Nicholas Morin, DO, Shinban Liu, DO, Erika King, George Ferzli, MD. NYU langone Brooklyn
Introduction: The surgical management of arrested sharp foreign bodies (FB) in the small bowel is often managed with a concurrent approach that balances endoscopy, laparoscopy, and laparotomy for their removal. Controversy exists as to the timing of surgical intervention and the management of asymptomatic patients. Here we discuss the management and present a case series with a review of the current literature.
Cases series: Patient one underwent endoscopic retrieval of a wire bristle embedded in the duodenum. Patient two underwent diagnostic laparoscopy converted to open small bowel resection of chronically retained FB after it eroded through the bowel wall of the mid jejunum. Patient three underwent laparoscopic removal via enterotomy and primary repair of a chicken bone embedded in the terminal ileum.
Discussion: Any arrested sharp foreign body should be surgically removed in a timely fashion. The literature shows that longer delays to the operating room, and asymptomatic patients with retained small FBs, increases the risk of significant morbidity; such as migration of the FB through the bowel wall, enterocolic fistula, aortic – duodenal fistula, and frank acute perforation. Any known or suspected ingestion of a sharp FB should be staged with imaging if it is detectable. If progression fails, then surgery is indicated. If it has arrested in the stomach or duodenum endoscopic retrieval is appropriate. A skilled endoscopist can attempt balloon endoscopy for proximal jejunal FB retrieval, but retrieval should not be delayed. Laparoscopic retrieval is preferable when endoscopic attempts have failed. This can be performed via an enterotomy and primary repair for small FBs or laparoscopic small bowel resection with primary anastomosis. If there is frank perforation (or a skilled laparoscopic surgeon is not available) then a laparotomy and washout with resection of affected segment may be indicated.
Conclusion: Retrieval after ingestion of a sharp FB should be performed in a timely manner. A review of the literature shows that chronically retained FBs, and traditional long delays to monitor for transit of the FB increase morbidity and mortality.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 92115
Program Number: P040
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster