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. 2024 Apr;12(3):390-398.
doi: 10.1002/ueg2.12505. Epub 2023 Dec 30.

Endoscopic management of duodenal perforation caused by foreign bodies in adults: A retrospective study

Li-Yun Ma  1 , Zu-Qiang Liu  1 , Ye Wang  2 , Tao Wang  3 , Guang-Bin Sun  4 , Li Wang  1 , Ke-Yang Fan  1 , Jing-Zheng Liu  1 , Li-Li Ma  1 , Wen-Zheng Qin  1 , Jian-Wei Hu  1 , Ming-Yan Cai  1 , Guo-Liang Zhang  2 , Quan-Lin Li  1   5 , Ping-Hong Zhou  1   5
Affiliations

Endoscopic management of duodenal perforation caused by foreign bodies in adults: A retrospective study

Li-Yun Ma et al. United European Gastroenterol J. 2024 Apr.

Abstract

Background and aims: Duodenal perforation caused by foreign bodies (FBs) is very rare but is an urgent emergency that traditionally requires surgical intervention. Several case reports have reported the successful endoscopic removal of duodenal perforating FBs. Here we aimed to evaluate the safety and efficacy of endoscopic management of duodenal perforating FBs in adults.

Methods: Between October 2004 and October 2022, 12,851 patients with endoscopically diagnosed gastrointestinal FBs from four tertiary hospitals in China were retrospectively reviewed. Patients were enrolled if they were endoscopically and/or radiographically diagnosed with duodenal perforating FBs.

Results: The incidence of duodenal total FBs and perforating FBs was 1.9% and 0.3%, respectively. Thirty-four patients were enrolled. Endoscopic removal was achieved in 25 patients (73.5%), and nine patients (26.5%) received surgery. For the endoscopic group, most perforating FBs were located in the duodenal bulb (36.0%) and descending part (28.0%). The adverse events included 3 mucosal injuries and 1 localized peritonitis. All patients were cured after conventional treatment. In the surgical group, most FBs were lodged in the descending part (55.6%). One patient developed localized peritonitis and one patient died of multiple organ failure. The significant features of FBs requiring surgery included FB over 10 cm, both sides perforation, multiple perforating FBs and massive pus overflow.

Conclusion: Endoscopic removal of duodenal perforating FBs is safe and effective, and can be the first choice of treatment for experienced endoscopists. Surgical intervention may be required for patients with FBs over 10 cm, both sides perforation, multiple perforating FBs, or severe infections.

Keywords: adult; duodenum; endoscopic removal; foreign body; perforation.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flowchart of patient selection.
FIGURE 2
FIGURE 2
CT and endoscopic findings of duodenal perforation caused by foreign body. (a) CT showing the foreign body (yellow arrow) and localized mesenteric fatty infiltration (white arrow). (b) CT showing localized mesenteric fatty infiltration (red arrow) and extraluminal air (white arrow) adjacent to a thickened bowel wall (yellow arrow). (c) CT showing pelvic effusion. (d) Endoscopic image showing mucosal redness and pus overflow. (e) Endoscopic image showing a mucosal ulcer caused by foreign body. (f) Endoscopic image showing the granuloma caused by a foreign body.
FIGURE 3
FIGURE 3
Case illustration of endoscopic removal of a leg of glasses. (a) Computerized tomography showing the foreign body. (b) Endoscopic image showing the perforating leg of glasses in the duodenal bulb. (c) Endoscopic image showing the other side of the foreign body in the descending part. (d) Extraction of the leg of glasses by grasping forceps. (e) Bleeding and pus of the wound after extraction of the leg of glasses. (f) The extracted leg of glasses.
See this image and copyright information in PMC

References

    1. Lee CY, Kao BZ, Wu CS, Chen MY, Chien HY, Wu LW, et al. Retrospective analysis of endoscopic management of foreign bodies in the upper gastrointestinal tract of adults. J Chin Med Assoc. 2019;82(2):105–109. 10.1097/jcma.0000000000000010 - DOI - PubMed
    1. Birk M, Bauerfeind P, Deprez PH, Häfner M, Hartmann D, Hassan C, et al. Removal of foreign bodies in the upper gastrointestinal tract in adults: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2016;48(05):489–496. 10.1055/s-0042-100456 - DOI - PubMed
    1. AsoP C, Ikenberry SO, Jue TL, Appalaneni V, Banerjee S, Ben‐Menachem T, et al. Management of ingested foreign bodies and food impactions. Gastrointest Endosc. 2011;73(6):1085–1091. 10.1016/j.gie.2010.11.010 - DOI - PubMed
    1. Mosca S, Manes G, Martino R, Amitrano L, Bottino V, Bove A, et al. Endoscopic management of foreign bodies in the upper gastrointestinal tract: report on a series of 414 adult patients. Endoscopy. 2001;33(8):692–696. 10.1055/s-2001-16212 - DOI - PubMed
    1. Wang X, Zhao J, Jiao Y, Jiang D. Upper gastrointestinal foreign bodies in adults: a systematic review. Am J Emerg Med. 2021;50:136–141. 10.1016/j.ajem.2021.07.048 - DOI - PubMed

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