POLSKI PRZEGLĄD CHIRURGICZNY 2014, 86, 12, 594–597
10.1515/pjs-2015-0006
CASE REPORTS
Foreign body in the gastrointestinal tract leading to small bowel obstruction – case report and literature review Bartosz Wnęk, Aleksandra Łożyńska-Nelke, Jacek Karoń Department of General and Colorectal Surgery, Medical University in Poznań Kierownik: prof. dr hab. P. Krokowicz
The presence of a foreign body in the gastrointestinal tract constitutes a common pathology, considering surgical clinical practice. The management of the ingestion of a foreign body depends on many factors. The study presented a case of a 33-year-old female patient subjected to surgical treatment, due to deliberate swallowing of a balloon. The above-mentioned was the amateur equivalent of intragastric balloon insertion, inducing weight loss. This is a rare cause of a foreign body ingestion, seldomly found in literature data. The patient reported to the Emergency Department on the second day after ingestion with symptoms of mechanical subobstruction, and after initial diagnostics, was qualified for surgery. The postoperative period proved uneventful. The study illustrated the often unfavourable access to false data on the internet, which may stimulate towards the above-mentioned behaviour. Key words: foreign body, gastrointestinal obstruction, weight loss
Foreign bodies in the gastrointestinal tract are a significant problem in surgical practice. They apply to the entire human population, regardless patient age. One may distinguish accidental foreign body ingestion, as well as deliberate ingestion. Depending on the location of the foreign body in the gastrointestinal tract, clinical symptoms, and patient age, different therapeutic methods are accepted. The aim of the study was to present a case of deliberate foreign body ingestion, as a weight reduction method. Case report A 33-year old female patient was admitted to the Emergency Department in August, 2012, due to nausea and vomiting, loss of appetite, bloating, and abdominal pain, intensifying for the past two days. The patient did not complain of gas retention, nor constipation. She had no history of concomitant diseases, prior surgery, nor admitted to the use of drugs. The patient confessed that due to obesity (BMI-31) she
tried numerous slimming diets without success. She admitted to swallowing a small (5 x 3 cm) rubber balloon filled with water, two days earlier. This was motivated by the aim to induce weight loss. She denied suicidal thoughts. The patient had been recently reading on the internet about surgical methods of gastric balloon implantation procedures, in order to reduce weight. She did not consult the matter with her physician. With incomplete, secular and untested data gathered from the internet, as well as not fully understanding the essence of the bariatric procedure, the patient decided to swallow a balloon filled with water. When the physician asked the patient how she would remove the balloon, she answered that “she had not read that part”. The physical examination showed a distended abdomen, painful on palpation, without peritoneal symptoms and increased peristalsis. The per rectum examination showed no pathology. Laboratory results showed high leucocytosis 19.4 G/l with a normal CRP level. The remaining laboratory results (coagulation and biochemistry) were within normal limits. The Unauthenticated Download Date | 12/28/16 7:06 PM
Foreign body in the gastrointestinal tract leading to small bowel obstruction
595
abdominal X-ray examination in the standing position (fig. 1) showed distended intestinal loops with fluid levels-radiological features of high gastrointestinal obstruction. After the above-mentioned examinations the patient was admitted to the Department of General and Colorectal Surgery. Conservative treatment was initiated, including strict diet, fluid therapy, antibiotics (Biotraxone, Metronidazol), and proton pump inhibitors. Due to abdominal cavity inflammatory symptoms, oral lubricants, such as paraffin, used to facilitate the passage of the foreign body through the gastrointestinal tract were not used. Gastroscopy was performed. During endoscopy of the upper gastrointestinal tract we observed inflammation of the cardia and hiatal hernia presence. The remaining part of the stomach, duodenal bulb, and extrabulbar area showed no signs of pathology. No foreign body was observed in the upper GI tract. Due to significant reduction of abdominal pain, nausea, vomiting, lack of peritoneal symptoms, and good general condition, conservative therapy was initiated. After one day of hospitalization, due to intensification of abdominal symptoms, recurrence of nausea and vomiting, retention of gas and stool, as well as increased peristalsis emergency laparotomy was performed. A midline incision in the mesogastrium was performed, approximately 8 cm in length. Distended small bowel loops and peritoneal cavity fluid were observed. The fluid culture
was collected for bacteriological examination. When viewing through the small bowel loops a foreign body was detected. After a longitudinal incision of the small bowel wall, 15 mm in length, a small rubber balloon filled with water was visualized. After its puncture and emptying it was removed from the small bowel (fig. 2). The size of the balloon was 5 x 3 x 3 cm. Double layer sutures were used for the closure of the small bowel. A drain was left in Douglas’s sinus following abdominal lavage. The integument was closed with sutures through all the abdominal layers. The patient remained hospitalized at The Department of General and Colorectal Surgery for a period of 5 days. Empiric antibiotics were continued. Bacteriological results showed no presence of bacteria in the peritoneal fluid. The patient was consulted by a psychiatrist for the cause of foreign body ingestion. The patient was discharged from the hospital in good general condition and referred to the outpatient clinic. Further psychological care and dietarys consultation were recommended. The patient remained under a three-month outpatient hospital follow-up. Surgical controls showed no abnormalities.
