Endoscopic Removal of Sharp-Pointed Foreign Bodies with Both Sides Embedded into the Duodenal Wall in Adults: A Retrospective Cohort Study

Abstract

Purpose Sharp-pointed FBs with both sides embedded in the duodenal wall are rare. Compared with smooth edged FBs, sharp objects are more likely to be associated with significant adverse events, when penetrating the wall of the digestive tract. The clinical features of patients who experienced sharp-pointed FBs embedded in both sides of the duodenum were retrospectively analyzed, as were the efficacy and safety of endoscopic removal of these FBs. Patients and Methods This retrospective study included 21 adults with both sides of sharp-pointed FBs embedded into the duodenal wall who were admitted to the Second Xiangya Hospital in China between January 1, 1996, and May 31, 2021. Data associated with the endoscopic removal of these FBs were collected from the electronic medical record system (EMRS) of the hospital. Results The incidence rate of duodenal total FBs and FBs embedded in both sides was 8.87% and 1.03%, respectively. The success rate of endoscopic treatment was 100.00% in 124 patients without embedded duodenal FBs and 97.14% in 35 patients with one side embedded duodenal FBs. Of the 21 patients with FBs embedded in both sides of the duodenal wall, endoscopic removal was successful in 85.71% of patients, whereas 14.29% required surgery. FBs removed from these patients included toothpicks in 12; needles in 3; jujube pits in 2; and a chopstick, dentures, fish bones, and chicken bones in one each. Most of these 21 FBs were located in the bulb and descending duodenum, followed by the third part of duodenum. Conclusion Sharp-edged FBs with both sides embedded in the duodenal wall are rare. Endoscopic removal may be considered as a feasible, safe, and effective method of removing sharp-pointed FBs with both sides embedded in the duodenal wall. And if endoscopic removal is unsuccessful, surgical management can be a secondary option.

Endoscopic management of duodenal perforation caused by foreign bodies in adults: A retrospective study

“…For FBs with both sides perforated, the looser side was clamped first and was gently pushed to the opposite side to remove it. The long or sharp‐pointed FB should be grasped at its end and kept parallel to the longitudinal axis of the gastrointestinal tract to lower the risk of a procedure‐related perforation or mucosal damage during extraction 2,3,6 . After retrieval of the FBs, it is necessary to observe the entire upper gastrointestinal tract for any FB residue, perforation, bleeding, mucosal injury, etc.…”

“…Most perforations are located in the duodenal bulb and/or descending part. The acute angulation here makes long or sharp‐pointed objects often incarcerated, while the thin wall of the duodenum makes the FBs prone to perforation 6,7,13 . Therefore, more attention should be paid to duodenal FBs in clinical practice.…”

“…Duodenal perforation caused by FBs is a challenging emergency that traditionally requires surgical management 8,11 . Duodenal surgery is difficult due to the unique anatomical location of the duodenum, especially the third part, which is fixed to the retroperitoneum 6 . Likewise, endoscopic procedure to the duodenum is also challenging because of angulation of the duodenal sweep and the paradoxical motion of the endoscope 6,7 .…”

“…FB impaction, perforation, or obstruction often occurs at gastrointestinal narrowing or angulations, and the upper esophagus is the most common lodged location 3–5 . Although rare, long and sharp‐pointed objects are easily lodged in the duodenum and pose a higher risk for perforation because of the C‐loop shape and thin wall of the duodenum 6,7 …”

“…[3][4][5] Although rare, long and sharp-pointed objects are easily lodged in the duodenum and pose a higher risk for perforation because of the C-loop shape and thin wall of the duodenum. 6,7 Duodenal perforation caused by FBs is an urgent and lifethreatening emergency that traditionally requires surgical intervention. Several case reports have reported the successful endoscopic management of FB-induced duodenal perforation.…”