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Endoskopie heute 2013; 26(1): 46-49
DOI: 10.1055/s-0032-1330754
DOI: 10.1055/s-0032-1330754
Kasuistik
Fremdkörper im oberen Gastrointestinaltrakt
Foreign Bodies in the Upper Gastrointestinal TractFurther Information
Publication History
Publication Date:
06 March 2013 (online)
Fremdkörper im oberen Gastrointestinaltrakt
Es erfolgte die notfallmäßige Vorstellung eines 7 Monate alten Säuglings mit der Frage der endoskopischen Entfernung einer größeren Anzahl verschluckter Nägel und spitzer Gegenstände. Der endoskopische Eingriff erfolgte im OP in Intubationsnarkose mit einem Standard-Gastroskop (Olympus GIF-Q180, Durchmesser 8,8 mm). Im Korpus fand sich ein Nagelkonglomerat mit angedauten Milchresten ([Abb. 2]).
Im Magen und vor allem im Ösophagus zeigten sich keine Schleimhautverletzungen durch die verschluckten Nägel. Das Bergen mithilfe eines Gummitrichters oder der Aufsatz einer Kappe zum Schutz des Ösophagus erfolgte nicht, da hiermit die Passage aufgrund der anatomischen Enge des oberen Ösophagus-Sphinkters nicht möglich war. Schließlich erfolgte die fraktionierte Bergung jedes einzelnen Nagels mit der Fasszange. Hierbei wurde sorgfältig darauf geachtet, mit der Zange die Spitze des Nagels zu fassen und den Nagel unter Luftinsufflation in Längsrichtung parallel zum Ösophagus ohne Wandberührung zu extrahieren. Auf diese Weise konnten in etwa 60 min 17 Nägel entfernt werden ([Abb. 3]).
Zwei Nägel hatten den Magen zum Untersuchungszeitpunkt bereits verlassen, konnten am nächsten Tag aber im Stuhl des Säuglings detektiert werden. Bei klinisch völligem Wohlbefinden erfolgte die Entlassung des Kindes am Folgetag.
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