Fig. 1. Abdominal cavity X-ray examination (own material)
Fig. 2. Foreign body removed from the small bowelafter balloon puncture and emptying (own material)
Discussion The ingestion of foreign bodies, including undesired portions of food (bones, fish bones) occurs quite frequently in clinical practice. They are the second cause of emergency endoscopic interventions, after GI bleeding (1). Most foreign bodies pass through the GI tract without significant symptoms, being naturally excreted. Based on literature data many authors reported that 10-20% of foreign bodies require emergency endoscopy, while less than
Unauthenticated Download Date | 12/28/16 7:06 PM
596
B. Wnęk et al.
1% require surgical intervention (2-5). American statistics show that each year an average of 1500 patients die because of a swallowed foreign body (1, 3). Foreign bodies in the GI tract occur in patients of all ages. Most often they are observed in the pediatric population with peak incidence between the age of 6 months and 3 years. This is associated with the huge cognitive activity in this age group (6). In case of adult patients foreign bodies in the GI tract are most often found in the elderly, alcoholics, psychiatric patients and prisoners (7, 8). Velichkov et al. in their study described 542 patients with foreign bodies. 69.9% of the patients were prisoners, 22.9% were diagnosed with psychiatric disorders, and 7.2% were alcoholics. In the adult population, one may observe aspiration of the following: fish bones (9-45%), bones (8-40%), and dental prostheses (4-18%). Longstreth et al. mentioned the incidence of foreign body aspiration to the GI tract at 13/100,000 people (10). Symptoms associated with this pathology are diverse-acute respiratory failure, dyspepsia, GI bleeding, perforation, GI obstruction. Patients usually present quickly to the ER after foreign body aspiration. Proper medical history provides important information concerning type and size of the foreign body, as well as incidentality or motives of aspiration. The time elapsed since ingestion is also important. The patient can often indicate the exact position of the foreign body. According to Connolly et al. symptoms reported by the patient do not always correspond to the actual location of the foreign body (11). Abdominal cavity and chest X-ray examinations are considered as screening diagnostic methods. Mosca et al. confirmed the positive radiological result in 144 of 414 patients who reported to the ER after foreign body aspiration (12). Most GI tract foreign bodies are naturally excreted without the development of
clinical symptoms. Therefore, many authors recommend observation without changes in dietary habits. Foreign bodies, 2.5x6 cm in size, with a smooth surface can pass through the GI tract without symptoms. The time required to excrete the foreign body ranges between 4-6, in rare cases up to 4 weeks. Foreign body retention time in the duodenum is particularly important. If longer than 7 days risk of duodenal perforation is increased (2, 4, 13, 14). Statistically, endoscopic interventions are required in 1 of 5 foreign body aspiration cases. Table 1 illustrated the current guidelines (14). Important in the removal of the foreign body from the GI tract, although often unavailable in endoscopic labs is double-balloon enteroscopy introduced by Yamamoto et al. in 2001 (15). The method allows full endoscopic diagnostics of the small bowel. It can also be effectively used to remove GI tract foreign bodies from the small intestine. According to Yamamoto et al. in 2004 (16), small bowel diagnostics was possible from the stomach and colon in 86% of patients. Average duration of the examination from both approaches was 123 minutes: in case of the stomach – 73 min. and the small bowel – 47 min. The described method is safe, especially when the small bowel is free of pathology. The described complications, such as perforation were observed in case of patients diagnosed with Crohn’s disease or small bowel tumors. The method seems to be a minimally invasive alternative, in comparison to invasive methods, such as laparotomy or laparoscopic procedures. The main advantage of this method is that it is minimally invasive, with fewer complications, and shorter hospitalization. However, the method requires longer anesthesia, due to the longer duration of the endoscopic procedure, as compared to laparotomy and laparoscopy. The lower availability of double-balloon enteroscopy is often a limitation, considering GI tract foreign body removal.
