A Comprehensive Study of Foreign Body Lodgment in Digestive Passage in MGMGH, Trichy

Introduction: Foreign body (FB) among children is vital forclinicians to have a timely diagnosis and effective management.The study aimed to describe the profile and management offoreign body ingestion among children presenting to a tertiarycare hospitalMaterial and methods: The study was a prospectiveobservational study, conducted in the department of ENT ofMGMGH, Trichy, a tertiary care teaching hospital in southIndia. All the FB ingestion cases among children aged 1 to15 years were included. The type of FB, clinical presentation,level of lodgment, management etc. were analyzed. Meanand standard deviation was used to summarize quantitativevariables and frequency and proportion to summarizecategorical variables.Results: Majority (86%) of cases were aged less than 10 years.Males were slightly higher than females (56% Vs 44%). Mostcommon foreign body ingested was Coin 38 (76%) of cases,followed by safety pin and plastic objects. Majority (70%) offoreign bodies lodged in cricopharynx and 30% in proximalesophagus. Among boys, 71.43% of the FBs were found incricopharynx and 68.18% of the girls had FB in cricopharynx.The only type of foreign body found in cricopharynx wascoin. All the FBs in cricopharynx were managed by directlaryngoscopy. Out of the 15 foreign bodies in proximalesophagus, 80% were managed by esophagoscopy and 20%by direct laryngoscopy.Conclusion: FB ingestion Strategies regarding safe behaviorshave a key role in prevention of injuries due to FB and mustbe strictly implemented.

Giant Rhinolith- An Unusual Entity: A Case Report

Rhinolith is defined as a mineralized mass resulting from calcification of an endogenous or exogenous nidus within the nasal cavity. A case of a 25 year old female with a history of unilateral nasal stuffiness and nasal bleed, which was clinically and radiologically diagnosed as rhinolith, is being reported here.

Fluoroscopy-Guided Endoscopic Removal of Foreign Bodies

In most cases of ingested foreign bodies, endoscopy is the first treatment of choice. Moreover, emergency endoscopic removal is required for sharp and pointed foreign bodies such as animal or fish bones, food boluses, and button batteries due to the increased risks of perforation, obstruction, and bleeding. Here, we presented two cases that needed emergency endoscopic removal of foreign bodies without sufficient fasting time. Foreign bodies could not be visualized by endoscopy due to food residue; therefore, fluoroscopic imaging was utilized for endoscopic removal of foreign bodies in both cases.

Successful Removal of a Screw Nail in the Jejunum Using Double-Balloon Enteroscopy

The vast majority of foreign bodies (FBs) that enter the stomach pass through the gastrointestinal tract spontaneously. When the FB enters the small bowel-beyond the reach of conventional endoscopy-daily radiographs are needed to ensure its safe passage. However, endoscopic intervention is an appropriate management strategy for a sharp-pointed FB, because sharp FBs have a higher risk of intestinal perforation. We describe here a case in which a 1.5-cm, sharp-pointed screw nail in the proximal jejunum was removed successfully by double-balloon enteroscopy from a 19-year-old-male with autism. This case adds to the growing body of evidence demonstrating the value of therapeutic double-balloon enteroscopy in the field of FB ingestion

A Case of Endoscopic Removal of a Giant Appendicolith Combined with Stump Appendicitis

Stump appendicitis is an acute inflammation of the residual appendix and is a rare complication after appendectomy. The physician should be aware of the possibility of stump appendicitis in patients with right lower abdominal pain after appendectomy so that delayed diagnosis and treatment can be prevented. Stump appendicitis is usually treated by surgical resection, and endoscopic treatment has not been reported previously. A 48-year-old man who had undergone appendectomy 35 years earlier presented to the hospital because of right lower quadrant discomfort. A computed tomography scan showed a large stone in the residual appendix. Colonoscopic findings revealed a large, smooth, protruding lesion at the cecum with a stone inside the appendiceal orifice. Endoscopic removal after incision of the appendiceal orifice was performed successfully.

A Needle Penetrating the Stomach Cavity after Acupuncture

Although acupuncture is known as a safe procedure that is widely used in many countries, complications including infection, hemorrhage, hematoma, pneumothorax, nerve damage, and cardiac tamponade have been reported. A needle penetrating the stomach after acupuncture, however, is very rare. Here, we report the case of 47-year-old woman who experienced abdominal pain 2 days after receiving acupuncture. Upper gastrointestinal endoscopy identified an approximately 2.5-cm long needle in the posterior wall of the antrum. The needle was removed endoscopically using rat tooth forceps with no complications.

