Catch me if you can: Endoskopische Bergung einer Sicherheitsnadel aus dem tiefen Dünndarm

Zusammenfassung

Einleitung: In der klinischen Praxis wird der Endoskopiker immer wieder mit Fremdkörpern im Gastrointestinaltrakt konfrontiert. Der Versuch einer endoskopischen Bergung sollte bei potenziell penetrierenden Fremdkörpern erfolgen. Hierzu existieren verschiedene endoskopische Techniken. Im Gegensatz zu Fremdkörperbergungen aus dem oberen Gastrointestinaltrakt werden Entfernungen aus dem mittleren und tiefen Dünndarm nur sehr selten berichtet.

Fallbericht: Wir stellen den Fall einer Patientin vor, die eine geöffnete Sicherheitsnadel verschluckt hatte, welche mittels Doppelballonenteroskopie (DBE) unter Anwendung eines dünnen Enteroskops mit dickem Übertubus aus dem Jejunum entfernt werden konnte.

Schlussfolgerung: Unser Fallbericht beschreibt eine sichere Möglichkeit, potenziell penetrierende Fremdkörper aus dem tiefen Dünndarm durch Einziehen in den Übertubus eines DBE zu bergen. Es erscheint ratsam, bei radiologischem Nachweis eines potenziell penetrierenden Fremdkörpers im Dünndarm primär ein Ballonenteroskopiesystem zum Bergungsversuch einzusetzen.

Abstract

Introduction: The ingestion of foreign bodies is a frequently observed problem in daily clinical practice. In order to avoid complications such as perforation, endoscopic removal of potentially penetrating foreign bodies should be attempted quickly. The use of various endoscopic techniques has been reported for this purpose. However, extraction of foreign bodies from the mid gastrointestinal tract has rarely been reported.

Case Report: We present the case of a patient who had swallowed a safety needle which could safely be removed from the jejunum by means of double-balloon enteroscopy (DBE). The combination of a thin p-type enteroscope with a thick t-type overtube was used in order to improve the manoeuvrability of the endoscope. The needle was pulled into the overtube which served as a protective shield during the retrieval of the endoscope.

Conclusion: Our case report describes the potential of removing foreign bodies from the deep small bowel by pulling them into the overtube of a double-balloon enteroscope. If the suspicion of foreign body impaction in the small bowel is made, it may be advisable to primarily choose a balloon enteroscopy system. Through this, quick and deep insertion can be combined with a safe removal of the foreign body.