Table 1. Indications for gastroduodenoscopy in case of foreign body ingestion Time of gastroduodenoscopy Emergency gastroduodenoscopy Gastroduodenoscopy performed within 12-24 hours Elective gastroduodenoscopy
Type of foreign body GI bleeding, sharp edges of the foreign bodies, bateries, foreign bodies occluding the esophagus, foreign bodies containing poison or psychoactive substances foreign body in the stomach-visible on abdominal X-ray, foreign body > 6 cm in length and 2.5 cm/ >6 cm in the stomach
Unauthenticated Download Date | 12/28/16 7:06 PM
Foreign body in the gastrointestinal tract leading to small bowel obstruction
One should consider the transfer of a stable patient with a GI tract foreign body to a surgical center performing double-balloon enteroscopy. Surgical intervention is indicated in the absence of the possibility to remove the foreign body by means of endoscopy, clinical features of perforation, and obstruction. Classical laparotomy and laparoscopic procedures are preferred. Conclusions Foreign bodies in the GI tract are difficult pathologies considering diagnostics and treatment. Most foreign bodies may be asymptomatic, passing through the GI tract, being naturally excreted. However, the ingestion of a foreign body may also lead to significant complications, such as acute respiratory failure,
597
GI occlusion, GI perforation, and peritonitis. It seems that the growing problem of obesity in developed and developing countries may increase the tendency of aspiration of foreign bodies as a weight reduction method, as mentioned in the presented case. Especially in view of the easy access to the internet with nonprofessional, often false data. Certainly, diagnostics and treatment require surgical experience, the problem should not be trivialized. Proper medical history, in order to determine the possible motives of foreign body aspiration allow to quickly introduce a psychiatrist or psychologist to the therapeutic team. In conclusion, any suspicion of a foreign body in the GI tract, regardless the cause of aspiration and motive requires proper diagnostics, hospitalization, as well as strategy concerning the surgical management.
