Ingestion of A Sharp Foreign Body by an Infant

A four-month-old infant, previously healthy and developmentally normal, presented to the emergency department (ER) of a tertiary care hospital with hematemesis and pallor for one day, as well as a three-week history of irritability and intermittent vomiting. The infant was taken to various hospitals in their town, where he was given symptomatic treatment for vomiting and the mother was advised to feed infant. Nothing out of the ordinary was reported by the parents. The infant's symptoms were managed in the ER, and baseline labs were performed to determine the cause of the blood-stained vomiting and pallor. Except for a low Hb level, the baseline labs were normal. An abdominal x-ray revealed a stainlesssteel blade in his stomach. The ingestion of a blade was unknown to the parents. The case was referred to pediatric gastroenterology for further treatment. The blade was removed through endoscopy, and recovery was uneventful. Conclusion: The importance of supervising infants and young children under all circumstances is emphasized

Intramucosal esophageal dissection after esophagogastroduodenoscopy: two case reports

Introduction: Intramucosal esophageal dissection (IED) is an uncommon disorder, described as the separation of the mucosa and/or submucosa from deeper muscular layers due to abrupt increase in intraesophageal pressure. Case presentation: The first case il that of a 52 – years old female patient who underwent an esophagogastroduodenoscopy for control. After the procedure an extensive subcutaneous emphysema of the neck and a massive pneumomediastinum occurred. The patient was successfully treated with a conservative approach. The second case is that of a 43-years old male patient affected by Down’s Syndrome, who underwent an esopagogastroduodenoscopy because of persisting dysphagia. The endoscopic showed the presence of a serrated stricture at 20 centimeters from dental arcade. After the procedure he fell dysphagia. A neck-chest TC-SCAN showed superior and posterior pneumomediastinum and subcutaneous emphysema, without signs of mediastinitis. The patient was successfully treated with conservative approach. After a few days, a new chest CT-SCAN showed the presence of an anomalous right subclavian artery arising from the descending part of the aortic arch, causing dysphagia lusoria. Discussion: The causes of IED include iatrogenic instrumentation, hemostatic applications, mucosal injuries from ingestion of sharp foreign body, or spontaneous. A fluoroscopic upper gastrointestinal series or upper gastrointestinal endoscopy has been widely used to diagnose IED. CT and magnetic resonance are useful for differential diagnosis. In the absence of signs of mediastinitis management is conservative. Conclusion: CT SCAN should be the first exam to perform in the suspicion of IED. The first line treatment should be conservative. In case of the onset of complications and in patients who are refractory to conservative management, endoscopic or surgical treatment are indicated.

Aortic penetration due to a fish bone: a case report

Background Aortoesophageal fistula (AEF) caused by an esophageal foreign body is a life-threatening crisis, with rapid progress and high mortality. The first case of AEF was reported in 1818, but the first successfully managed case was not until 1980. Although there have been some reports on this condition, in most cases, the aorta was invaded and corroded due to its adjacent relationship with the esophagus and subsequent mediastinitis. To date, few reports have described an aortic wall directly penetrated by a sharp foreign body, likely because this type of injury is extremely rare and most patients cannot receive timely treatment. Here, we present a rare case of a fish bone that directly pierced the aorta via the esophagus. Case presentation A 31-year-old female experienced poststernum swallowing pain after eating a meal of fish. Gastroscope showed a fishbone-like foreign body had penetrated the esophagus wall. Computed tomography revealed that the foreign body had directly pierced the aorta to form an AEF. Surgery was successfully performed to repair the aorta and esophagus. The postoperation and follow-up was uneventful. Conclusions For the treatment of foreign bodies in the esophagus, we should be alert of the possibility of AEFs. The effective management of AEFs requires early diagnosis and intervention, as well as long-term treatment and follow-up, which still has a long way to go.

Improvising in Endoscopy: Endoscopic Removal of Sharp Foreign Bodies in the Upper GI Tract, Using a Handmade Protective Device

Introduction. Foreign body ingestion is a common problem in large-volume endoscopic departments. Several techniques and devices have been described for the safe endoscopic removal of these objects. However, these devices may not be suitable in every clinical setting or—as in our case—they may not even be available. Case Presentation. We report the case of a 34-year-old patient, presenting with sharp foreign body ingestion. The foreign bodies were safely removed using a handmade protective hood due to lack of a commercial device. In our case, improvisation proved to be of great benefit for the patient as well as for the endoscopist. Discussion. Improvised interventions can be of special interest in the setting of insufficiently funded or equipped endoscopic departments.

Repetitive Sharps Ingestion and Challenges with Retrieval and Prevention

Introduction: Recurrent deliberate sharp foreign body ingestion is associated with frequent hospitalizations and a high risk of complications, including perforation and peritonitis. These patients require urgent care. In addition, removal of foreign bodies can be challenging. Case Description:We describe the case of a patient with borderline personality disorder who was admitted multiple times with sharps ingestion and presented challenges with her care. Conclusion: Our case highlights the cause of recurrent sharps ingestion and provides recommendations on the retrieval of sharp foreign bodies and prevention.

Push Enteroscopy Guided Removal of a Sharp Foreign Body from the Midjejunum in a Child

Background The majority of foreign bodies entering the small intestine are passed spontaneously. However, in case of a sharp object, its removal is an urgency due to a higher risk of intestinal perforation, and endoscopic intervention is an appropriate management strategy as surgery is associated with greater morbidity. Although enteroscopy is the standard practice for the removal of a foreign body in the small intestine, gastroduodenoscopy may be used for small intestinal foreign body removal. Case Presentation We describe here the case of a 21-month-old child in whom a 5-cm, sharp-pointed nail in the midjejunum was removed successfully by a gastroduodenoscopy. This case highlights the difficulties in the removal of a sharp foreign body in a pediatric patient and the use of push enteroscopy. Conclusion Gastroduodenoscopy can be used for the removal of a foreign body in the small intestine in pediatric population in a resource-limited setup by performing push enteroscopy.

Ingestion of razor blades, a rare event: a case report in a psychiatric patient

Foreign body ingestion is a common condition in clinical practice, thankfully most of the cases do not require any surgery as most foreign bodies can pass through the bowel without injuring it. Treatment depends on the size and kind of foreign bodies. When complications arise, patients may require urgent medical attention. Self-harm by sharp foreign body ingestion is a rare event that must always be promptly treated and should always be prevented. Psychiatric patients and inmates are the most affected population. A high index of suspicion is required to treat this rare condition, which may be preventable if there is adequate mental and medical therapy along with close monitoring and family support. We present the case of a 31-year-old psychiatric patient. After prompt treatment, two razor blades were surgically removed from her intestines. She fully recovered and is doing well on follow-up controls.

Intracranial sewing needle in a dog

The objective of this clinical case study is to describe the first clinical case of an intracranial sewing needle identified in veterinary medicine and to describe the second case of intracranial foreign body secondary to pharyngeal perforation. A one-year-old Maltese dog with acute haemorrhagical vomiting and seizure was evaluated. A cerebral CT scan revealed the presence of a sewing needle inserted into the nasopharynx, which perforated the caudal cranial fossa through the brainstem, cerebellum and caudal part of the forebrain. An emergency surgery was performed, the needle was removed and the dog recovered well during the following 72 hours. One month after the surgery, the dog was still fine. This clinical case reinforces the possibility of cranial perforation after sharp foreign body ingestion. Intracranial foreign body should be part of the differential diagnosis in dogs when acute digestive signs are associated with acute neurological complications.