Sharp Foreign Body Ingestion: Laparoscopic and Conservative Management: 2 Case Reports

Alexandre C Stanescu, MD1, Marius Nedelcu, MD2, Iannis Rotas, MD3, Bernard Vincent, MD1. 1CH Albertville, 2CHU Strasbourg, 3HFR Fribourg

Introduction: Most of the blunt foreign bodies pass through the digestive tract uneventfully. The reported rate of complication of the ingested sharp foreign bodies is about 1%. In adults, the complications are more frequent identified in elderly, alcohol abuse history, or mentally impaired persons. About 70% of accidental ingestion of sharp foreign bodies, in normal adults, is dentures or other dentistry appliances.

Case reports: We report here 2 cases of patients, a 70 years old man and a 76 years old woman, presenting with sharp foreign body ingestion. In the first case, the patient presented an acute abdomen. The CT scan revealed the presence of a sharp dentistry appliance and caecal perforation. The laparoscopic exploration showed an appendix base perforation and laparoscopic appendectomy and partial resection of the cecum has been performed. The post-operative period was uneventful and the patient has been discharged after 72 hrs; the second case of an elderly female patient who swallowed, by accident, a needle. The plain X-ray exams were irrelevant and the both the bronchoscopy and gastroscopy were negative. A low dose CT scan has been performed and the needle has been identified at the left colic flexure. Since the patient was asymptomatic, clinical observation has been decided. The needle was naturally eliminated and the patient has been discharged after 48 hrs.

Conclusion: In the most cases (80-90%), the gastrointestinal foreign bodies are naturally eliminated. However, for the ingestion of sharp foreign bodies the clinical observation is highly recommendable. In case of impactation or obstruction endoscopic retrieval is indicated. In case of complications (1%), as perforation, the laparoscopic surgical management is feasible and safe

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