Retrieval of a large foreign body from the ileum with double-balloon enteroscopy (with videos)

摘要

A 31-year-old, institutionalized man with a psychiatric disorder presented after he swallowed a plastic fork. Initial CT demonstrated the fork in the second portion of the duodenum, with the tines oriented distally. The patient was followed expectantly. A subsequent CT scan demonstrated the fork, now in the distal small bowel, still with tines directed distally (A). Thickening of the small-bowel wall with adjacent stranding was identified, without evidence of free air or fluid collection. A lower double-balloon enteroscopy was performed. The fork was located 30 cm from the ileocecal valve. One of the outside prongs appeared embedded in the bowel wall. The fork was pushed back and out of the wall by use of a rat-tooth forceps. A large snare was threaded over the handle of the fork and brought back over the tines. The snare was closed, bunching the tines togethei (B). The fork was slowly withdrawn to the colon and removed (C) (Video 1; available online at www. giejournal.org). No significant trauma was seen. The patient was treated with intravenous antibiotics and admitted for 24-hour observation. Repeat abdominal plain films revealed no evidence of an adverse event.