Urgent endoscopy for foreign body retrieval: A case report
Recommended Citation
Dababneh Y, Brown P, Suresh S, Alsheik E, Schairer J. Urgent endoscopy for foreign body retrieval: A case report. Am J Gastroenterol 2021; 116(SUPPL):S1468.
Document Type
Conference Proceeding
Publication Date
10-1-2021
Publication Title
Am J Gastroenterol
Abstract
Introduction: Foreign body ingestion occurs commonly, and most will pass spontaneously. Studies have shown that the rate of endoscopic intervention in the setting of intentional foreign body ingestion is high. We present a case of foreign body ingestion and illustrate the importance of patient selection for urgent endoscopy. Case Description/Methods: A 58-year-old man with history of developmental disability presented with abdominal pain after a reported foreign body ingestion. He previously presented with similar symptoms and was found to have a small bowel obstruction from ingestion of multiple foreign bodies requiring exploratory laparotomy. On current presentation, computed tomography scan showed multiple metallic foreign bodies within the duodenum, terminal ileum, and colon. Indications for emergent endoscopy were not present based on imaging; however, given the patient's history of foreign body ingestion leading to small bowel perforation, an emergent endoscopy was performed. Esophagogastroduodenoscopy resulted in retrieval of one plastic object, two zippers, two brackets, one spoon, one hook, and four magnets from the duodenum with the aid of rat-toothed forceps, a 13 mm snare, and a Roth net. Serial abdominal X-rays showed foreign bodies in the colon with no signs of advancement through the colon. The patient subsequently underwent colonoscopy for retrieval of various other small metallic objects. Post-procedure imaging did not show any residual foreign bodies. Discussion: Initial management of foreign body ingestion focuses on airway management and timing of endoscopic intervention. The need for and timing of endoscopic intervention are affected by the patient's age as well as the size, shape, and anatomic location of the foreign body and the time elapsed since ingestion. Guidelines suggest patients who are clinically stable without symptoms of obstruction and/or presence of esophageal foreign bodies or food impactions do not require urgent endoscopy. Standard practice would have suggested serial imaging because all foreign bodies were post pyloric. However, given the patient's prior history of foreign body ingestion and the potential for miscommunication due to his developmental disability, endoscopic retrieval was performed. For cases of foreign body ingestion in patients with potential for imprecise communication, we advocate for early invasive strategies regardless of gastrointestinal tract location. This practice will help prevent adverse events, unnecessary surgery, and mortality.
PubMed ID
Not assigned.
Volume
116
Issue
SUPPL
First Page
S1468