Endoscopic Removal of an Impacted Fishhook That Was in the Esophagus for Two Months / 대한소화기내시경학회지

An esophageal foreign body has clinical significance because it may cause serious complications such as esophageal perforation, mediastinitis and/or aorto-esophageal fistula. A prompt attempt to remove an esophageal foreign body via flexible endoscopy should be made when the shape of the foreign body is especially sharp and long as it can easily lead to esophageal perforation. We report here on a case of endoscopic removal of an impacted esophageal foreign body, a fishhook, that hade been present in the esophagus for two months, and there were no serious complications from the procedure.

Esophageal Impaction of Trichobezoar Caused by Endoscopic Removal / 대한소화기내시경학회지

Trichobezoar usually occurs in patients who have trichotillomania combined with trichophagia. Bezoars can result in serious complications including gastric ulceration, bleeding, perforation and small bowel obstruction when undiagnosed. The three main venues of bezoar removal (chemical dissolution, endoscopic removal and surgical removal) are chosen mainly by the size and composition of the bezoar. Trichobezoars generally require endoscopic or surgical removal. An 8-year-old girl visited our emergency room with recurrent epigastric pain and vomiting. Gastroduodenoscopy showed a 2x10 cm trichobezoar causing pyloric obstruction. During endoscopic removal of trichobezoar, esophageal impaction occurred. The trichobezoar was pushed into the stomach and was removed through surgical gastrostomy under general anesthesia. We report this case as an instructive reference for the proper treatment of trichobezoar in children.

Endoscopic Removal of a Pork Bone from the Sigmoid Colon in a Patient with Ulcerative Colitis / 대한소화기내시경학회지

Inflammatory bowel disease is a risk factor for low gastrointestinal foreign body impaction, but such cases are very rare. Impaction of a foreign body in the lower gastrointestinal tract can result in perforation, bleeding, abscess formation and fistula. A risk factor for perforation is inflammatory bowel disease, a sharp foreign body and a long-standing foreign body in the gastrointestinal tract. Thus, a foreign body in the lower gastrointestinal tract should be promptly removed by surgery or endoscopy. Most of these cases can currently be managed by endoscopy because of the development of endoscopic devices and the accumulation of experience. Here we report on a case of successful removal of a pork bone from the sigmoid colon in a patient with ulcerative colitis.

Spontaneous Passage of Gastrointestinal Foreign Bodies in Children / 대한소아소화기영양학회지

PURPOSE: Ingested foreign bodies are removed by endoscopy, surgery or spontaneous passage, however, the decision of therapeutic modality chosen depends on the type, size, shape and location of the ingested foreign bodies. Therefore, this study was conducted to investigate the rate and characteristics of foreign bodies that were passed spontaneously out of the intestine. METHODS: One hundred and sixty patients who visited Samsung Medical Center for treatment of gastrointestinal foreign bodies between January 2001 to July 2007 were enrolled in this study. Related data was colleted by reviewing the medical records of patients with proven foreign bodies retrospectively, as well as by conducting phone interviews with the parents of the patients. All cases were classified based on the nature and location of the ingested foreign body, as well as whether it was treated by spontaneous passage. RESULTS: Of the 160 cases involving the passage of foreign bodies in children were included in this study (95 boys and 65 girls), endoscopic removals, operative removals or spontaneous passages were conducted in 80, 3 and 77 patients, respectively. The spontaneous passage rates for each type of object were as follows; coins (36.5%), bead and baduk stones (83.3%), long and sharp materials (52.6%), magnets (69.2%) and disc batteries (50.0%). In cases involving round-shaped foreign bodies, such as coins, the diverse spontaneous passage rates were more diverse. When foreign bodies were stuck below esophagus, similar sized coins and baduk stones had spontaneous passage rates greater than 80% regardless of age. CONCLUSION: It is better for clinicians to wait for spontaneous passage to occur in cases involving coins or round-shaped foreign bodies that are located at or below the stomach.

