The Enigma in Management of Complicated Foreign Body Ingestion Impacted Distal to Oesophagus: A Case Series and Literature Review

Abstract BackgroundIngestion of foreign bodies leading to impaction at the pharynx and oesophagus have been extensively described in English literatures. However, impactions at the gastrointestinal tract distal to the oesophagus are less commonly encountered due to the more capacious luminal diameter as it approaches the stomach. While intentional foreign body ingestions impacted distal to the oesophagus are often more complicated, literatures on the management of these distal oesophageal impactions are scarce. Case presentationWe present five cases of foreign body impaction at varying sites of gastrointestinal tract beyond the oesophagus, contrasting management approach comparing the role of endoscopy, open surgery and conservative management. Cases presented include patients aged 40 to 70 with intentional foreign bodies ingestion. The first case described a cerebral palsy patient with pica who had to undergo difficult evacuation under anaesthesia followed by colonoscopy; the second and third cases presented two different schizophrenic patients with two differing management approach. The second case was managed with multiple operations due to complications and died eventually, making the only mortality in our case series; whereas the third case was managed conservatively with acceptable outcome after multiple laparotomies prior. Fourth and fifth cases described two body packers who swallowed tobacco and two phones, respectively; the former was uneventfully managed conservatively, the latter, had to undergo surgical extraction. Individualized approach to these distal impactions of ingested foreign bodies are described with a review of available literatures which are tabulated and discussed in this case series. ConclusionEndoscopy, surgery, conservative management and sometimes a combination of approaches are utilised for the management of foreign bodies impacted distal to the oesophagus, especially in complex and recurrent cases. Decision, timing and approach of extraction must be individualised with consideration of risk weighed against the benefit of each intervention over the other.

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Spontaneous Expulsion of Ingested Foreign Bodies: Case Series and Review of Literature

Birat Journal of Health Sciences ◽

10.3126/bjhs.v1i1.17106 ◽

2017 ◽

Vol 1 (1) ◽

pp. 78-82

Author(s):

A.K. Yadav ◽

R.S. Shrestha ◽

R. Sharma ◽

B. Khadka ◽

L. Awale ◽

...

Keyword(s):

Gastrointestinal Tract ◽

Foreign Body ◽

Illicit Drugs ◽

Foreign Bodies ◽

Psychiatric Patients ◽

Case Series ◽

The Elderly ◽

Health Sciences ◽

Drug Abusers ◽

Pass Through

Foreign body ingestion is a commonly seen event in emergencies, usually in children, psychiatric patients, chronic alcoholics, drug abusers and the elderly patients with poor fitting dentures as well as the mentally challenged individuals. While ingestion of foreign bodies into Gastrointestinal Tract (GIT) may be accidental (especially in children), or experimental (anal insertion by adults), it may be purely intentional as in smugglers of illicit drugs, jewels and other valuables so as to evade detection by the security. About, 90% of ingested foreign bodies pass through the gastrointestinal tract without complications, 1020% necessitate endoscopic removal, while only 1% of them will finally need surgical intervention. In clinical practice we often face the dilemma of choosing the appropriate treatment modality. We present five cases treated in the emergency ward of B P Koirala Institute of Health Sciences, Dharan, Nepal, emphasizing in a "waiting and close observation" policy. Among these cases, all expelled the foreign body spontaneously in their stool without any complications.Birat Journal of Health Sciences 2016 1(1): 78-82

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512 The Management of Aural Foreign Bodies During the COVID-19 Pandemic - MKUH ENT Department Experience

