Indications for medical endoscopy for foreign bodies

Methods of management of patients with foreign bodies.

Expectant tactics: sharp objects (pins, needles, nails and toothpicks) pass through the gastrointestinal tract in 70-90% of cases without complications for several days. There are two factors that allow foreign bodies to safely pass through the gastrointestinal tract:

1. foreign bodies usually pass along the central axis of the lumen of the gut;
2. reflex relaxation of the muscles of the intestinal wall and slowing of the peristalsis of the intestine leads to the fact that sharp objects in the lumen of the intestine unfold in such a way that they move forward with a blunt end. It is necessary to monitor a patient in a hospital with X-ray control over the progress of a foreign body.

Conservative therapy: give the patients buckwheat porridge, indigestible food.

Operative treatment - is performed in the presence of signs of perforation of the esophagus, stomach or duodenum with corresponding complications.

Endoscopic treatment of patients with foreign bodies of the upper part of the digestive tract.

In 1881 Mikulich pushed a foreign body from the esophagus into the stomach for the first time. In 1907, Eksler described the "needle reflex". This is a protective reflex. When pressure is applied to the mucosa with the thin, sharp end of the foreign body, the organ wall does not resist, but forms a bay-like depression, the foreign body enters this cavity and does not pierce the wall, the peristalsis turns the foreign body with a blunt end down, and the foreign body moves along the digestive tract. Jackson was the first to extract a foreign body from the stomach with the help of Schindler's apparatus.

Indications for medical endoscopy for foreign bodies.

1. Foreign bodies lying freely in the esophagus, stomach and duodenum, small in size, with sharp ends and facets (needles, pieces of glass, nails, halves of razor blades), because These items can move deeper and remove them will be difficult.
2. Foreign bodies inserted into the organ wall, taking into account the data of X-ray examination (whether there are signs of perforation of the organ wall).
3. Massive foreign bodies with blunt ends and faces, if the dimensions of these objects permit.
4. Foreign bodies of small size with blunt ends and facets or soft consistency, which are long in the stomach or esophagus, for example, a coin.
5. Bezoar, with unsuccessful attempts to wash or dissolve it.
6. The left drains after the expiration of their rejection or in case of complications.
7. Obstruction of the esophagus by badly chewed food.

Contraindications to the medical endoscopy.

1. Presence of complications requiring surgical treatment.
2. Heavy general condition of the patient.

Before fibroendoscopy for foreign bodies, a clinical examination and fluoroscopy or radiography (non-contrast) is performed to determine the number of foreign bodies and their location. Most foreign bodies are moving forward, so fibroendoscopy should be done as quickly as possible. The urgency of removing a foreign body depends on its nature, for example, for foreign bodies with sharp edges and edges, the attempt to remove a foreign body must be made immediately, The needle is more often fixed by a small curvature due to the nature of the peristalsis (for better inspection it is possible to change the position of the patient's body). With unsuccessful attempts, take a break for 6-8 hours (all food from the stomach moves to the distal sections) and repeat the study, and for large-sized foreign bodies it is not necessary to rush - the study is conducted after 6-8 hours.

Anesthesia and premedication depends on the nature of the foreign body and the mental state of the patient. Most often the procedure is performed under local anesthesia. With sufficiently large foreign bodies, obturation of the esophagus with badly chewed food, as well as children easily excitable to patients and mentally ill esophagoscopy is conducted under general anesthesia with the introduction of muscle relaxants and intubation of the trachea. Full relaxation of skeletal muscles, as well as striated muscles of the pharynx and upper third of the esophagus facilitates the extraction of foreign bodies and minimizes the danger of perforation. Under anesthesia should be removed and foreign bodies with sharp edges.

Tools used to extract foreign bodies.

1. Polypectomy loop. The main tool. Loops are soft and hard. A rigid loop for removing foreign bodies is better.
2. Hooks. Are used rarely, because they are low-power.
3. Magnets. Japanese magnets made of magnetized steel are weak. Independently make magnets from vanadium, but they are more expensive than gold.
4. Hard, powerful tools of domestic production for crossing bones. For example, a knife on the bar.
5. Polyvinylchloride tube for safe extraction of foreign bodies with sharp edges and faces (needles, pins, razors). After the foreign body is captured, the tube, put on the apparatus, is shifted so that the foreign body is inside it, after which the apparatus is removed.
6. Catheters and medical glue. The glue can be applied to the cutting surface by turning it into a dull, and then removing the foreign body. With the help of glue, brittle foreign bodies (for example, a thermometer) can be extracted. The glue is applied to a site of a foreign body, and then a loop is thrown on this site.
7. Devices for intubation, tracheostomy and mechanical ventilation.

[1], [2], [3]