references 1. Ginsberg GG, Kochman ML, Norton I et al.: Ingested foreign objects and food bolus impactions. Clinical Gastrointestinal Endoscopy. Saunders Elsevier 2005; 291-304. 2. Ginsberg GG et al.: Management of ingested foreign objects and foodbolus impactions. Gastrointest Endosc 1995; 41: 33-38. 3. Eisen GM, Baron TH, Dominitz JA et al.: Guideline for the management of ingested foreign bodies. Gastrointest Endosc 2002; 55: 802-06. 4. Webb WA et al.: Management of foreign bodies of the upper gastrointestinal tract: update. Gastrointest Endosc 1995; 41: 39-51. 5. Zhang S, Cui Y, Gong X et al.: Endoscopic Management of Foreign Bodies in the Upper Gastrointestinal Tract in South China: A Retrospective Study of 561 Cases. Dig Dis Sci 2010; 55: 1305-12. 6. Ignyś I, Celińska-Cedro D: Postępowanie z ciałami obcymi w obrębie przewodu pokarmowego dzieci. Stand Med 2002; 3: 126-32. 7. Cosimati A, Terrinoni V, Bianchi G et al.: Foreign bodies in the gastrointestinal tract. Our cases and a review of the literature. G Chir 1996; 11-12: 581-85. 8. Thomas SH, Brown DFM: Foreign bodies. In: Marx JA, Hockberger RS, Walls RM i wsp. Rosen’s Emergency Medicine: Concepts and Clinical Practice. Wyd 6. Mosby: Elsevier; 2006, s. 859-881. 9. Vielichkov NG, Grigorov GI, Losanoff JE et al. Intested foreign bodies of the gastrointestinal tract:
retrospective analysis of 542 cases. World J Surg 1996; 8: 1001-05. 10. Longstreth GF, Longstreth KJ, Yao JF et al.: Esophageal food impaction: epidemiology and therapy. A retrospective, observational study. Gastrointest Endosc 2001; 53: 193-98. 11. Connolly AA, Birchall M, Walsh-Waring GP et al.: Ingested foreign bodies: patient-guided localization is a useful clinical tool. Clin Otolaryngol Allied Sci 1992; 17: 520-24. 12. Mosca S, Manes G, Martino R et al.: Endoscopic management of foreign bodies in the upper gastrointestinal tract: report on a series of 414 adult patients. Endoscopy 2001; 33: 692-96. 13. Ambe P, Weber SA, Schauer M et al.: Swallowed Foreign Bodies in Adults. Dtsch Arztebl Int 2012; 109: 869-75. 14. Ikenberry SO, Jue TL, Anderson MA et al.: Management of ingested foreign bodies and food impactions. Gastrointest Endosc 2011; 73: 108591. 15. Yamamoto H, Sekine Y, Sato Y et al.: Total enteroscopy with a nonsurgical steerable doubleballoon method. Gastrointest Endosc 2001; 53: 216-20. 16. Yamamoto H, Kita H, Sunada K et al.: Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases. Clin Gastroenterol Hepatol 2004; 2: 101016.
Received: 6.03.2014 r. Adress correspondence: 61-285 Poznań, ul. Szwajcarska 3 e-mail: [email protected]
Unauthenticated Download Date | 12/28/16 7:06 PM
10.1515/pjs-2015-0006
CASE REPORTS
Foreign body in the gastrointestinal tract leading to small bowel obstruction – case report and literature review Bartosz Wnęk, Aleksandra Łożyńska-Nelke, Jacek Karoń Department of General and Colorectal Surgery, Medical University in Poznań Kierownik: prof. dr hab. P. Krokowicz
The presence of a foreign body in the gastrointestinal tract constitutes a common pathology, considering surgical clinical practice. The management of the ingestion of a foreign body depends on many factors. The study presented a case of a 33-year-old female patient subjected to surgical treatment, due to deliberate swallowing of a balloon. The above-mentioned was the amateur equivalent of intragastric balloon insertion, inducing weight loss. This is a rare cause of a foreign body ingestion, seldomly found in literature data. The patient reported to the Emergency Department on the second day after ingestion with symptoms of mechanical subobstruction, and after initial diagnostics, was qualified for surgery. The postoperative period proved uneventful. The study illustrated the often unfavourable access to false data on the internet, which may stimulate towards the above-mentioned behaviour. Key words: foreign body, gastrointestinal obstruction, weight loss
Foreign bodies in the gastrointestinal tract are a significant problem in surgical practice. They apply to the entire human population, regardless patient age. One may distinguish accidental foreign body ingestion, as well as deliberate ingestion. Depending on the location of the foreign body in the gastrointestinal tract, clinical symptoms, and patient age, different therapeutic methods are accepted. The aim of the study was to present a case of deliberate foreign body ingestion, as a weight reduction method. Case report A 33-year old female patient was admitted to the Emergency Department in August, 2012, due to nausea and vomiting, loss of appetite, bloating, and abdominal pain, intensifying for the past two days. The patient did not complain of gas retention, nor constipation. She had no history of concomitant diseases, prior surgery, nor admitted to the use of drugs. The patient confessed that due to obesity (BMI-31) she
