Surg Endosc (1992) 6:78-79
Surgical .Endoscopy 9 Springer-VerlagNew YorkInc. 1992
Laser-assisted removal of a foreign body from the colon Matthias Kaltheuner 1, Hans Stallkamp 1, Helmut Malchow 1, Andreas Kiose 2, and Karl-Heinz Vestweber 2 ] Medizinische Klinik II and 2Allgemeinchirurgische Klinik, St~.dtisches Krankenhaus Leverkusen, Am Dh~nnberg 60, W-5090 Leverkusen 1, Federal Republic of Germany
Summary. An 81-year-old woman underwent a colonoscopy because of a sigmoiditis poorly responding to conservative therapy. A rod-shaped foreign body found in the sigma proved impossible to remove conventionally. Irradiation with a low laser energy caused the foreign body to break apart, after which its extraction was straightforward. The further clinical course was uncomplicated. In this case a partial sigmoidectomy would have been indicated had the laser-supported extraction not been successful. The authors suggest that a similar procedure could be helpful in the management of foreign bodies in the esophagus. Key words: Foreign b o d y - L o w e r gastrointestinal tract - Laser therapy
The multitude of publications over the last few years show that the removal of foreign bodies from the gastrointestinal tract is still a subject of interest. This case report illustrates a new procedure in gastrointestinal endoscopy.
Case report A 81-year-old female was treated for a sigmoidodiverticulitis in November 1989. The inflammation then showed a good response to parenteral nutrition without antibiotic therapy. In April 1990 the pain in the lower left abdominal quadrant returned. With the aid of colonoscopy an impassable stenosis of the sigma and a diverticulosis were diagnosed. An enema of the colon revealed signs for diverticulitis, but no foreign body was seen. Parenteral nutrition and antibiotic therapy improved the condition only marginally. Therefore, a second colonoscopy was performed. This time a rod-shaped foreign body was found in the sigma surrounded by an inflamed and swollen colonic mucosa (Fig. 1). Extraction by
Offprint requests to: M. Kaltheuner
foreign-body endoscopy forceps was considered not possible because the foreign body was fixed in the intestinal wall. After irradiation with laser energy of 161 J from an Nd-Yag laser the foreign body broke. Both parts of the foreign body were then easily extracted with a foreign-body endoscopy forceps (Figs. 2-4). Following removal the further clinical course was uncomplicated. The foreign body was discovered to be a 5-cm-long chicken bone [5] (Fig. 5). A knowledge Of the foreign body's shape allowed it to be retrospectively identified on the radiographs of the colon enema.
Discussion Swallowed foreign bodies pass the gastrointestinal tract in 80-90% percent of cases without complications [2, 5, 6]. Those that do not pass (10-20%) are usually found in the upper gastrointestinal tract [1, 3, 5, 6, 7]. Most authors state that foreign bodies thicker than 2 cm and longer than 5 cm tend to remain in the stomach [3, 6]. Summarizing the results of studies by Wechselberg [7], Bloom [1], Suita [5], and Mayer [4], only 143 out of 599 foreign bodies were found in the lower gastrointestinal tract. Of these, 11 (7.7%) required surgical treatment. Perforation of the gut and infection of the surrounding organs were the most common reasons for surgery. Adults predominantly swallowed nutritional components, mainly bones. In the case reported here a rare complication at an untypical site of a commonly ingested foreign body had occurred. As a conventional extraction appeared impossible, low-energy laser irradiation of the foreign body was performed. In Index Medicus 1986-1990 no case of a laserassisted foreign body removal could be found. Although the described procedure will be rarely indicated in the colon, a similar division of a foreign body might be indicated in the esophagus. Foreign bodies lodge relatively often in the esophagus wall, and there is thus a need for surgical removal. A mediastinitis might be the limiting factor for this endoscopic procedure.
79 Fig. 1. The rod-shaped foreign body in the sigma Fig. 2. An end of the foreign body after laser irradiation Fig. 3. The other end of the foreign body after laser irradiation Fig. 4. The same region after the extraction of both ends of the foreign body. The colonoscopy was performed with an Olympus CF-HL 20 colonoscope Fig. 5. The chicken bone
References 1. Bloom RR, Nakano PH, Gray SW, Skandalakis JE (1986) Foreign bodies of the gastrointestinal tract. Am Surg 52: 618-621. 2. Classen M, Manegold BC, Ottenjann R, R6sch W (1976) Endoskopische Fremdk6rperentfernung aus dem oberen Verdauungstrakt. Dtsch ~.rztebl 73:1967-1973 3. Henderson CT, Engel J, Schlesinger P (1987) Foreign body ingestion: review and suggested guidelines for management. Endoscopy 19:68-71
4. Mayer J (1977) Problematik verschluckter und aspirierter Fremdk6rper. Dissertation, Technische Universit~t M0nchen 5. Suita S, Ohgami H, Nagasaki A, Yakabe S (1989) Management of pediatric patients who have swallowed foreign objects. Am Surg 55:585-590 6. Webb WA (1988) Management of foreign bodies of the upper gastrointestinal tract. Gastroenterology 94:204-216 7. Wechselberg K (1968) Zur Fremdk6rperingestion im Kindesalter. Monatsschr Kinderheilkd 116:465-471
Surgical .Endoscopy 9 Springer-VerlagNew YorkInc. 1992
Laser-assisted removal of a foreign body from the colon Matthias Kaltheuner 1, Hans Stallkamp 1, Helmut Malchow 1, Andreas Kiose 2, and Karl-Heinz Vestweber 2 ] Medizinische Klinik II and 2Allgemeinchirurgische Klinik, St~.dtisches Krankenhaus Leverkusen, Am Dh~nnberg 60, W-5090 Leverkusen 1, Federal Republic of Germany
Summary. An 81-year-old woman underwent a colonoscopy because of a sigmoiditis poorly responding to conservative therapy. A rod-shaped foreign body found in the sigma proved impossible to remove conventionally. Irradiation with a low laser energy caused the foreign body to break apart, after which its extraction was straightforward. The further clinical course was uncomplicated. In this case a partial sigmoidectomy would have been indicated had the laser-supported extraction not been successful. The authors suggest that a similar procedure could be helpful in the management of foreign bodies in the esophagus. Key words: Foreign b o d y - L o w e r gastrointestinal tract - Laser therapy
The multitude of publications over the last few years show that the removal of foreign bodies from the gastrointestinal tract is still a subject of interest. This case report illustrates a new procedure in gastrointestinal endoscopy.