Spontaneous Passage of Gastrointestinal Foreign Bodies in Children / 대한소아소화기영양학회지

PURPOSE: Ingested foreign bodies are removed by endoscopy, surgery or spontaneous passage, however, the decision of therapeutic modality chosen depends on the type, size, shape and location of the ingested foreign bodies. Therefore, this study was conducted to investigate the rate and characteristics of foreign bodies that were passed spontaneously out of the intestine. METHODS: One hundred and sixty patients who visited Samsung Medical Center for treatment of gastrointestinal foreign bodies between January 2001 to July 2007 were enrolled in this study. Related data was colleted by reviewing the medical records of patients with proven foreign bodies retrospectively, as well as by conducting phone interviews with the parents of the patients. All cases were classified based on the nature and location of the ingested foreign body, as well as whether it was treated by spontaneous passage. RESULTS: Of the 160 cases involving the passage of foreign bodies in children were included in this study (95 boys and 65 girls), endoscopic removals, operative removals or spontaneous passages were conducted in 80, 3 and 77 patients, respectively. The spontaneous passage rates for each type of object were as follows; coins (36.5%), bead and baduk stones (83.3%), long and sharp materials (52.6%), magnets (69.2%) and disc batteries (50.0%). In cases involving round-shaped foreign bodies, such as coins, the diverse spontaneous passage rates were more diverse. When foreign bodies were stuck below esophagus, similar sized coins and baduk stones had spontaneous passage rates greater than 80% regardless of age. CONCLUSION: It is better for clinicians to wait for spontaneous passage to occur in cases involving coins or round-shaped foreign bodies that are located at or below the stomach.

Sigmoidoscopic Removal of Migrated Plastic Biliary Stents / 대한소화기내시경학회지

Endoscopic retrograde biliary drainage is a well-established, minimally invasive procedure for treating biliary obstructions caused by malignant or benign diseases. Although there is a low rate of complications with biliary stenting, late complications of stent migration can occur, occasionally resulting in bowel inflammation, obstruction or perforation. We report a case of a migrated biliary stent that induced an obstruction of the colon following ERBD in the stricture of hepatic ducts after a liver transplant, and was removed endoscopically

A Case of Foreign Body Removal Using Latex Glove and Two Endoscopes / 대한소화기내시경학회지

Foreign body ingestion is a common clinical problem. Foreign bodies are generally swallowed accidentally and most pass out spontaneously. However, if a sharp object is not eliminated early, it can penetrate the bowel wall and cause severe complications. Endoscopic techniques for removing sharp foreign bodies safely include methods using a protector hood and overtube. An overtube is uncomfortable and has limitations in its diameter. We introduced a method using a latex glove, which is easily available, comfortable, and has no limitations in diameter. In addition, two endoscopes were used to reduce the risk of complications, and the large sharp object was easily wrapped with the latex glove. We report a case of a sharp and large foreign body being removed endoscopically using a latex glove and two endoscopes without any complications.

Endoscopic Removal of a Spoon from the Stomach Using Guidewire / 대한소화기내시경학회지

Foreign body ingestion is a relatively uncommon, but potentially serious condition. Most of gastrointestinal foreign bodies pass spontaneously. But, large objectives are usually lodged in the stomach and cause perforation, bleeding, and obstruction. Therefore, prompt retrieval of lodged foreign bodies are necessary before complications develop. Particularly, in the case of long metallic spoon, there have been no cases of spontaneous passage reported. Therefore, prompt retrieval of a metallic spoon are necessary. A 28-year-old woman with schizophrenia who ingested a long spoon for suicidal attempt was referred to our hospital. Simple abdomen showed a 18 cm sized long, metallic spoon with saw-toothed end placed in the stomach. We removed a spoon by an endoscopic technique and an extraction maneuver using a guidewire and a Magill forceps.

A Gastric Foreign Body Incidentally Diagnosed by a Follow-up Abdominal Computed Tomography for Hepatoma / 대한소화기내시경학회지

Foreign bodies in the stomach usually are accidentally swallowed and rarely produce symptoms. For diagnosis, suspicion and report of related history with abdominal symptoms are important. Simple radiographs and endoscopy easily identify foreign objects. Abdominal computed tomography may be useful in some cases, although it is not essential. We experienced a case of a gastric foreign body incidentally diagnosed by a follow-up abdominal computed tomography (CT) for hepatoma. A 53-year-old male with B viral liver cirrhosis and hepatoma, visited our hospital for a routine follow-up check of hepatoma. He had a symptom of epigastric discomfort for two weeks. An abdominal CT showed a foreign body penetrating the stomach wall, and it was successfully removed endoscopically.

