Medical endoscopy for foreign bodies

Foreign bodies of the upper part of the digestive tract

Foreign bodies - all the bodies coming from the outside in a special way or formed in the body, digested or not, living or inanimate nature, whether or not they serve food, with or without clinical manifestations.

Without forcible pushing, a foreign body can enter the upper parts of the digestive tract if its length does not exceed 15 cm and the width is 1.5 cm. The limiting stretching of the esophagus is 3.5 cm wide.

In the esophagus most often acute foreign bodies (mostly bones) get stuck in the cervical part and much less often - in the thoracic, respectively, places of physiological constrictions. The latter include the region of the cricoid-pharyngeal muscle (M. Cricopharyngeus) in the proximal part, the external compression of the esophagus in its middle third by the arch of the aorta and the left main bronchus, and also the region of the lower esophageal sphincter over the esophageal-gastric transition. Large blunt foreign bodies, for example, coins, are stuck mainly in the thoracic part, where the esophagus is also obstructed by badly chewed dense food. If the foreign body has a long length, one end of it can be located in the esophagus, and the other end up against the wall of the stomach in the region of great curvature. Occasionally, the foreign body can remain in the esophagus for a long time and cause cicatricial changes in its walls.

In the stomach foreign bodies that are large enough or sharp edges and spines are retained. Most often, the pyloric pulp in the area of the gastroduodenal-intestinal transition becomes an obstacle to the passage of a foreign body. Relatively small foreign bodies, even having sharp edges, are usually freely evacuated into the intestine, but heavy metal objects (for example, shot) are sometimes encapsulated in the wall of the stomach. Sharp objects are occasionally introduced into the mucous membrane; thus a through puncture of the wall (long needle, pin) is possible with the development of peritonitis . Large foreign bodies, which are in the stomach for a long time, can cause a bleeding of the wall with bleeding or perforation. Foreign bodies of animal or vegetable origin can form in the stomach the so-called bezoars. Trichobezoars are formed from tangles of swallowed hair, phytobezoars - from plant fibers and seeds of fruits. Bezoars gradually increase in size and can fill almost the entire lumen of the stomach.

In the duodenum, in the region of fixed bends and the Treacy ligament, needles and other long objects that can perforate the intestinal wall are often stuck. Pathological changes in the upper gastrointestinal tract (cicatricial or tumor narrowing, segmental spasm, inflammatory infiltration, etc.) also contribute to jamming of foreign bodies.

Most patients with foreign bodies of the gastrointestinal tract are children. Other high-risk groups include people with mental disorders and people who abuse alcohol and sedatives and hypnotics. The increased risk of foreign bodies entering the gastrointestinal tract exists in elderly people who have substandard dentures and in the elderly with a weakened criticism of their behavior due to drug therapy, senile dementia, and also in the presence of dysphagia due to a stroke. Intentionally introducing into the gastrointestinal tract of foreign bodies is described in people who smuggle illegal drugs, drugs, jewelry or other valuable items.

The number of patients with foreign bodies is increased due to:

1. Population aging. Absence of teeth, violation of the act of swallowing, sensation.
2. The acceleration of the pace of life. Absence of a reflex to eating.
3. An increase in the number of patients with mental illness and alcoholics.

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.

 Indications for medical endoscopy for foreign bodies

Method of conducting fibroendoscopy in foreign bodies. In all cases, it is better to take an esophagogastroduodenoscope with end optics for the study. Do not take a new device, tk. When removing foreign bodies, the apparatus is often damaged. When a foreign body is detected in the duodenum, after a preliminary examination, a duodenoscope is used with the facial optics.

With foreign bodies located in the esophagus, the apparatus is injected only under the control of vision, starting inspection from the oropharynx, the root of the tongue, pear-shaped sinuses - foreign bodies get stuck there often, and X-ray diagnostics is not effective. Most foreign bodies of the esophagus get stuck between I and II physiological constrictions, which corresponds to the Lammer triangle, where a physiological diverticulum is formed. The wall of the esophagus here is not involved in peristalsis and foreign bodies are delayed here. When stretching the esophagus by air, they fall through lower. Often it is possible to pass the device below the foreign body. Often, foreign bodies are not quite the usual form: on the bone there are remains of meat, the metal quickly darkens, acquiring a dark or black color. Foreign bodies are often covered with mucus, remnants of food, which makes diagnosis difficult. If a foreign body is known in advance, it is good, but sometimes it is extremely difficult to determine its nature. Foreign bodies of the esophagus are usually easily diagnosed: narrow lumen, foreign bodies are more often solitary. Foreign bodies of the stomach are often multiple. It is necessary to try to wash the foreign bodies with a stream of water.

Method for conducting fibroendoscopy in foreign bodies

[1], [2], [3], [4], [5], [6]