tried numerous slimming diets without success. She admitted to swallowing a small (5 x 3 cm) rubber balloon filled with water, two days earlier. This was motivated by the aim to induce weight loss. She denied suicidal thoughts. The patient had been recently reading on the internet about surgical methods of gastric balloon implantation procedures, in order to reduce weight. She did not consult the matter with her physician. With incomplete, secular and untested data gathered from the internet, as well as not fully understanding the essence of the bariatric procedure, the patient decided to swallow a balloon filled with water. When the physician asked the patient how she would remove the balloon, she answered that “she had not read that part”. The physical examination showed a distended abdomen, painful on palpation, without peritoneal symptoms and increased peristalsis. The per rectum examination showed no pathology. Laboratory results showed high leucocytosis 19.4 G/l with a normal CRP level. The remaining laboratory results (coagulation and biochemistry) were within normal limits. The Unauthenticated Download Date | 12/28/16 7:06 PM
Foreign body in the gastrointestinal tract leading to small bowel obstruction
595
abdominal X-ray examination in the standing position (fig. 1) showed distended intestinal loops with fluid levels-radiological features of high gastrointestinal obstruction. After the above-mentioned examinations the patient was admitted to the Department of General and Colorectal Surgery. Conservative treatment was initiated, including strict diet, fluid therapy, antibiotics (Biotraxone, Metronidazol), and proton pump inhibitors. Due to abdominal cavity inflammatory symptoms, oral lubricants, such as paraffin, used to facilitate the passage of the foreign body through the gastrointestinal tract were not used. Gastroscopy was performed. During endoscopy of the upper gastrointestinal tract we observed inflammation of the cardia and hiatal hernia presence. The remaining part of the stomach, duodenal bulb, and extrabulbar area showed no signs of pathology. No foreign body was observed in the upper GI tract. Due to significant reduction of abdominal pain, nausea, vomiting, lack of peritoneal symptoms, and good general condition, conservative therapy was initiated. After one day of hospitalization, due to intensification of abdominal symptoms, recurrence of nausea and vomiting, retention of gas and stool, as well as increased peristalsis emergency laparotomy was performed. A midline incision in the mesogastrium was performed, approximately 8 cm in length. Distended small bowel loops and peritoneal cavity fluid were observed. The fluid culture
was collected for bacteriological examination. When viewing through the small bowel loops a foreign body was detected. After a longitudinal incision of the small bowel wall, 15 mm in length, a small rubber balloon filled with water was visualized. After its puncture and emptying it was removed from the small bowel (fig. 2). The size of the balloon was 5 x 3 x 3 cm. Double layer sutures were used for the closure of the small bowel. A drain was left in Douglas’s sinus following abdominal lavage. The integument was closed with sutures through all the abdominal layers. The patient remained hospitalized at The Department of General and Colorectal Surgery for a period of 5 days. Empiric antibiotics were continued. Bacteriological results showed no presence of bacteria in the peritoneal fluid. The patient was consulted by a psychiatrist for the cause of foreign body ingestion. The patient was discharged from the hospital in good general condition and referred to the outpatient clinic. Further psychological care and dietarys consultation were recommended. The patient remained under a three-month outpatient hospital follow-up. Surgical controls showed no abnormalities.
Fig. 1. Abdominal cavity X-ray examination (own material)
Fig. 2. Foreign body removed from the small bowelafter balloon puncture and emptying (own material)
Discussion The ingestion of foreign bodies, including undesired portions of food (bones, fish bones) occurs quite frequently in clinical practice. They are the second cause of emergency endoscopic interventions, after GI bleeding (1). Most foreign bodies pass through the GI tract without significant symptoms, being naturally excreted. Based on literature data many authors reported that 10-20% of foreign bodies require emergency endoscopy, while less than
