Accidental ingestion of unusual metallic foreign body

R. Lana, J. L. Mendoza¹ and A. I. Lérida

Departments of Emergency and ¹Digestive Diseases. Hospital Clínico San Carlos. Madrid, Spain

A 41 year-old woman, without pathological antecedents of interest that goes to the emergency department coming from the dentist's consultation. During the endodontic treatment she has ingested accidentally one of the metallic instruments (dental screwdriver) with which the intervention was being made. She refers sharp body sensation at epigastrium. Abdominal radiograph is made in which is appraised in the gastric camera a metallic object of great size with a sharp edge (Fig. 1). Before the perforation risk, emergent endoscopic removal is made without complications in spite of the size of this object (Fig. 2). The ingestion of foreign bodies supposes a frequent consultation in the emergency department and it is the second cause of accomplishment of emergency upper flexible (1). The most frequent location is in the esophagus and although until 90% of the foreign bodies they are eliminated spontaneously recommends its precocious endoscopic removal once identified to avoid complications (perforation, hemorrhage, aspiration, pneumomediastinum, mediastinitis). When the foreign bodies are in the stomach is possible to be had an expectant attitude except the characteristics of the object are susceptible to cause complications, as it is our case when being a metallic instrument with a sharp edge that can produce a perforation in its progression by digestive tract (2). The flexible fibroendoscopy has demonstrated to be a safe and effective technique for the removal of foreign bodies, reason why it is exceptional to resort to the use of rigid endoscopy or surgery (3,4).

REFERENCES

1. Llompart A, Reyes J, Ginard D, Barranco L, Riera J, Gayá J, et al. Abordaje endoscópico de los cuerpos extraños esofágicos. Resultados de una serie retrospectiva de 501 casos. Gastroenterol Hepatol 2002; 25 (7): 448-51.

2. Velitchkov NG, Grigorov GI, Losanoff JE, Kjossev KT. Ingested foreign bodies of the gastrointestinal tract: retrospective analysis of 542 cases. World J Surg 1996; 20: 1001-5.

3. Schleiman el-Halabi H, Linares A, Alonso JL, Rodríguez M, Pérez-Lombrana JL, Rodrigo L. Cuerpos extraños esofágicos: manejo endoscópico. Rev Esp Enferm Dig 1996; 88 (1): 56-7.

4. Jover R, Casellas JA, Gutiérrez A, Martínez JF, Alonso G. Tratamiento endoscópico de los cuerpos extraños esofágicos. Rev Esp Enferm Dig 1996; 88 (12): 885-6.