was performed on characteristics with low risk of confounding.

RESULTS

An overall 57 studies involving 91 patients were included. Grill brush bristles presented most commonly in the upper aerodigestive tract (48/91), followed by the abdomen (26/91) and deep neck (17/91). Computed tomography was the most accurate imaging modality for initial diagnosis, identifying 92.8% of bristles. Less invasive or adjunctive techniques such as endoscopy, intraoperative imaging, or minimally invasive surgery may be useful particularly for bristles located in the head and neck given the low rate of success of transoral surgery (66.7%).

CONCLUSION

Although this review of retained bristle may be biased toward complex cases, retained grill brush bristles represent an underrecognized and difficult-to-manage hazard. When cases are suspected, clinicians should obtain computed tomography imaging based on presentation and tailor management appropriately.

Grilling pains: case series of four patients needing operative intervention after accidental ingestion of a wire bristle

Accidental ingestion of a grill brush wire bristle is a rare event. Retrieval rarely requires surgical intervention as the wire typically causes symptoms above the gastro-oesophageal junction and can frequently be removed endoscopically. There are few reported cases of gastrointestinal injury due to ingestion of wire bristles lodging past the gastro-oesophageal junction in adults. We present four cases of wire brush bristle ingestion that required operative intervention. Our case series illustrates how the commonly used wire grill brush may cause a serious injury. This diagnosis should be considered in patients who present with abdominal pain, non-specific symptoms and normal labs, with liner radio-opaque imaging findings and a history of grill use. Education as to the dangers of grill wire brushes to clean grills should be provided commercially.

Appendicitis-mimicking presentation in fishbone induced microperforation of the distal duodenum: A case report

BACKGROUND

Upper gastrointestinal fishbone microperforations are rare and not commonly reported in medical literature. Despite the increasing use of computer tomography (CT) imaging and the employment of the Alvardo criteria, misdiagnosis of acute appendicitis can still occur. We report the rare case of an elderly Chinese gentleman who had a fish-bone induced microperforation of the duodenum that closely mimicked the symptoms of acute appendicitis.

CASE SUMMARY

This 79-year-old man presented with migratory lower abdominal pain that localized at his periumbilical region and right lower quadrant. He had associated pyrexia, general malaise and was noted to have an elevated white cell count. CT investigations initially revealed a distended appendix which was resected laparoscopically but showed no obvious signs of gross inflammation. The patient then deteriorated clinically and had increased oxygen requirements immediately after the surgery. This prompted further investigations. A further review of his CT scan revealed a fine fishbone microperforation in the distal duodenum associated with retroperitoneal abscess formation and seepage extending into the right lower quadrant. He was then started on broad spectrum intravenous antibiotics and subsequently underwent a laparotomy 12 h later to manage the obscure aetiology and to drain the abscess. The post-operative course was uneventful and he was discharged 11 d later including a 2-d stay in the intensive care unit.

CONCLUSION

This case offers an insight into a potential mimic of acute appendicitis and the diagnostic difficulties experienced in such presentations.

Chronic ileitis with transmural migration of ingested foreign body treated by laparoscopy

BACKGROUND

Ingestion of foreign bodies such as fish bone or chicken bone is relatively common in adults; however, resultant transmural migration is extremely rare.

METHODS

We present a case of a 79-year-old woman with chronic low-grade abdominal pain, worsening over the last 4 days. Computed tomography revealed segmental small bowel wall thickening with chronic inflammation suggestive of Crohn's ileitis and oral steroids were commenced; only later, ingestion of a foreign body was suspected.

RESULTS AND CONCLUSION

At diagnostic laparoscopy, a linear foreign body resembling a wooden splinter was identified. It had partly migrated through the chronically inflamed bowel wall without causing perforation or abdominal contamination. It was removed laparoscopically without an enterotomy or bowel resection. Microscopy revealed non-viable bone, likely fish or chicken bone. The patient made an uneventful recovery and was discharged 3 days later. Herein we emphasise on the differential diagnosis and presentation of chronically ingested foreign bodies, as well as the feature of chronic ileitis with uncomplicated transmural migration of the ingested foreign body that was treated laparoscopically without an enterotomy.

A Current Approach to Halitosis and Oral Malodor- A Mini Review

BACKGROUND

Halitosis, in other words, oral malodor is an important multifactorial health problem affecting the psychological and social life of individuals and is the most common reason for referral to dentists after dental caries and periodontal diseases.

OBJECTIVE

The objective of this review was to present and discuss conventional and recently introduced information about the types, causes, detection and treatment methods of halitosis.

METHODS

An expanded literature review was conducted which targeted all articles published in peer-reviewed journals relating to the topic of halitosis. Only articles written in Turkish and English languages were considered. The review itself began with a search of relevant subject headings such as 'halitosis, oral malodor, volatile sulfur compounds in PubMed/Medline, Scopus, Google Scholar and Tubitak Ulakbim databases. A hand search of references was also performed.

RESULTS

When search results are combined, the total number of relevant literature was found to be 4646 abstracts and 978 full-text articles. Abstracts, editorial letters were not included and about half of full-text articles were not related to dental practice. Among the remaining 124 full-text articles, duplicated articles and articles written other than Turkish and English languages were removed and 54 full-text articles were used for this review.

DISCUSSION

According to the reviewed articles, both conventional and new methods were introduced in the management of halitosis. However, conventional methods seem to be more effective and widely used in the diagnosis and treatment of halitosis.

CONCLUSION

As being first line professionals, dentists must analyze and treat oral problems which may be responsible for the patient's malodor, and should inform the patient about halitosis causes and oral hygiene procedures (tooth flossing, tongue cleaning, appropriate mouthwash and toothpaste selection and use) and if the problem persists, they should consult to a medical specialist.