Retrieval of a bread bag clip from the duodenum

Abstract

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 [1]. Bread clips are made of plastic and are therefore nondegradable. With an aging population, we postulate that such cases will be increasingly seen [2]. The shape of the clip results in a traplike effect, which prevents easy removal once it is embedded [3]. 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. Endoscopy_UCTN_Code_TTT_1AO_2ALCompeting interests: None This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

Peritonitis with small intestinal perforation caused by a plastic bread bag clip: A case report

“…However, some cases of gastrointestinal tract perforation or bleeding due to the ingestion of bread bag clips have been reported overseas. Between the 1975 and the 2010s, there were 30 cases reported that diagnosed ingestion of bread bag clips in foreign countries [ [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] ].…”

“…Sharp pointed objects like toothpicks, stiff wires, food impaction, superabsorbent objects, and objects over 6 cm should be manually removed when they are accidentally ingested [ 4 , 6 ]. The shape of plastic bread bag clips is unique and can result in a trap-like effect, which prevents easy removal once ingested [ 7 ]. There is a report of successful removal of a bread bag clip from the duodenum with biopsy forceps [ 8 ], but in cases where the clips reach the small intestine, retrieval is quite difficult.…”

“…Including the present case, 11 cases of small intestinal perforation, 1 case of colonic perforation, 1case of esophageal perforation, 2 cases of small bowel obstruction, and 3 cases of gastrointestinal tract bleeding were diagnosed due to accidental ingestion of bread bag clips (sourced from Pubmed from the 1975 to 2010s) [ [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] ]. Among these cases, 3 postoperative deaths occurred after surgery for gastrointestinal tract perforation.…”

A Bread Bag Clip causing Small Bowel Perforation diagnosed on Computed Tomography

“…[2][3][4] Other reported complications include upper gastrointestinal hemorrhage. 5 There are case reports in the literature of endoscopic retrieval of bread bag clips that are embedded in the mucosa of the duodenum. 5,6 A number of endoscopic instruments have been used for this improvised purpose, 5,6 but due to its relative infrequency, the choice of instrument remains up to the individual endoscopist.…”

“…5 There are case reports in the literature of endoscopic retrieval of bread bag clips that are embedded in the mucosa of the duodenum. 5,6 A number of endoscopic instruments have been used for this improvised purpose, 5,6 but due to its relative infrequency, the choice of instrument remains up to the individual endoscopist. There have even been reports of fatalities from the complications of bread bag clip ingestion.…”