IMAGE
MONTH
OF THE
Baby Bottle Nipple Causing Small Bowel Obstruction
FIGURE 1. Upper gastrointestinal series with the silicone nipple in the third portion of the duodenum.
FIGURE 2. Upper endoscopy image of silicone nipple impacted in third portion of the duodenum with surrounding erosions and ulcerations.
A 13-year-old boy with neurodevelopmental delay and seizure disorder presented with 1 day of nonbilious, nonbloody emesis. Emesis progressed and became bilious and bloody. Abdominal examination was significant for diffuse tenderness. Abdominal radiograph revealed a distended air-fluid–filled stomach. Upper gastrointestinal series revealed a silicone nipple in the third portion of the duodenum (Fig. 1). Emergent esophogastroduodendoscopy was preformed and foreign body (FB) removal was attempted, but was unsuccessful. The wide end of the nipple produced a suction effect, causing an obstruction (Fig. 2). A repeat esophogastroduodendoscopy with FB removal was performed with surgery prepared for possible laparotomy. The nipple was dislodged and removed using rat-tooth forceps and persistent slow, gentle traction. Mucosal ulcerations, erosions, and erythema were noted at the impaction site. There was no evidence of perforation. A proton-pump inhibitor therapy was initiated and feedings resumed. More than 100,000 cases of FB ingestion are reported annually in the United States; 10% to 20% of ingested FBs require endoscopic removal, and
MONTH
OF THE
Baby Bottle Nipple Causing Small Bowel Obstruction
FIGURE 1. Upper gastrointestinal series with the silicone nipple in the third portion of the duodenum.
FIGURE 2. Upper endoscopy image of silicone nipple impacted in third portion of the duodenum with surrounding erosions and ulcerations.
A 13-year-old boy with neurodevelopmental delay and seizure disorder presented with 1 day of nonbilious, nonbloody emesis. Emesis progressed and became bilious and bloody. Abdominal examination was significant for diffuse tenderness. Abdominal radiograph revealed a distended air-fluid–filled stomach. Upper gastrointestinal series revealed a silicone nipple in the third portion of the duodenum (Fig. 1). Emergent esophogastroduodendoscopy was preformed and foreign body (FB) removal was attempted, but was unsuccessful. The wide end of the nipple produced a suction effect, causing an obstruction (Fig. 2). A repeat esophogastroduodendoscopy with FB removal was performed with surgery prepared for possible laparotomy. The nipple was dislodged and removed using rat-tooth forceps and persistent slow, gentle traction. Mucosal ulcerations, erosions, and erythema were noted at the impaction site. There was no evidence of perforation. A proton-pump inhibitor therapy was initiated and feedings resumed. More than 100,000 cases of FB ingestion are reported annually in the United States; 10% to 20% of ingested FBs require endoscopic removal, and
