Evaluation of the risk factors for severe complications and surgery of intestinal foreign bodies in adults: a single-center experience with 180 cases

Abstract

Background Foreign bodies (FBs) lodged in the intestine or causing intestinal complications are uncommon in clinical practice but may pose diagnostic difficulties and prove life-threatening. This study aimed to evaluate the risk factors for severe complications and surgery to aid clinicians in the diagnosis and management of intestinal FBs. Methods We performed a retrospective analysis of patients in whom FBs were lodged in the intestine or caused complications from 2010 to 2020 in the First Affiliated Hospital of Wenzhou Medical University (Zhejiang, China). The characteristics of the patients and FBs, symptoms, imaging findings, diagnostics, treatment strategies, and clinical outcomes were analysed. Furthermore, the risk factors for complications and surgery were investigated. Results In total, 180 patients were included in our study. Most patients (76.1%) were unable to provide a history of ingestion. Bezoars were the most common FBs (35.6%). The FBs were mainly located in the duodenum (32.8%) and the ileum (27.8%). Surgical removal of FBs was successful in 89 (49.4%) patients and endoscopic removal in 54 (30.0%) patients. Eleven with perforations were treated conservatively. FBs located in the jejunum or ileum were more likely to cause severe complications than those located in the duodenum. FBs located in the jejunum, ileum, or sigmoid colon were more likely to undergo surgery, and severe complications were an independent risk factor for surgery. Conclusion Intestinal FBs, often localized in angulation, are likely to be misdiagnosed because most patients do not provide a history of FB ingestion. Surgery and endoscopic therapy are the most commonly used treatment modalities. Surgery is not mandatory in clinically stable patients with small and contained perforations. FBs located in the jejunum or ileum are risk factors for both complications and surgery.

Occurrence of multiple fistulas decades after ingestion and neglect of numerous thermometers: a case report

“…Such difficult and unusual cases require a close interdisciplinary communication and collaboration between gastroenterologists and surgeons. Our case confirmed that the foreign bodies were particularly concentrated in areas with angled regions as the duodenum or sigmoid colon and in the area of the most common impaction point orally of the ileocecal valve [ 9 , 12 ]. Because of the acute course of the disease, we concentrated on the obvious perforation, as ingestion of large foreign bodies is principally associated with perforation of hollow organs.…”

“…As in our case, previous reports also showed that plain radiographs failed to reveal the presence of intra-abdominal free air. CT scans demonstrated the highest sensitivity of imaging techniques in detecting intestinal foreign bodies [ 9 ]. In our case CT could not visualize the fistulas, probably because of artefacts caused by the foreign bodies.…”

Duodenal and inferior vena cava perforation due to a rosemary branch ingestion: a Case Report

“…[18] CT shows a sensitivity between 42 to 78% in the detection of FB and is paramount to making a correct diagnosis [11] [14]. It allows identifying the localization of the FB, the shape and its relation with the surrounding organs and eventual complications, which helps plan surgery [11] [12]. It makes it possible to recognize an inflammatory reaction surrounding the foreign body, linear objects (eventually encircled by a thickened intestinal wall), fat infiltration, peritoneum and intra-abdominal abscess when perforation occurs [7] If a CT scan detects any foreign bodies stuck in the upper part of the small intestine or large intestine, then endoscopy should be done for diagnosis and treatment.…”

“…Foreign objects lodged in the esophagus must be emergently removed for their life-threatening complications. [12] No definite guidelines are available for objects that pass through the pylorus, the usual therapeutic approach is a watchful waiting within 2-3 weeks until its expulsion. If watchful waiting does not lead to the passage of these objects to the stomach the recommendations suggest an endoscopic removal.…”

When It’s Not Pancreatitis, Don’t Brush It Off: A Case Report of Small Bowel Perforation Caused by a Grill Brush Bristle Masquerading As Pancreatitis

“…Depending on the site of penetration, the clinical presentation may mimic more common medical conditions, e.g., peptic ulcer disease or gastritis if the bristle lodges in the stomach, or pancreatitis if the bristle is in the pancreas or duodenum [9]. Micro-perforations of the small bowel are usually subtle and subacute in nature and present with less severe symptoms than perforations in other parts of the gastrointestinal tract [10][11][12].…”