Keywords
endoscopy - foreign body ingestion - Gastric foreign body
Introduction
Gastrointestinal (GI) foreign bodies may result from intentional or unintentional
ingestion. It is a relatively common emergency faced by endoscopists. Almost 80% of
subgroup belongs to pediatric population and it is almost always unintentional. The
most common groups among adults that intentionally ingested foreign bodies are psychiatric
patients and prisoners. Often complex foreign bodies found in these groups of patients,
especially in the latter group. Most (90%) ingested foreign bodies pass without the
need for intervention.[1]
[2] Endoscopic intervention is required in 10 to 20%of patients, and surgical intervention
is required in less than 1%.[3]
[4] Most of guidelines talk about common foreign bodies.[3]
[5] Complex foreign bodies ingestions are mostly described in case reports. Approach
to these cases is not standardized. Endoscopic removal is uncommonly attempted and
rarely successful. Few case reports are there about removal of rare or complex foreign
bodies. Here we discuss one of a rare case of mobile phone retrieved endoscopically,
very safely and averting need of surgery. Till date, there are only three case reports
on mobile phone ingestion as foreign body, out of which only one showed that it could
be removed endoscopically.[6]
[7]
[8]
Case
A 35-year-old male prisoner was referred to our outpatient department with alleged
history of ingestion of a mobile phone. An abdominal X-ray was done at the prison
hospital which was showing a mobile phone in the stomach ([Fig. 1]). Patient was hemodynamically stable and had no comorbidities.
Fig. 1 X-ray abdomen showing the mobile phone (red arrow).
After obtaining consent, we did upper GI endoscopy. We found a mobile phone wrapped
with polythene in stomach along ([Fig. 2]) with five polythene wrapped pouches. With the help of snare, mobile phone was held
tightly from the mouthpiece end so that the long axis comes parallel to the esophagus.
While withdrawing at gastrointestinal endoscopy (GE) junction position was manipulated
to align long axis of mobile phone with esophagus. This way phone was gently taken
out without any resistance. We also removed all plastic pouches from stomach, one
by one. After removal of all foreign bodies, we confirmed that there was no injury
in upper GI tract. Postprocedure, patient was kept nil by mouth for 4 hours. After
4 hours, oral liquids were allowed. Patient was discharged from day care and referred
back to the prison hospital. All the foreign bodies were handed over to the police
personal accompanying the patient. He was followed-up 1 week later in outpatient department
(OPD) and was completely asymptomatic.
Fig. 2 Endoscopic images showing the mobile phone and drug packet in stomach.
Discussion
Although 80 to 90% foreign bodies spontaneously pass through GI tract without complications,
10 to 15% require endoscopic removal and less than 1% needs surgical intervention.
Blunt objects more than 2.5 cm or long objects more than 5 cm are unlikely to pass
beyond pylorus.[9] Our case was a similar case scenario where a mobile phone (6.5 cm × 2.5 cm; [Fig. 3]) was found in stomach after 24 hours as expected. There is a scarcity of data on
endoscopic removal of large blunt objects endoscopically. There are only three case
reports published till date describing mobile phone as foreign body, two of which
described the use of surgery as a definitive therapy.[6]
[7] The other case report is the only one till now showing endoscopic removal of mobile
phone.[8] We used snare to remove mobile phone, using a technique where phone was removed
along the long axis parallel to esophagus, so that there was no injury.
Fig. 3 Drugs packets and mobile phone after removal.
Our case is the second case report of successful endoscopic removal of mobile phone.
Conclusion
Though a single case report cannot make recommendations, but a message can be given
to clinicians that endoscopic removal is a safe and can prevent surgery and worth
an attempt before surgery.