Unauthenticated Download Date | 12/28/16 7:06 PM
596
B. Wnęk et al.
1% require surgical intervention (2-5). American statistics show that each year an average of 1500 patients die because of a swallowed foreign body (1, 3). Foreign bodies in the GI tract occur in patients of all ages. Most often they are observed in the pediatric population with peak incidence between the age of 6 months and 3 years. This is associated with the huge cognitive activity in this age group (6). In case of adult patients foreign bodies in the GI tract are most often found in the elderly, alcoholics, psychiatric patients and prisoners (7, 8). Velichkov et al. in their study described 542 patients with foreign bodies. 69.9% of the patients were prisoners, 22.9% were diagnosed with psychiatric disorders, and 7.2% were alcoholics. In the adult population, one may observe aspiration of the following: fish bones (9-45%), bones (8-40%), and dental prostheses (4-18%). Longstreth et al. mentioned the incidence of foreign body aspiration to the GI tract at 13/100,000 people (10). Symptoms associated with this pathology are diverse-acute respiratory failure, dyspepsia, GI bleeding, perforation, GI obstruction. Patients usually present quickly to the ER after foreign body aspiration. Proper medical history provides important information concerning type and size of the foreign body, as well as incidentality or motives of aspiration. The time elapsed since ingestion is also important. The patient can often indicate the exact position of the foreign body. According to Connolly et al. symptoms reported by the patient do not always correspond to the actual location of the foreign body (11). Abdominal cavity and chest X-ray examinations are considered as screening diagnostic methods. Mosca et al. confirmed the positive radiological result in 144 of 414 patients who reported to the ER after foreign body aspiration (12). Most GI tract foreign bodies are naturally excreted without the development of
clinical symptoms. Therefore, many authors recommend observation without changes in dietary habits. Foreign bodies, 2.5x6 cm in size, with a smooth surface can pass through the GI tract without symptoms. The time required to excrete the foreign body ranges between 4-6, in rare cases up to 4 weeks. Foreign body retention time in the duodenum is particularly important. If longer than 7 days risk of duodenal perforation is increased (2, 4, 13, 14). Statistically, endoscopic interventions are required in 1 of 5 foreign body aspiration cases. Table 1 illustrated the current guidelines (14). Important in the removal of the foreign body from the GI tract, although often unavailable in endoscopic labs is double-balloon enteroscopy introduced by Yamamoto et al. in 2001 (15). The method allows full endoscopic diagnostics of the small bowel. It can also be effectively used to remove GI tract foreign bodies from the small intestine. According to Yamamoto et al. in 2004 (16), small bowel diagnostics was possible from the stomach and colon in 86% of patients. Average duration of the examination from both approaches was 123 minutes: in case of the stomach – 73 min. and the small bowel – 47 min. The described method is safe, especially when the small bowel is free of pathology. The described complications, such as perforation were observed in case of patients diagnosed with Crohn’s disease or small bowel tumors. The method seems to be a minimally invasive alternative, in comparison to invasive methods, such as laparotomy or laparoscopic procedures. The main advantage of this method is that it is minimally invasive, with fewer complications, and shorter hospitalization. However, the method requires longer anesthesia, due to the longer duration of the endoscopic procedure, as compared to laparotomy and laparoscopy. The lower availability of double-balloon enteroscopy is often a limitation, considering GI tract foreign body removal.
Table 1. Indications for gastroduodenoscopy in case of foreign body ingestion Time of gastroduodenoscopy Emergency gastroduodenoscopy Gastroduodenoscopy performed within 12-24 hours Elective gastroduodenoscopy
Type of foreign body GI bleeding, sharp edges of the foreign bodies, bateries, foreign bodies occluding the esophagus, foreign bodies containing poison or psychoactive substances foreign body in the stomach-visible on abdominal X-ray, foreign body > 6 cm in length and 2.5 cm/ >6 cm in the stomach
Unauthenticated Download Date | 12/28/16 7:06 PM
Foreign body in the gastrointestinal tract leading to small bowel obstruction
One should consider the transfer of a stable patient with a GI tract foreign body to a surgical center performing double-balloon enteroscopy. Surgical intervention is indicated in the absence of the possibility to remove the foreign body by means of endoscopy, clinical features of perforation, and obstruction. Classical laparotomy and laparoscopic procedures are preferred. Conclusions Foreign bodies in the GI tract are difficult pathologies considering diagnostics and treatment. Most foreign bodies may be asymptomatic, passing through the GI tract, being naturally excreted. However, the ingestion of a foreign body may also lead to significant complications, such as acute respiratory failure,
597
GI occlusion, GI perforation, and peritonitis. It seems that the growing problem of obesity in developed and developing countries may increase the tendency of aspiration of foreign bodies as a weight reduction method, as mentioned in the presented case. Especially in view of the easy access to the internet with nonprofessional, often false data. Certainly, diagnostics and treatment require surgical experience, the problem should not be trivialized. Proper medical history, in order to determine the possible motives of foreign body aspiration allow to quickly introduce a psychiatrist or psychologist to the therapeutic team. In conclusion, any suspicion of a foreign body in the GI tract, regardless the cause of aspiration and motive requires proper diagnostics, hospitalization, as well as strategy concerning the surgical management.
