Endoscopic retrieval of a duodenal perforating teaspoon

Abstract

Foreign objects ingestion occur commonly in pediatric patients. The majority of ingested foreign bodies pass spontaneously the gastrointestinal tract and surgery is rarely required for extraction. Endoscopic removal of foreign bodies larger than 10 cm has not yet been described. We present the case of a 16 years old bulimic girl that swallowed a 12 cm long teaspoon in order to provoke vomiting. The teaspoon perforated the duodenum. However, it was removed during gastroscopy and the site of perforation was closed endoscopically. This particular case shows the importance of endoscopy for retrieval of large foreign bodies, and the possibility to endoscopically close a perforated duodenal wall.

Keywords: Bowel perforation; Bulimia; Foreign body ingestion; Upper endoscopy.

Figure 1

Endoscopic retrieval of a duodenal perforating teaspoon. A: Plain abdominal X-ray showing the teaspoon in the right upper abdominal quadrant. Note the absence of free intra-abdominal air; B: The tip of the teaspoon handle impacted into the duodenal mucosa at the level of the superior duodenal genu; C: The spoon after extraction: 12 cm long, 2 cm large at the cup and 0.5 cm at the handle; D: Urgent computed tomography scan showing diffuse bilateral retro-pneumoperitoneum extending to the right inguinal region, with a small amount of fluid into the retro-duodenal region near the right kidney.