| Abstract|| |
We describe a case of 12 inches long rigid, radiolucent foreign body in a 17 year old female accidentally ingested and impacted in upper G.I. Tract. Patient was haemodynamically stable, walking-talking with presenting complaints of dysphgia and nausea. Though Radio-opaque foreign bodies are easily evident on plain radiographs but Radiolucency and midline location (overlapped by thoracic vertebral shadow) made it a difficult task to map this unusual foreign body on plain skiagram. Barium study revealed a straight, 12 inches long foreign body from mid esophagus to greater curvature of stomach with evidence of erosion at the terminal ends. Laparotomy revealed the presence of 12 inches long rigid foreign body DATUN (Neem stick -a ayurvedic remedy used for oral hygiene-cleaning and brushing teeth) impending to rupture the viscera at both ends.
Keywords: Foreign body, wooden, 12 inches long DATUN, Barium study, esophagus, stomach.
|How to cite this article:|
Pandya V K, Malik R, Lakhole M. Rigid 12 inches long impacted foreign body in upper gastro-intestinal-tract. Indian J Radiol Imaging 2006;16:495-7
|How to cite this URL:|
Pandya V K, Malik R, Lakhole M. Rigid 12 inches long impacted foreign body in upper gastro-intestinal-tract. Indian J Radiol Imaging [serial online] 2006 [cited 2019 Oct 20];16:495-7. Available from: http://www.ijri.org/text.asp?2006/16/4/495/32254
| Introduction|| |
Small foreign bodies like coin, disc battery, beads, buttons are easily evident on plain X-Ray Films and usually swallowed accidentally by children or by mentally ill persons. Small sized foreign bodies with smooth edges are managed conservatively by radiological surveillance and inspection of stool  and rarely need Surgical Intervention unless impacted. Hard and long foreign bodies usually get impacted in Esophagus and lead to Esophageal perforation and sudden death due to pneumothorax or rupture of greater vessels . Such bezoar needs immediate radiological mapping and emergency surgical intervention. Accidental ingestion / swallowing of foreign bodies like fishbone, chicken leg pieces, Dentures even eyeball prosthesis are common in elderly. Iatrogenic foreign bodies are extremely rare i.e., stents, esophageal stents, esophageal stethoscopes, tumor prosthesis.
| Case reports|| |
A healthy looking 17 year old young female presented with history of swallowed Neem Stick "Datun" (Azarecta Indica) while cleaning her teeth 2 days back. Since then she is complaining of difficulty in swallowing & Nausea. She had no pain and was haemodynamically stable, She did not reveal the exact length of Datun. Endoscopy was suggestive of wooden foreign body in mid Esophagus and removal attempt failed by non-invasive regime [Figure - 3].Barium study performed in emergency hour showed filling defect which appears Straight and cylindrical from mid esophagus to greater curvature of stomach and normal passages of Contrast seen passing into the duodenum without intraperitonal leakage [Figure - 1],[Figure - 2]. The mucosal relief film shows mucosal erosion at terminal ends suggestive of pressure erosion [Figure - 1]. Barium study finding were suggestive of rigid, straight, cylindrical foreign body approximately 1 foot long, proximal end of which was impacted in mid Esophagus and distal end tenting the greater curvature of stomach. After the diagnosis was confirmed on Barium study, the patient was planned for emergency exploration.
On exploration by mid-line abdominal incision, tenting of stomach wall was seen at greater curvature. A rigid, 12 inches long straight Datun was causing pressure ulceration of gastric mucosa, Datun was removed surgically, [Figure - 4],[Figure - 5]. Stomach and anterior abdominal wall stitched in layers, patient stood the procedure well. Patients recovery was uneventful and was kept on Intra-Venous Fluid and Naso-Gastric aspiration for 7 days and discharged and adviced psychiatric evaluation.
| Discussion|| |
Most esophageal foreign bodies are small and usually pass through the G.I. tract without long term complications. Management of such orally ingested foreign body usually consists of endoscopic retrieval while the object resides within the esophagus and stomach. Small Foreign bodies that pass through the pylorus will be excreted without complications. Some may become impacted distally resulting in obstruction or perforation .
