Iatrogenic Foreign Bodies

The second most common category of foreign bodies comprises those of iatrogenic origin, such as probes, balloons or metal/ plastic prostheses.

Biliary prostheses. Plastic biliary prostheses usually pass the bowel spontaneously. However, they can also result in GI tract obstruction. If the prosthesis can be reached, it can be extracted with a forceps or polypectomy snare.

Metal stents. Dislodged metal stents such as duodenal enteral stents or colonic stents are problematic because of their size as well as their sharp edges and ends. They can easily cause obstruction as well as injury of the bowel wall with resulting bleeding or perforation. Retrieval is relatively difficult, especially if the stent is located above a stenosis. Endoscopic removal should be attempted (7), though surgical intervention may prove necessary.

For removing a dislodged metallic mesh stent, a similar technique is attempted as that used, for example, with esophageal stent migration in the stomach. The aim is to slide a snare over the stent, positioning it as close to the middle as possible, and closing it there. This causes the stent to collapse in a V-shape in the middle and the stent ends to fold in, away from the direction of pull, preventing the sharp or pointed edges from

Plastic Biliary Prosthesis
Fig. 23.1 Instruments for removal of foreign bodies in flexible endoscopy. Foreign body retrieval snare, alligator forceps, four-pronged grasping forceps, and basket.
Endoscopic Retrieval

Fig. 23.2 Instrumentation for retrieval of smaller foreign bodies in flexible endoscopy. Dormia baskets made of monofilament and wire; also a balloon for extraction.

Fig. 23.2 Instrumentation for retrieval of smaller foreign bodies in flexible endoscopy. Dormia baskets made of monofilament and wire; also a balloon for extraction.

Intravascular Retrieval Foreign Body
Fig. 23.3 CT image of a solid metal foreign body and artifacts in the appendix region. This turned out to be a swallowed gold tooth.

Fig. 23.4 Iatrogenic foreign body;

surgically placed local drainage visible through an anastomotic leak after low anterior rectal resection.

Drainage. Figure 23.4 shows a surgically placed local drainage that was protruding into the colon lumen from a wound dehiscence, preventing closure of the dehiscence. The local drainage was removed and the dehiscence wound closed with repeated sessions of irrigation and fibrin application.

Clips. Adherent hemoclips in the colon—as used for achieving hemostasis or fistula closure—are considered harmless foreign bodies (Fig. 23.5). There is thus no urgent need to remove them. Our own experience with one patient who "suddenly" recovered after retrieval of a hemoclip used for hemostasis in the sigmoid colon following polypectomy, should certainly be considered merely anecdotal evidence.

Foreign Body Sigmoid Colon

Fig. 23.4 Iatrogenic foreign body;

surgically placed local drainage visible through an anastomotic leak after low anterior rectal resection.

Was this article helpful?

0 0
Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

Get My Free Ebook


Post a comment