Ingested foreign bodies

　　How are foreign objects swallowed caused? Briefly described as follows:

　　1, Etiology

　　There are many types of foreign objects swallowed, too numerous to list, the most common being safety pins, needles, hairpins, coins, buttons, round nails, screws, small toys, dentures, etc. Generally speaking, any foreign object that can pass through the esophagus and the cardia can also pass through the entire gastrointestinal tract. However, according to statistics, about 5% of foreign objects may become embedded at some part of the gastrointestinal tract, especially at the pylorus, duodenum, and terminal ileum. There was a case where a patient accidentally swallowed a metal spoon into the stomach, and because the patient did not seek medical attention in time, abdominal peritonitis occurred before coming to the hospital. The photograph showed that the foreign object was located in the right upper abdominal pyloric area, and when the surgery was explored, it was found that the metal spoon had cut a nearly 3cm incision in the anterior wall of the pylorus, causing peritonitis. Any foreign object that is long, pointed, or sharp, and where there is inflammation or stenosis in a part of the intestinal tract, is prone to be embedded in that location.

　　2, Pathogenesis

　　Currently, there is no relevant content description.

　　Swallowing foreign objects can cause serious diseases such as retained foreign bodies, gastrointestinal obstruction, gastrointestinal perforation, abscess formation, internal or external fistula, gastrointestinal bleeding, and so on, which seriously harm the health of patients and must be treated in a timely manner.

　　Esophageal foreign bodies can cause dysphagia or difficulty in swallowing, vomiting, while gastric foreign bodies usually have no obvious symptoms, or there may be upper abdominal discomfort, loss of appetite; or it may cause pyloric obstruction, causing spastic pain, vomiting; after perforation, there are signs of peritonitis, with persistent abdominal pain, distension, tenderness, muscle tension, and rebound pain; if a foreign object is embedded for a long time in a certain part, it can cause ulcer bleeding, and pointed foreign objects can directly pierce the mucosa, causing obvious bleeding, or the patient may have hematochezia or vomiting blood. Literature reports that a duodenal foreign body can penetrate into the renal pelvis, forming a duodenal renal pelvis fistula, with the patient experiencing high fever and chills. Abdominal signs: small foreign bodies have no local signs, while large foreign bodies (such as spoons, toothbrushes) can be felt in the abdomen during palpation, with local tenderness. Perforation of the gastrointestinal tract can cause peritoneal irritation signs.

　　How to prevent swallowing foreign objects? Briefly described as follows:

　　Strengthen supervision of children to prevent them from swallowing foreign objects. Instruct children not to accidentally ingest hard foods, indigestible foods, or irregular foods.

　　If there are gastrointestinal or oral diseases, it is also very easy to cause serious harm by swallowing foreign objects, so chewing slowly is also very important.

　　What examinations should be done for swallowing foreign bodies? Briefly described as follows:

　　1. Abdominal X-ray.Pure metal foreign bodies can be diagnosed definitively through X-ray examination.

　　2. Barium meal examination.Non-metallic foreign bodies can be very helpful through barium swallow imaging; if there is bleeding or perforation, it is prohibited to perform barium meal examination.

　　What should be paid attention to in the diet and health care of patients who have swallowed foreign bodies? Briefly described as follows:

　　1. Have the patient take some vinegar, swallow it slowly, soften the fish bone, and then eat foods such as steamed buns or cakes, which can help to swallow the fish bone with the food.

　　2. Take an appropriate amount of Chinese prune, wash and remove the kernel, dip it in sugar and take it by mouth slowly, which has the effect of softening fish bones and other foreign bodies.

　　3. Take 10 grams of clematis root and 20 grams of Chinese prune, boil the mixture into a concentrated decoction, take it by mouth slowly within half an hour, twice a day, usually taking 1 to 4 doses, and fish bones and other foreign bodies can be softened and excreted naturally, leading to recovery.

　　The treatment of gastrointestinal foreign bodies has made great progress in recent years due to the application of fiberoptic endoscopes, and foreign bodies in the esophagus and stomach can all be removed through endoscopy. Only a few patients with complications may need to be removed surgically.

　　First, endoscopic removal of foreign bodies

　　1. Timing of removal

　　About 80% to 90% of foreign bodies that are accidentally swallowed can be naturally excreted, but the natural excretion rate for children is only 60% to 80%. Therefore, for pointed foreign bodies (such as chicken bones, toothpicks) or toxic foreign bodies (such as lead-containing items), active treatment is necessary to prevent mucosal injury or poisoning. Other foreign bodies in the stomach (except for pointed, toxic, large, or long ones) can be observed for a period of time to wait for natural excretion. According to literature reports, the average time for natural excretion of foreign bodies is 5.1 days.

