Laparoscopic Management of Complicated Foreign Body Ingestion: A Case Series

Abstract

This study aims to demonstrate the safety and feasibility of laparoscopic management of complicated foreign body (FB) ingestion in a series of 5 patients. We present the merits of a minimally-invasive approach in this clinical setting from our series as well as published case reports. FB ingestion is occasionally complicated by abscess formation or perforation, requiring surgical intervention. Anecdotal reports of such cases managed by laparoscopic surgery have alluded to its merits over the conventional approach of open surgery. Over an 18-month period, 5 of 256 patients with FB ingestion at our unit were managed by laparoscopic surgery. Clinical and operative data were collected for this study. In all 5 cases, patients could not recall their FB ingestion and had normal plain radiographs. The diagnosis was made on a computed tomography (CT) scan. Laparoscopy was successfully employed to retrieve all FBs (fish bones), deroof abscesses, and primarily repair gastrointestinal perforations. The mean operative time was 69 minutes (55-85), utilizing 2 to 4 noncamera ports. There was no operative mortality and patients were discharged on average postoperative day (POD) 5 (2-8). Laparoscopic surgery is safe and feasible in small-diameter, complicated FB ingestion requiring surgical intervention and should be considered in similar patients. ed FB ingestion were successfully managed with minimally-invasive surgery (MIS). [4][5][6][7][8][9][10] The potential benefits of a laparoscopic approach in abdominal surgery are well known and include reduced postoperative ileus and pain, smaller incisions and superior cosmetic results, shorter duration of hospitalization, and earlier return to work and a decreased incidence of postoperative hernias. 4,11 This paper presents the largest case series to date of 5 consecutive patients, who were managed via laparoscopic approach for complicated FB ingestion. We aim to review and report the salient clinical features of this series of patients to demonstrate that laparoscopic management is safe, feasible, and should be considered when managing FB ingestions in a similar clinical setting. Materials and MethodsOver an 18-month period, 256 patients presented with FB ingestion to our center. Of these, 5 patients were managed surgically via laparoscopic approach. Records of relevant clinical and demographic data, presenting symptoms, investigations, operative procedures, and length of hospitalization were reviewed after obtaining Institutional Review Board (IRB) approval. Operative findings and data were collected. These included FB size, location, number of ports used, and total operative time.

Injuries due to foreign body ingestion and insertion in children: 10 years of experience at a single institution

“…Surgical approaches to remove FB ingestions that cannot be easily removed are standard treatments. However, in experienced hands, laparoscopic surgery is a safe and minimally invasive surgical technique . Continuous flow vaginoscopy is a simple safe technique to detect and remove any vaginal FB .…”

A very persistent chicken bone: two separate perforations from the same foreign object 2 months apart

“…Diagnosis may be challenging as patients tend not to remember ingestion7 and hence, the diagnosis is typically made via CT. In the case of inconclusive imaging, diagnostic laparoscopy may be helpful 4 8…”

“…This is often diagnosed via CT scan as patients rarely recollect accidental ingestion. Management is typically via laparotomy although case series have demonstrated the merits of a laparoscopic approach 1 3 4…”

The Foreign Body Ingestion which is an important cause of mortality and morbidity

“…[42] Laparoscopy can be used to safely and successfully remove foreign objects, as well as to treat complications, such as the repair of perforations caused by FBI, and to drain abscesses. [43] There are currently no guidelines for the management FBI. But recommendations on approach are provided in high volume series.…”