Retrieval of a bread bag clip from the duodenum
05 September 2013 (online)
A 73-year-old woman presented with iron deficiency anemia and melena. Biochemical parameters revealed a hemoglobin of 77 g/L and urea 8.5 mmol/L with normal renal indices. She was transfused with 2 units of red blood cells. Gastroscopy revealed a bread clip embedded in D1 (showing the date Friday, 13 April; [Fig. 1]), pinching the distal and proximal duodenal roof fold and dangling like an earring. Attempts to remove the clip by crushing with grasping forceps, cutting with a needle-knife device, and snapping with snare were unsuccessful. A gastric band cutter (Endotherapeutics, Sydney, Australia) was employed endoscopically. The cutting wire was threaded between the bread clip and the duodenum ([Fig. 2]), and the free end was retrieved and locked into the racheting device, forming a loop. Tightening of the loop resulted in the wire snapping the clip, which was then retrieved orally ([Fig. 3]).
Only 21 cases of bread clip ingestion have been reported since 1975. Most cases present as small-bowel perforation requiring bowel resection . Bread clips are made of plastic and are therefore nondegradable. With an aging population, we postulate that such cases will be increasingly seen . The shape of the clip results in a traplike effect, which prevents easy removal once it is embedded . Endoscopic removal of embedded foreign bodies can require taking a unique approach. This is the first reported case of the use of a gastric band cutter to divide an embedded foreign body followed by successful retrieval.
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