Endoscopic Removal of the Antral Portion of Antrochoanal Polyp by Powered Instrumentation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aims of the current study are to reintroduce a surgical technique for endoscopic removal of the antral portion of antrochoanal polyp (ACP) by powered instrumentation and to determine its efficacy by evaluating the outcome of the patients. MATERIALS AND METHOD: A prospective study was performed in 28 patients undergoing endoscopic sinus surgery for ACP by the author's surgical technique. Improvements of clinical symptoms and endoscopic and computed tomographic findings were evaluated postoperatively with a follow-up period ranging from 12 to 52 months. All symptom scores on a 100 mm visual analog scale before operation were compared with those obtained at the last visit after operation. Postoperative endoscopic and computed tomographic findings were graded using a three-point scale ranging from 0 to 2. In the surgical technique, the antral portion of ACP was identified through the enlarged ostium under intranasal endoscopy and removed by a blade of powered instrumentation that was inserted through the canine fossa. RESULTS: Symptom scores were all significantly reduced postoperatively. All but one patient showed improvement in clinical symptoms and endoscopic and computed tomographic findings during the follow-up period. There were no major complications specific to this technique. CONCLUSION: This technique provides an attractive alternative to other methods for removing the antral portion of ACP and is associated with excellent outcomes and the minimal morbidities rate.

Safe Endoscopic Removal of a Sharp Foreign Body Using Latex Glove / 대한소화기내시경학회지

Most of swallowed foreign bodies pass spontaneously. However, sharp objects are usually lodged in the proximal esophagus and cause aspiration, bleeding, obstruction, and perforation. Therefore, prompt retrieval of lodged foreign bodies are necessary. The safe extraction of sharp foreign bodies using endoscopic technique is difficult because sharp objects carry a significant risk of mucosal injury and perforation. Endoscopic techniques for retrieval of foreign body include methods using protector hood and overtube. The former is not available, the later is uncomfortable and its diameter is the limiting factor. Method using a latex glove is available, comfortable, and its diameter is not limited. The thickness of the glove is thinner than protector hood, but we think that a latex glove would seem to be a effective alternative. We report a case in which a sharp foreign body was endoscopically removed using a latex glove without complication.

Endoscopic Removal of a Metal Thread in the Duodenal Wall after Eating Raw Fish: A case report / 대한소화기내시경학회지

Foreign bodies in the stomach and duodenum are usually accidentally swallowed by children, mentally ill patients, alcoholics, or persons with dentures. Swallowed foreign bodies are usually asymptomatic, and moved down the alimentary tract to be passed spontaneously without discomfort. There had been reported many kinds of foreign bodies, for example, metal fragments, fish bones and so on. A metal thread, which looks like a fishing hook in gastrointestinal tract as a foreign body, has never been reported in humans. A 62-year-old male patient was admitted due to abdominal discomfort for five days after eating raw fish. We performed gastroduodenoscopy and could find a thread penetrating to the anterior wall of duodenal bulb. It was removed by biopsy forcep. Herein, we report a case of a metal thread in duodenal bulb, which looked like a fishing hook.

Endoscopic Removal of Embedded Chicken Bone from Sigmoid Colon Using Balloon Dilatation / 대한소화기내시경학회지

Ingested foreign bodies usually pass through the digestive system uneventfully. The diagnosis of inadvertently swallowed foreign bodies is usually delayed. It often induces serious complications, such as perforation, enterocolic fistula, abscess formation, or aortointestinal fistula. Therapeutic colonoscopy has replaced to a significant degree the need for traditional open surgical procedures to extract foreign bodies from the colon. Various foreign bodies may be extracted from the colon by a number of endoscopic techniques. We describe a case of a patient who presented with abdominal pain, loose stool during 3 months due to the impaction of a chicken bone in the sigmoid colon. The chicken bone was successfully removed by using balloon dilatation during colonoscopy.

A Case of a Gastric Bezoar Regurgitated from the Stomach to the Esophagus / 대한소화기내시경학회지

Bezoars are persistent concretions of indigestible material, usually seen in the stomach. Esophageal bezoars are very rare and generally occur in elderly patients with anatomic defects such as diverticulum or stricture, or with esophageal motility disorders. However, it is quite unusual that a gastric bezoar would be regurgitated into a normal esophagus during forceful vomiting. Endoscopic removal of a bezoar is safe and successful in most cases. A case of a gastric bezoar regurgitated into the esophagus was recently experienced and removed by an endoscopic polypectomy snare and bezoar (lithotripsy) basket.