Section: Small bowel Curriculum: Curriculum, page 58
Incidence
- 1% of all SBO
Causes
- Glass
- metal fragments
- pins
- needles
- toothpicks
- fish bones
- coins
- whistles
- toys
- broken razor blades
- gallstone
Symptoms/Signs
- Abdominal pain, tenderness, fever, leucocytosis
Potential complications
- Perforation
- Obstruction
- Ischaemia
- Inflammation
- Scarring
- Toxic – batteries – mercury/lead
Radiology
- If radio-opaque can follow with serial abdominal films
Management
- Observational where possible – 95% of FN pass through GIT after leaving stomach
- Small blunt objects less than 2.5 cm will pass
- Indication for endoscopic removal
-
2.5cm
- Sharp
- Battery
- Multiple magnets
- Failure to progress
-
- Endoscopy; usually the esophagus is protected with an over-tube (a plastic tube of varying length), through which the gastroscope and retrieved objects are passed.
- Once the foreign body has been identified with the gastroscope, various devices can be used
- forceps
- snares
- oval loops
- Roth baskets (mesh nets) and
- magnets
- Foley catheter
Indications for surgical intervention
- If a foreign body cannot be retrieved endoscopically, daily radiographs should be performed to assess the object’s passage through the gastrointestinal tract.
- Sսrgеrу
- Complications (eg, obstruction, perforation)
- Nonprogression of a foreign body
- blunt object that remains in the same location distal to the duodenum for more than one week
- sharp foreign body that does not advance rаԁiοgrаphiсаllу for three consecutive days
- Operation – Enterotomy + Closure