references 1. Ginsberg GG, Kochman ML, Norton I et al.: Ingested foreign objects and food bolus impactions. Clinical Gastrointestinal Endoscopy. Saunders Elsevier 2005; 291-304. 2. Ginsberg GG et al.: Management of ingested foreign objects and foodbolus impactions. Gastrointest Endosc 1995; 41: 33-38. 3. Eisen GM, Baron TH, Dominitz JA et al.: Guideline for the management of ingested foreign bodies. Gastrointest Endosc 2002; 55: 802-06. 4. Webb WA et al.: Management of foreign bodies of the upper gastrointestinal tract: update. Gastrointest Endosc 1995; 41: 39-51. 5. Zhang S, Cui Y, Gong X et al.: Endoscopic Management of Foreign Bodies in the Upper Gastrointestinal Tract in South China: A Retrospective Study of 561 Cases. Dig Dis Sci 2010; 55: 1305-12. 6. Ignyś I, Celińska-Cedro D: Postępowanie z ciałami obcymi w obrębie przewodu pokarmowego dzieci. Stand Med 2002; 3: 126-32. 7. Cosimati A, Terrinoni V, Bianchi G et al.: Foreign bodies in the gastrointestinal tract. Our cases and a review of the literature. G Chir 1996; 11-12: 581-85. 8. Thomas SH, Brown DFM: Foreign bodies. In: Marx JA, Hockberger RS, Walls RM i wsp. Rosen’s Emergency Medicine: Concepts and Clinical Practice. Wyd 6. Mosby: Elsevier; 2006, s. 859-881. 9. Vielichkov NG, Grigorov GI, Losanoff JE et al. Intested foreign bodies of the gastrointestinal tract:
retrospective analysis of 542 cases. World J Surg 1996; 8: 1001-05. 10. Longstreth GF, Longstreth KJ, Yao JF et al.: Esophageal food impaction: epidemiology and therapy. A retrospective, observational study. Gastrointest Endosc 2001; 53: 193-98. 11. Connolly AA, Birchall M, Walsh-Waring GP et al.: Ingested foreign bodies: patient-guided localization is a useful clinical tool. Clin Otolaryngol Allied Sci 1992; 17: 520-24. 12. Mosca S, Manes G, Martino R et al.: Endoscopic management of foreign bodies in the upper gastrointestinal tract: report on a series of 414 adult patients. Endoscopy 2001; 33: 692-96. 13. Ambe P, Weber SA, Schauer M et al.: Swallowed Foreign Bodies in Adults. Dtsch Arztebl Int 2012; 109: 869-75. 14. Ikenberry SO, Jue TL, Anderson MA et al.: Management of ingested foreign bodies and food impactions. Gastrointest Endosc 2011; 73: 108591. 15. Yamamoto H, Sekine Y, Sato Y et al.: Total enteroscopy with a nonsurgical steerable doubleballoon method. Gastrointest Endosc 2001; 53: 216-20. 16. Yamamoto H, Kita H, Sunada K et al.: Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases. Clin Gastroenterol Hepatol 2004; 2: 101016.
Received: 6.03.2014 r. Adress correspondence: 61-285 Poznań, ul. Szwajcarska 3 e-mail: [email protected]
Unauthenticated Download Date | 12/28/16 7:06 PM