Case report A 81-year-old female was treated for a sigmoidodiverticulitis in November 1989. The inflammation then showed a good response to parenteral nutrition without antibiotic therapy. In April 1990 the pain in the lower left abdominal quadrant returned. With the aid of colonoscopy an impassable stenosis of the sigma and a diverticulosis were diagnosed. An enema of the colon revealed signs for diverticulitis, but no foreign body was seen. Parenteral nutrition and antibiotic therapy improved the condition only marginally. Therefore, a second colonoscopy was performed. This time a rod-shaped foreign body was found in the sigma surrounded by an inflamed and swollen colonic mucosa (Fig. 1). Extraction by
Offprint requests to: M. Kaltheuner
foreign-body endoscopy forceps was considered not possible because the foreign body was fixed in the intestinal wall. After irradiation with laser energy of 161 J from an Nd-Yag laser the foreign body broke. Both parts of the foreign body were then easily extracted with a foreign-body endoscopy forceps (Figs. 2-4). Following removal the further clinical course was uncomplicated. The foreign body was discovered to be a 5-cm-long chicken bone [5] (Fig. 5). A knowledge Of the foreign body's shape allowed it to be retrospectively identified on the radiographs of the colon enema.
Discussion Swallowed foreign bodies pass the gastrointestinal tract in 80-90% percent of cases without complications [2, 5, 6]. Those that do not pass (10-20%) are usually found in the upper gastrointestinal tract [1, 3, 5, 6, 7]. Most authors state that foreign bodies thicker than 2 cm and longer than 5 cm tend to remain in the stomach [3, 6]. Summarizing the results of studies by Wechselberg [7], Bloom [1], Suita [5], and Mayer [4], only 143 out of 599 foreign bodies were found in the lower gastrointestinal tract. Of these, 11 (7.7%) required surgical treatment. Perforation of the gut and infection of the surrounding organs were the most common reasons for surgery. Adults predominantly swallowed nutritional components, mainly bones. In the case reported here a rare complication at an untypical site of a commonly ingested foreign body had occurred. As a conventional extraction appeared impossible, low-energy laser irradiation of the foreign body was performed. In Index Medicus 1986-1990 no case of a laserassisted foreign body removal could be found. Although the described procedure will be rarely indicated in the colon, a similar division of a foreign body might be indicated in the esophagus. Foreign bodies lodge relatively often in the esophagus wall, and there is thus a need for surgical removal. A mediastinitis might be the limiting factor for this endoscopic procedure.
79 Fig. 1. The rod-shaped foreign body in the sigma Fig. 2. An end of the foreign body after laser irradiation Fig. 3. The other end of the foreign body after laser irradiation Fig. 4. The same region after the extraction of both ends of the foreign body. The colonoscopy was performed with an Olympus CF-HL 20 colonoscope Fig. 5. The chicken bone
References 1. Bloom RR, Nakano PH, Gray SW, Skandalakis JE (1986) Foreign bodies of the gastrointestinal tract. Am Surg 52: 618-621. 2. Classen M, Manegold BC, Ottenjann R, R6sch W (1976) Endoskopische Fremdk6rperentfernung aus dem oberen Verdauungstrakt. Dtsch ~.rztebl 73:1967-1973 3. Henderson CT, Engel J, Schlesinger P (1987) Foreign body ingestion: review and suggested guidelines for management. Endoscopy 19:68-71
4. Mayer J (1977) Problematik verschluckter und aspirierter Fremdk6rper. Dissertation, Technische Universit~t M0nchen 5. Suita S, Ohgami H, Nagasaki A, Yakabe S (1989) Management of pediatric patients who have swallowed foreign objects. Am Surg 55:585-590 6. Webb WA (1988) Management of foreign bodies of the upper gastrointestinal tract. Gastroenterology 94:204-216 7. Wechselberg K (1968) Zur Fremdk6rperingestion im Kindesalter. Monatsschr Kinderheilkd 116:465-471