British Journal of Surgery ◽

10.1093/bjs/znab259.549 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

G C Ho ◽

R Thind ◽

D Yap ◽

A Hunt

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Case Series ◽

Success Rates ◽

First Case ◽

Prolonged Duration ◽

Successful Removal ◽

The Impact ◽

The Relationship

Abstract Aim During the initial wave of the COVID-19 pandemic, ENT UK published a clinical guide on surgical prioritisation which suggested that aural foreign bodies can be removed between one and three months from initial presentation. This case series aims to investigate the impact of leaving aural foreign bodies in situ for a prolonged period of time, including the risk of complications, success rates of subsequent removal attempts and whether foreign bodies can clear themselves without intervention. Method Retrospective study of all aural foreign body referrals to the ENT emergency clinic over a 6-month period. Results Thirty-four patients were identified. The duration of foreign bodies left in-situ ranged from 1 to 78 days. Four patients suffered from traumatic removal upon initial attempts, however there were no other significant complications. First attempts made by non-ENT specialists (68.8%) all failed and were associated with a high risk of trauma (36.4%). The chances of successful removal on second attempt (28.6%) reduced dramatically when compared to the first attempt (52.9%). Two patients had no foreign body visualised upon second attempt, suggesting it has cleared itself. A total of 7 patients (20.6%) required removal under general anaesthesia. Conclusions Due to the unique circumstances of the COVID-19 pandemic, this is the first case series to look specifically at the relationship between duration of aural foreign bodies left in situ for over 30 days from presentation and the risk of complications. Our data suggests that prolonged duration did not increase the incidence of complications.

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Challenging Presentations of Seven Cases of Gastrointestinal Basidiobolomycosis in Sudan: Clinical Features, Histology, Imaging, and Recommendations

Journal of Laboratory Physicians ◽

10.1055/s-0040-1721149 ◽

2020 ◽

Vol 12 (04) ◽

pp. 281-284

Author(s):

Sawsan A. Mohammed ◽

Azza A. Abdelsatir ◽

Mohamed Abdellatif ◽

Suliman Hussein Suliman ◽

Omer Mohammed Ibrahim Elbasheer ◽

...

Keyword(s):

Gastrointestinal Tract ◽

Fungal Infection ◽

Clinical Features ◽

Subcutaneous Tissue ◽

Case Series ◽

First Case

AbstractsBasidiobolomycosis is a fungal infection caused by Basidiobolus ranarum which affects the skin and subcutaneous tissue and rarely the gastrointestinal tract. We report seven cases of gastrointestinal basidiobolomycosis with interesting clinical, radiological, and histological presentations. To our knowledge, this is the first case series of abdominal basidiobolomycosis to be reported from Sudan.

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Conservative Management in Two Penetrating Fishbone Injuries: A Case Series and Literature Review

Journal of Clinical and Medical Research ◽

10.37191/mapsci-2582-4333-3(6)-094 ◽

2021 ◽

Keyword(s):

Foreign Body ◽

Literature Review ◽

Conservative Management ◽

Case Reports ◽

Case Series ◽

Foreign Body Ingestion ◽

Medical Referral

Foreign body ingestion is a regular medical referral. Patients present with different objects such as chicken bones, nails, coins, and fishbones. It is usually managed in causality and passes without any intervention. However, occasionally, we come across fishbone complications requiring intervention. We discuss the course and management of two case reports of fishbone injuries in different abdominal regions.

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Unusual foreign body in the upper digestive tract: case report

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20181885 ◽

2018 ◽

Vol 4 (3) ◽

pp. 850

Author(s):

Snigdha Elaprolu ◽

Gowri Sankar Marimuthu ◽

Raghul Sekar ◽

Sunil Kumar Saxena

Keyword(s):

Case Report ◽

Gastrointestinal Tract ◽

Foreign Body ◽

Digestive Tract ◽

Foreign Bodies ◽

Psychiatric Patients ◽

Unusual Foreign Body ◽

Upper Digestive Tract ◽

Entire Gastrointestinal Tract

Unusual foreign bodies in the digestive tract are common in psychiatric patients and children requiring screening of the entire gastrointestinal tract. We here report two cases of unusual ingested blunt foreign body in the upper digestive tract managed differently.

