Users Online : 1078 About us |  Subscribe |  e-Alerts  | Feedback | Login   
Journal of Minimal Access Surgery Current Issue | Archives | Ahead Of Print Journal of Minimal Access Surgery
           Print this page Email this page   Small font sizeDefault font sizeIncrease font size 
  Search
 
  
 ¤   Similar in PUBMED
 ¤  Search Pubmed for
 ¤  Search in Google Scholar for
 ¤Related articles
 ¤   Article in PDF (1,195 KB)
 ¤   Citation Manager
 ¤   Access Statistics
 ¤   Reader Comments
 ¤   Email Alert *
 ¤   Add to My List *
* Registration required (free)  


 ¤  Abstract
 ¤ Introduction
 ¤ Case report
 ¤ Discussion
 ¤ Conclusion
 ¤  References
 ¤  Article Figures

 Article Access Statistics
    Viewed1255    
    Printed30    
    Emailed0    
    PDF Downloaded75    
    Comments [Add]    

Recommend this journal

 


 
 Table of Contents     
UNUSUAL CASE
Year : 2014  |  Volume : 10  |  Issue : 4  |  Page : 210-212
 

Laparoscopic retrieval of an unusual foreign body


Department of Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspeciality Hospital, Saket, New Delhi, India

Date of Submission11-Jun-2014
Date of Acceptance23-Jul-2014
Date of Web Publication23-Sep-2014

Correspondence Address:
Anil Sharma
Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Super Specialty Hospital, 1-2, Press Enclave Road, Saket, New Delhi - 110 017
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-9941.141530

Rights and Permissions

 ¤ Abstract 

Ingestion of foreign body is a serious problem commonly encountered in our clinical practice. Most of them pass spontaneously, whereas in others endoscopic or surgical intervention is required because of complications or non-passage from the gastrointestinal tract. We present here a case of teaspoon ingestion, which did not pass spontaneously. Laparoscopic retrieval of teaspoon was done from mid jejunum after enterotomy and the patient recovered uneventfully. Right intervention at the right time is of paramount importance.


Keywords: Enterotomy, foreign body, laparoscopy, small intestine


How to cite this article:
Shukla BK, Khullar R, Sharma A, Soni V, Baijal M, Chowbey P. Laparoscopic retrieval of an unusual foreign body . J Min Access Surg 2014;10:210-2

How to cite this URL:
Shukla BK, Khullar R, Sharma A, Soni V, Baijal M, Chowbey P. Laparoscopic retrieval of an unusual foreign body . J Min Access Surg [serial online] 2014 [cited 2019 Dec 6];10:210-2. Available from: http://www.journalofmas.com/text.asp?2014/10/4/210/141530



 ¤ Introduction Top


Foreign body ingestion is a common cause of accidental death. Although approximately 90% of them pass spontaneously, they can result in perforation or obstruction in the gastrointestinal (GI) tract. Toddlers aged 2-3 years are most commonly affected; as children in this age group are ambulatory and more orally explorative. [1] Intestinal perforation by a foreign body is uncommon occurring in <1% of patients. It normally affects the ileocaecal and rectosigmoid regions. According to Goh et al., the most common site of intra-abdominal perforation as the terminal ileum (approximately 39%). [2]

We present a case of young female with ingestion of foreign body which was impacted in a small intestine.


 ¤ Case report Top


A 23-year-old female presented to the emergency of the Max Super Speciality Hospital, Saket, New Delhi, India with a history of ingestion of teaspoon, while she was eating ice cream 1 day before. She complained of pain abdomen and nausea. Physical examination revealed soft abdomen with mild tenderness around umbilicus and no signs of peritonitis. A plain X-ray abdomen revealed presence of a radio-opaque foreign body (metallic teaspoon) in the stomach. Initially, we decided to observe and closely monitor the patient after admitting her and starting conservative expectant treatment. The next day she was not relived, and the abdominal pain continued. In view of that, we took the decision to proceed with diagnostic laparoscopy. Repeat X-ray abdomen was performed in erect and supine position to locate the position of the teaspoon [Figure 1].
Figure 1: Abdominal X-ray showing spoon in jejunum

Click here to view


Diagnostic laparoscopy was performed with one 10 mm and two 5 mm midline ports. On initial evaluation, the bowels looked normal. There were no bowel adhesions. On the exploration and careful examination of upper GI tract jejunum was found to be dilated. On tracing the loop of jejunum, the spoon was located at the mid jejunal level. Enterotomy was performed on the antimesenteric border, and tablespoon identified and was retrieved [Figure 2] and [Figure 3]. Enterotomy closed with Endo GI stapler.
Figure 2: Retrieving the spoon

Click here to view
Figure 3: The foreign body (spoon)

Click here to view


Patient had an uneventful post-operative recovery and was ultimately discharged on post-operative day 4.