Schlüsselwörter

Fremdkörper - Endoskopie - Doppelballonenteroskopie - Übertubus

Key words

foreign body - endoscopy - push-and-pull enteroscopy - overtube

• Literatur

• 1 Schunk JE, Harrison AM, Corneli HM et al. Fluoroscopic foley catheter removal of esophageal foreign bodies in children: experience with 415 episodes. Pediatrics 1994; 94: 709-714
• 2 Wu WT, Chiu CT, Kuo CJ et al. Endoscopic management of suspected esophageal foreign body in adults. Diseases of the esophagus: official journal of the International Society for Diseases of the Esophagus/ISDE 2011; 24: 131-137
• 3 Feder BH, Myers GG. Swallowed foreign bodies. California medicine 1953; 79: 293-296
• 4 Palta R, Sahota A, Bemarki A et al. Foreign-body ingestion: characteristics and outcomes in a lower socioeconomic population with predominantly intentional ingestion. Gastrointestinal endoscopy 2009; 69: 426-433
• 5 Weiland ST, Schurr MJ. Conservative management of ingested foreign bodies. Journal of gastrointestinal surgery: official journal of the Society for Surgery of the Alimentary Tract 2002; 6: 496-500
• 6 Adams DB. Endoscopic removal of entrapped coins from an intraluminal duodenal diverticulum 20 years after ingestion. Gastrointestinal endoscopy 1986; 32: 415-416
• 7 Eisen GM, Baron TH, Dominitz JA et al. Guideline for the management of ingested foreign bodies. Gastrointestinal endoscopy 2002; 55: 802-806
• 8 Vizcarrondo FJ, Brady PG, Nord HJ. Foreign bodies of the upper gastrointestinal tract. Gastrointestinal endoscopy 1983; 29: 208-210
• 9 Selivanov V, Sheldon GF, Cello JP et al. Management of foreign body ingestion. Annals of surgery 1984; 199: 187-191
• 10 Gmeiner D, von Rahden BH, Meco C et al. Flexible versus rigid endoscopy for treatment of foreign body impaction in the esophagus. Surgical endoscopy 2007; 21: 2026-2029
• 11 Berggreen PJ, Harrison E, Sanowski RA et al. Techniques and complications of esophageal foreign body extraction in children and adults. Gastrointestinal endoscopy 1993; 39: 626-630
• 12 Li ZS, Sun ZX, Zou DW et al. Endoscopic management of foreign bodies in the upper-GI tract: experience with 1088 cases in China. Gastrointestinal endoscopy 2006; 64: 485-492
• 13 Neustater B, Barkin JS. Extraction of an esophageal food impaction with a Roth retrieval net. Gastrointestinal endoscopy 1996; 43: 66-67
• 14 Bertoni G, Pacchione D, Sassatelli R et al. A new protector device for safe endoscopic removal of sharp gastroesophageal foreign bodies in infants. Journal of pediatric gastroenterology and nutrition 1993; 16: 393-396
• 15 Lee BI, Choi H, Choi KY et al. Retrieval of a retained capsule endoscope by double-balloon enteroscopy. Gastrointestinal endoscopy 2005; 62: 463-465
• 16 May A, Nachbar L, Ell C. Extraction of entrapped capsules from the small bowel by means of push-and-pull enteroscopy with the double-balloon technique. Endoscopy 2005; 37: 591-593
• 17 May A, Nachbar L, Wardak A et al. Double-balloon enteroscopy: preliminary experience in patients with obscure gastrointestinal bleeding or chronic abdominal pain. Endoscopy 2003; 35: 985-991
• 18 Plum N, May AD, Manner H et al. Peutz-Jeghers syndrome: endoscopic detection and treatment of small bowel polyps by double-balloon enteroscopy. Zeitschrift fur Gastroenterologie 2007; 45: 1049-1055
• 19 May A, Nachbar L, Pohl J et al. Endoscopic interventions in the small bowel using double balloon enteroscopy: feasibility and limitations. The American journal of gastroenterology 2007; 102: 527-535
• 20 Moschler O, May A, Muller MK et al. Complications in and performance of double-balloon enteroscopy (DBE): results from a large prospective DBE database in Germany. Endoscopy 2011; 43: 484-489
• 21 Neumann H, Fry LC, Rickes S et al. A 'double-balloon enteroscopy worth the money': endoscopic removal of a coin lodged in the small bowel. Digestive diseases 2008; 26: 388-389
• 22 Safatle-Ribeiro AV, Couto Jr DS, Ferreira de Souza T et al. Single-balloon endoscopy for removing a foreign body in the small bowel (with video). Gastrointestinal endoscopy 2009; 70: 781-782
• 23 Monkemuller K, Zabielski M, Poppen D et al. Endoscopic removal of an impacted root canal needle in the jejunum using double-balloon enteroscopy. Gastrointestinal endoscopy 2011; 73: 844-846
• 24 May A, Nachbar L, Schneider M et al. Prospective comparison of push enteroscopy and push-and-pull enteroscopy in patients with suspected small-bowel bleeding. The American journal of gastroenterology 2006; 101: 2016-2024
• 25 Toyonaga T, Shinohara M, Miyatake E et al. Penetration of the duodenum by an ingested needle with migration to the pancreas: report of a case. Surgery today 2001; 31: 68-71
• 26 Masoodi I, Alsayari K, Al Mohaimeed K et al. Fish bone migration: an unusual cause of liver abscess. BMJ Case Rep 2012; Mar 8; 2012, pii: bcr0920114838. DOI: 10.1136/bcr.09.2011.4838
• 27 Santos SA, Alberto SC, Cruz E et al. Hepatic abscess induced by foreign body: case report and literature review. World journal of gastroenterology: WJG 2007; 13: 1466-1470
• 28 May A, Farber M, Aschmoneit I et al. Prospective multicenter trial comparing push-and-pull enteroscopy with the single- and double-balloon techniques in patients with small-bowel disorders. The American journal of gastroenterology 2010; 105: 575-581