Endoscopic removal of a challenging gastric foreign body causing unexplained abdominal pain

A 33-year-old woman presented with a 3-month history of upper abdominal pain, which was exacerbated by bending or twisting. Blood tests revealed no abnormalities, and pharmacological interventions failed to alleviate symptoms. Gastroscopy at a local hospital had shown a 0.6-cm firm protrusion on the greater curvature of the gastric antrum, without discoloration or texture changes, that was suspicious for a submucosal tumor (SMT) ([Fig. 1] a). However, gastroscopy at our center revealed that the lesion had shrunk in size compared to the initial assessment, casting doubt on the SMT diagnosis ([Fig. 1] b). Subsequent endoscopic ultrasound (EUS) showed a cordlike hyperechoic shadow penetrating the gastric muscular layer, suggesting the presence of a foreign body ([Fig. 1] c). Despite the patient denying ingestion of any foreign object, a computed tomography scan corroborated the EUS findings ([Fig. 1] d). Given the patient’s persistent pain and the shrinkage of the lesion, endoscopic submucosal dissection (ESD) was carried out with her consent ([Video 1]). After the lesion had been marked and a circular incision had been made, intraoperative EUS helped to locate the deeply embedded foreign body ([Fig. 2] a–c). The foreign body was carefully extracted and found to be a sharp, 2-cm metallic object (iron wire), which had caused the gastric mucosal lesion to resemble an SMT ([Fig. 2] d,e). The wound was closed with endoscopic clips, and no bleeding was observed ([Fig. 2] f). The patient was discharged 5 days after the operation, with no recurrence of pain reported at the 2-month follow-up.

Fig. 1 a Gastroscopy at a local hospital had shown a 0.6-cm protrusion on the greater curvature of the gastric antrum, that was suspected to be a submucosal tumor. b Gastroscopy at our center revealed a reduction in lesion size. c Endoscopic ultrasound showed a cordlike hyperechoic shadow penetrating the gastric muscular layer (arrow), suggestive of a foreign body. d Computed tomography scan confirmed the presence of a foreign body.

Fig. 2 a Gastroscopy showed a reduction in lesion size compared to the initial assessment. b A cordlike hyperechoic shadow (arrow) in the muscular layer of the gastric antrum was accurately identified and marked under endoscopic ultrasound guidance. c The foreign body was deeply embedded in the muscular layer. d The foreign body was carefully clamped with foreign body forceps. e Successfully extracted foreign body that proved to be a 2-cm length of iron wire. f The wound after closure with endoscopic clips.

Successful removal of a foreign body from the gastric antrum using endoscopic submucosal dissection under endoscopic ultrasound guidance.Video 1

Ingestion of a foreign body is common and most cases are asymptomatic; only a few foreign bodies cause symptoms and complications [1] [2] [3]. In this rare case, EUS was crucial in detecting the foreign body and guiding its successful removal via ESD, highlighting the diagnostic challenges of atypical foreign bodies and the value of applying multiple endoscopic techniques for precise, minimally invasive treatment.

Endoscopy_UCTN_Code_TTT_1AO_2AL

Conflict of Interest

The authors declare that they have no conflict of interest.

• References

• 1 Mao Y, Hu B, Gong X. et al. Endoscopic extraction of a gastric submucosal foreign body after precise location with endoscopic ultrasound combined with endoscopic submucosal dissection. Endoscopy 2022; 54: E415-416
• 2 Wander P, Trindade AJ, Grimaldi G. et al. Endoscopic submucosal dissection technique for removing a perforating foreign body. Am J Gastroenterol 2020; 115: 1390-1390
• 3 Carvalho AC, Pires F, Araújo R. Removal of an embedded foreign body in the stomach by a technique of endoscopic submucosal dissection. Dig Endosc 2022; 34: e1-e2

Publication History

Article published online:
04 December 2024