 ¤ Discussion Top


The management of foreign bodies in GI tract is based on collective anecdotal experience of surgeons. Majority of foreign bodies passes through the GI tract without any adverse effects. [3] The highest incidence of swallowed foreign bodies occurs in children between 6 months and 3 years, and coins are the most commonly ingested foreign bodies. There is a definite predilection for swallowed foreign bodies to become impacted at the level of cricopharyngeus and just below it or at the oesophagogastric junction. In our patient, the spoon crossed the pylorus and was lodged in jejunum.

A large number of foreign bodies will pass through the entire GI tract once past the gastroesophageal junction; nevertheless it is preferable to observe them in the hospital for a possible need for immediate abdominal exploration should bleeding, [4] or features of perforation occurs. [5] During the observation period, a daily radiograph should be obtained, and patient should be checked for signs of peritonitis or GI bleeding. Stools should also be examined for the foreign body in the follow-up.

Sharp objects may get impacted in the bowel wall or even penetrate through it. All sharp foreign bodies should be removed before they pass from the stomach because 15-35% of these will cause intestinal perforation, usually in the area of the ileocecal valve. [6] If a sharp foreign body does not progress for three consecutive days surgical intervention should be considered, and if the patient becomes symptomatic, surgical intervention will be necessary. Intraluminal endoscopic techniques are limited by the length of the instrument and the curved path it takes. Laparoscopic removal of foreign bodies from the peritoneal cavity (translocated intrauterine contraceptive devices) and a needle from the pelvis have been reported previously. [7] Wichmann et al. [8] laparoscopically removed a toothpick causing small bowel perforation followed by lavage of the abdominal cavity and laparoscopic closure of the perforation including omentoplasty. Murshid and Khairy [9] removed a metallic pin from small intestine laparoscopically under fluoroscopic guidance. Accurate localisation of foreign body in the small bowel is the main challenge. In our case, smooth contours of spoon through the bowel wall helped us to retrieve it. For irregular objects such as a safety pin, the site requires localisation and then a small enterotomy. This obviates the need for a formal laparotomy.

Depending on the availability of skill and expertise, laparoscopic removal of the GI foreign bodies should be considered an option. It is less invasive, less painful and offers faster recovery.


 ¤ Conclusion Top


Patients with a history of ingestion of GI foreign bodies should be diligently monitored. The most optional method of retrieval in the form of endoscopy or surgery should be contemplated at the earliest indication. Laparoscopic retrieval may be a better option in comparison with laparotomy where facility and proper expertise are available.

 
 ¤ References Top

1.Hesham A-Kader H. Foreign body ingestion: children like to put objects in their mouth. World J Pediatr 2010;6:301-10.  Back to cited text no. 1
    
2.Goh BK, Chow PK, Quah HM, Ong HS, Eu KW, Ooi LL, et al. Perforation of the gastrointestinal tract secondary to ingestion of foreign bodies. World J Surg 2006;30:372-7.  Back to cited text no. 2
    
3.Conners GP, Chamberlain JM, Ochsenschlager DW. Conservative management of pediatric distal esophageal coins. J Emerg Med 1996;14:723-6.  Back to cited text no. 3
    
4.Sumskiene J, Janciauskas D, Pilkauskaite G, Kristalnyj V, Kupcinskas L. An unusual case of bleeding from stomach due to a giant diospyrobezoar. Medicina (Kaunas) 2009;45:476-9.  Back to cited text no. 4
    
5.Losanoff JE, Kjossev KT. Gastrointestinal "crosses": An indication for surgery. J Clin Gastroenterol 2001;33:310-4.  Back to cited text no. 5
    
6.Maleki M, Evans WE. Foreign-body perforation of the intestinal tract. Report of 12 cases and review of the literature. Arch Surg 1970;101:475-7.  Back to cited text no. 6
    
7.McKenna PJ, Mylotte MJ. Laparoscopic removal of translocated intrauterine contraceptives devices. Br J Obstet Gynaecol 1982;89:163-5.  Back to cited text no. 7
    
8.Wichmann MW, Hüttl TP, Billing A, Jauch KW. Laparoscopic management of a small bowel perforation caused by a toothpick. Surg Endosc 2004;18:717-8.  Back to cited text no. 8
    
9.Murshid KR, Khairy GE. Laparoscopic removal of a foreign body from the intestine. J R Coll Surg Edinb 1998;43:109-11.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
Print this article  Email this article
 

    

© 2004 Journal of Minimal Access Surgery
Published by Wolters Kluwer - Medknow
Online since 15th August '04