　　Spitz believes that if foreign bodies in the esophagus are not excreted within 12 hours, or if foreign bodies in the stomach and duodenum are not excreted within 10 to 12 days, active endoscopic removal is necessary. For foreign bodies that are estimated to be difficult to excrete, it is preferable to remove them with an endoscope as soon as possible.

　　2. Selection of endoscopes

　　Foreign bodies in the esophagus should be removed using an esophagoscope or a frontal oblique gastroscopy. Foreign bodies in the descending segment of the duodenum are best removed using a duodenoscope. For foreign bodies in the stomach, any type of gastroscopy can be used, and it is preferable to remove them in a frontal oblique manner.

　　Double-bore surgical gastroscopes have two biopsy channels with diameters of 3.7mm and 2.8mm, allowing the simultaneous insertion of two surgical instruments, making the operation more convenient. For children with foreign bodies in the stomach, a thin-bore gastroscopy such as the GIF-P2 type should be used.

　　3. Selection of retrieval instruments

　　(1) Long, rod-like objects: such as pens, bamboo chopsticks, thermometers, silicone rubber tubes, toothbrushes, keys, etc. This type of foreign body is most suitable for removal with a snare device. For rod-like objects with a thin outer diameter and smooth surface, it is more suitable to use tools such as three-jaw pliers, rat's mouth pliers, alligator mouth pliers, V-shaped pliers, and flat pliers.

　　(2) Spherical objects: If it is difficult to remove foreign bodies such as fruit seeds with forceps, it is more suitable to use basket-shaped stone removal instruments or mesh-type retrieval tools.

　　(3) Flat-shaped foreign bodies: such as coins, small knives, etc., most of which can be removed using a foreign body retrieval forceps or biopsy forceps. Smaller iron foreign bodies can be removed by inserting a specialized magnet rod through the endoscope, which is then attracted and removed along with the endoscope.

　　(4) Remaining sutures in the stomach: They can be clamped off with a biopsy forceps and then removed, or cut with a special surgical scissors, and then the suture ends can be removed with a grasping forceps. It is also possible to remove them directly with a suture remover.

　　After determining the instruments for removing foreign bodies, a simulation test should be performed before surgery to verify whether they can effectively grasp foreign bodies, and the lubricating effect of gastric juice during operation should also be considered.

　　4. Precautions for Operations

　　(1) Use X-ray examination before surgery to determine the nature, size, and location of the foreign body.

　　(2) When lying flat, foreign bodies in the stomach are often located in the mucous layer of the gastric fundus and upper body, which affects the operation. During surgery, try to remove as much gastric juice as possible to facilitate the removal of foreign bodies.

　　(3) Grab the proximal end of a long rod-like foreign body. When clamping glass-like objects, avoid applying excessive force.

　　(4) For sharp and pointed foreign bodies, when clamping, the tip should be facing down to avoid mucosal injury when the mirror is retracted.

　　(5) The oropharynx and hypopharynx have an angle. When removing a long rod-like foreign body, the assistant helps to fix it in a backward position to make the oropharynx and hypopharynx a straight line, which is convenient for removing the foreign body.

　　II. Surgical Removal of Foreign Bodies

　　For larger, longer, sharper, and more numerous foreign bodies, surgery may sometimes be required.

　　1. Indications for Surgery

　　(1) For those who fail to remove foreign bodies through conservative or endoscopic methods, have severe自觉symptoms, and have difficulty in excretion.

　　(2) For those with signs of peritonitis.

　　(3) For those with X-ray findings of foreign bodies embedded in a certain location, with no movement for a week and a risk of piercing an important organ.

　　(4) For those with gastrointestinal bleeding or obstruction.

　　(5) For those with internal fistula or abscess caused by foreign bodies.

　　2. Precautions

　　(1) Perform abdominal fluoroscopy or X-ray examination before surgery to determine the position of the foreign body clearly.

　　(2) Insert a gastric tube before surgery to remove all the contents of the stomach.

　　(3) The incision is determined by the position of the foreign body. Whether the foreign body is in the stomach or intestines, it is best to directly cut the gastrointestinal wall to remove the foreign body.

　　(4) If a foreign body enters the duodenum and is accompanied by an obstruction, it is best to push the foreign body into the stomach and then remove it through a small incision in the gastric wall.

　　(5) For a large number of foreign bodies, attention should be paid to removing all foreign bodies, and it is best to perform X-ray examination during surgery if possible.

　　(6) For patients with complications such as hemorrhage, perforation, and peritonitis, in addition to removing foreign bodies, appropriate treatment for the complications should be given.