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Endoscopic management of foreign bodies in the upper gastrointestinal tract

International Surgery Journal ◽

10.18203/2349-2902.isj20174105 ◽

2017 ◽

Vol 4 (10) ◽

pp. 3277

Author(s):

Pramod Mirji ◽

Vikas Daddenavar ◽

Eshwar Kalburgi

Keyword(s):

Gastrointestinal Tract ◽

Foreign Body ◽

Foreign Bodies ◽

Flexible Endoscopy ◽

Definitive Treatment ◽

Endoscopic Management ◽

Food Bolus Impaction ◽

Bolus Impaction ◽

Age Range ◽

Upper Gastrointestinal

Background: Foreign body ingestion and food bolus impaction is a common clinical scenario and can present as an endoscopic emergency. Though majority of them pass spontaneously 10-20% require endoscopic intervention. Flexible endoscopy is recommended as therapeutic measure with minimal complications. The aim of our study is to present 2 years’ experience in dealing with foreign bodies in the upper gastrointestinal tract.Methods: Cases of foreign body (FB) ingestion admitted to department of general surgery from January 2015 to December 2016 were evaluated. The patients were reviewed with details on age, sex, type of FB, its location in gastrointestinal tract, treatment and outcome.Results: A total of 23 cases were studied. Age range was 2-75 years. Males were predominant (60.87%). Coins were found most commonly (52.17%). Esophagus was the commonest site of FB lodgment (65.22%). Upper esophagus being the most common (39.13%). Upper gastrointestinal flexible endoscopy was useful in retrieving FB in all the 23 cases. There were no complications throughout the study period.Conclusions: Flexible endoscopy should be used as definitive treatment and endoscopic treatment is safe and effective.

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Tracheo-bronchial foreign bodies: our experience at a tertiary care hospital

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20161848 ◽

2016 ◽

Author(s):

Shashidhar S. Suligavi ◽

Mallikarjun N. Patil ◽

S. S. Doddamani ◽

Chandrashekarayya S. Hiremath ◽

Afshan Fathima

Keyword(s):

Foreign Body ◽

Early Diagnosis ◽

Foreign Bodies ◽

Tertiary Care ◽

Case Series ◽

Team Work ◽

Care Hospital ◽

Retrospective Case ◽

Presenting Symptoms ◽

Case Series Study

Background:Tracheo- bronchial foreign bodies have always posed a challenge to the ENT surgeon as they present with varied symptomatology ranging from a simple cough and fever to more grave respiratory distress. It requires a strong suspicion, early diagnosis and timely intervention to reduce the overall morbidity and mortality .This study was undertaken to highlight our experiences in handling cases of tracheo- bronchial foreign bodies (FB) at our setup.Methods:It is a retrospective case series study conducted in S. Nijalingappa Medical College between January 2011 and January 2015. Results:Most commonly affected were children between 1year to 3years of age. Chronic cough and wheeze were the commonest presenting symptoms. Vegetative foreign body was found to be the commonest variety of foreign body. The mortality rate in our study was 4.7% (n=3).Conclusions:A good clinical acumen, team work, early diagnosis and timely intervention are all needed to reduce the overall mortality and morbidity associated with tracheo- bronchial foreign bodies.

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Gastric perforation secondary to ingestion of a plastic bag

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2016.0036 ◽

2016 ◽

Vol 98 (2) ◽

pp. e29-e30 ◽

Cited By ~ 1

Author(s):

YM Goh ◽

IM Shapey ◽

K Riyad

Keyword(s):

Clinical Practice ◽

Gastrointestinal Tract ◽

Foreign Body ◽

Foreign Bodies ◽

Gastric Perforation ◽

Foreign Body Ingestion ◽

Pathophysiological Process ◽

Common Presentation ◽

Plastic Bag ◽

Pass Through

Foreign body ingestion is a common presentation in clinical practice, seen predominantly in children. Most foreign bodies pass through the gastrointestinal tract without any additional morbidity. We present a case of gastric perforation secondary to the ingestion of a small plastic bag. We discuss the likely pathophysiological process underlying perforation secondary to plastic bag ingestion, which is most commonly associated with the concealment of narcotics.