In children the majority of impacted esophageal foreign bodies are located at the level of cricopharyngeus muscle, while in adults the site of impaction is lower esophageal sphincter . Most common symptoms of esophageal foreign body are dysphagia and nausea ,. Though impacted esophageal foreign body may cause intrathorcic esophageal perforation and rupture of great vessels, tension pneumothorax needs emergency surgical intervention . Benign complication of impacted Bezoar was ulcerative esophagitis due to pressure necrosis at the site of impaction . Preservation of Airway is regarded to be the most important consideration in esophageal foreign body management .
If the Radiolucent esophageal foreign body is not detected on plain Radiograph, Barium study is better option to outline the site and size of impacted foreign body. Radioopaque foreign bodies like Disc Battery, Button, Marble is usually evident on plain AP-Lat X-ray film. In this case Datun (Radiolucent Foreign Body) was impacted in upper G.I. tract superimposed by thoracic vertebral shadow and not evident on plain Radiograph. Barium study helped us to demarcate the exact size & site of impacted foreign body and study also revealed type of tissue damage at the site of impaction (i.e., tenting of esophageal and gastric mucosa at the site of impaction causing pressure erosion with danger of impending rupture), these findings were confirmed intraoperatively.
In conclusion we feel that the rigid, long, foreign body if impacted results in pressure erosion and subsequently resulting into erosive necrosis and danger of impending rupture ,. The present case is interesting because of the length (12, inches) and the rigid nature with evidence of pressure erosion which helped in guiding the Surgeon for immediate operative intervention there by preventing rupture and its complications.
| References|| |
|1.||Seggie J, Knottenbelt JD esophageal obstruction by phytobezoar, rare complication of gastric bezoar. Dig Dis Sic 1981 Jan. 26(1) : 90-30. |
|2.||Al-Qudah A, Daradkeh S, Abu-Khalaf M, Esophageal foreign bodies. Eur J Cardiothrorac Surg 1900 May : 13 (5): 494-8. |
|3.||Chang YJ, Chao HC,, Kong MS, Lal MW, Clinical analysis of disc battery ingestion in children. Chang Gung Med. J. 2004 Sep : 27 (9) : 673. |
|4.||Santamarina R, Yeso VO, Fanelli RD colonoscopic retrieval of an appendiceal foreign body : prophylaxis for appendicitis? Surg Endosc. 2003 Feb.; 17 (2) : Epub Non.20. |
|5.||Zhang Y, Lu P, Discussion on diagnosis and treatment of 12 patients with intrathoracic oesophageal perforation caused by foreign body. Lin Chuang Er. BI Yan Hou Ke Za Zhi. 2004 Mar; 18 (3) : 145-6. |
|6.||Nwaorgu OG, Onakoya PA, Sogebi OA Kokong DD, Dosumu OO, Esophageal impacted dentures. Nati Med Assoc. 2004, Oct; 96 (10): 1350-3. |
|7.||Sreetharan SS, Prepageran N, Singh S. Migratory foreign body in the neck. Asian J Surg. 2005 Apr; 28(2) : 136-8. Department of Otolaryngiology, National University of Malaysia, Kuala Lumpur, Malaysia. |
|8.||Uyemure MC Foreign body ingestion in children. Am Fam Physician, 72 (2) : 287-91, 2005. |
|9.||Ruckauer K Dinkel E. Endoscopic extration of a tumor prosthesis dislodge into the stomach. Article in Germany RADIOLOGE 1985 sep 25(9), 440-1. |
V K Pandya
Department of Radiodiagnosis & Imaging, Gandhi Medical College & Associated Hamidia Hospital. Bhopal
Source of Support: None, Conflict of Interest: None
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]