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Paediatric aerodigestive foreign bodies: remember the nasopharynx

The Journal of Laryngology & Otology ◽

10.1017/s0022215110000708 ◽

2010 ◽

Vol 124 (10) ◽

pp. 1132-1135 ◽

Cited By ~ 2

Author(s):

S D MacNeil ◽

J P Moxham ◽

F K Kozak

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Case Series ◽

Aerodigestive Tract ◽

Endoscopic Approach ◽

Lower Airway ◽

Endoscopic Evaluation ◽

Tertiary Referral ◽

Children's Hospital ◽

Distal Airway

AbstractIntroduction:Nasopharyngeal foreign bodies are relatively uncommon, compared with other aerodigestive sites. They may mimic a lower airway location, or may be coughed up into the nasopharynx prior to endoscopic evaluation.Objective:To describe our experience with nasopharyngeal foreign bodies mimicking a more distal airway location.Method:Case series from a tertiary referral children's hospital.Results:We present a series of four children who were initially thought to have a lower aerodigestive tract foreign body (three respiratory, one oesophageal), but who were finally diagnosed with nasopharyngeal foreign body. The concept of panendoscopy at all foreign body removals is suggested as a means to avoid a missed nasopharyngeal foreign body.Conclusion:Although nasopharyngeal foreign bodies are uncommon, their rare ability to mimic distal sites mandates a thorough endoscopic approach to ensure that all sites (i.e. larynx, lungs, oesophagus and nasopharynx) are evaluated endoscopically.

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Endoscopic Management of Foreign Body Impaction in the Upper Gastrointestinal Tract in a Tertiary Care Centre of Nepal

Kathmandu University Medical Journal ◽

10.3126/kumj.v18i2.33223 ◽

2020 ◽

Vol 18 (2) ◽

pp. 36-40

Author(s):

A. Shrestha ◽

R.B. Gurung ◽

P. Sharma ◽

R. Shrestha ◽

P. Shrestha

Keyword(s):

Gastrointestinal Tract ◽

Foreign Body ◽

Foreign Bodies ◽

Tertiary Care ◽

Upper Gastrointestinal Tract ◽

Endoscopic Management ◽

Tertiary Care Centre ◽

Male Predominance ◽

Foreign Body Impaction ◽

Upper Gastrointestinal

Background Ingested foreign body impaction on upper gastrointestinal tract is common incidence among children, older age group, mentally challenged individuals, and people the influence of alcohol. In most cases, the foreign bodies pass spontaneously and uneventfully but when this does not occur; endoscopic management to ensure removal under direct visualization is required. Relief upon removal of foreign body and prevention of complications is essential. Objective To assess the endoscopic management and outcome of foreign body impacted in the upper gastrointestinal tract. Method This is a hospital based observational retrospective cross sectional study involving 165 patients at Endoscopy Department of Dhulikhel Hospital in Nepal between November 2015 and October 2019. The data regarding the demographic profile, clinical characteristics and endoscopic findings were retrieved and analyzed to determine endoscopic interventions performed, complications and outcomes. Result One hundred and sixty five patients presenting with history of ingestion of foreign body were included in the study. The mean age of the patients was 46.8 ± 19.1 years with male predominance (60%). The most common site of foreign body impaction was oesophagus (70%). The most common foreign body encountered was bone (62.2%) among which chicken bones (91.1%) were most frequent. For the retrieval of sharp-pointed foreign bodies, rat forceps and graspers (45.7%) were most commonly used. Total 14 cases required rigid oesophagoscopy as the foreign body could not be retrieved by flexible endoscopy. Conclusion Foreign body ingestion and its impaction in the upper gastrointestinal tract has been found to be common in endoscopic practise. Early detection and timely removal of foreign bodies is of utmost importance to avoid discomfort to the patient as well as to ensure successful removal without complications.

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