Weiland Steven T, Schurr Michael J
Department of Surgery, University of Wisconsin Hospital, Madison, Wisconsin 53792, USA.
J Gastrointest Surg. 2002 May-Jun;6(3):496-500. doi: 10.1016/s1091-255x(01)00027-0.
We reviewed the clinical benefits of hospitalization, esophagogastroduodenoscopy, and surgical intervention for ingested foreign bodies in adults. Patients with esophageal foreign bodies were not included in the study group. A 10-year experience is reported. Each patient's physical examination findings at presentation, white blood cell count, length of hospital stay, number and types of foreign bodies ingested, endoscopic interventions, surgical interventions, and complications were reviewed. There were 75 separate hospitalizations, all occurring in 22 male prison inmates. A total of 256 foreign bodies were ingested. Patients incurred 281 hospitalization days (average 3.7 days per admission). One patient had signs of peritonitis. White blood cell count was less than 10 K/microL in 85%. Sixty-four endoscopies were performed with removal of 79 of 163 foreign bodies (48% success rate). Five patients required general anesthesia because of a lack of cooperation. Complications occurred in four of them, one requiring laparotomy. Eight additional laparotomies were performed. One was performed for an acute abdomen on admission and one for the development of an acute abdomen after conservative management. Two were performed to remove metal bezoars. Four additional laparotomies were performed because of surgeon preference. Among the 23 patients admitted and managed conservatively, 77 (97%) of 79 foreign bodies passed spontaneously. One patient required laparotomy. Of the 256 ingested foreign bodies, 79 were removed endoscopically, 71 were removed surgically, and 106 passed spontaneously. The size, shape, and number were not predictive of the ability to transit the gastrointestinal tract. Foreign body ingestion is problematic in prison inmates. With conservative management, most foreign bodies will pass spontaneously. Endoscopy has a high failure rate and is associated with significant complications. Surgical intervention should be reserved for those who have acute conditions in the abdomen or large bezoars.
我们回顾了住院治疗、食管胃十二指肠镜检查以及手术干预对成人摄入异物的临床益处。食管异物患者未纳入研究组。报告了10年的经验。回顾了每位患者就诊时的体格检查结果、白细胞计数、住院时间、摄入异物的数量和类型、内镜干预、手术干预及并发症情况。共有75次单独住院，均发生在22名男性监狱服刑人员中。共摄入256个异物。患者共住院281天（每次住院平均3.7天）。1例患者有腹膜炎体征。85%的患者白细胞计数低于10K/微升。共进行了64次内镜检查，成功取出163个异物中的79个（成功率48%）。5例患者因不配合需要全身麻醉。其中4例出现并发症，1例需要剖腹手术。另外进行了8次剖腹手术。1次是因入院时急腹症进行，1次是保守治疗后出现急腹症进行。2次是为取出金属粪石。另外4次剖腹手术是出于外科医生的偏好。在23例接受保守治疗的患者中，79个异物中的77个（97%）自行排出。1例患者需要剖腹手术。在256个摄入的异物中，79个经内镜取出，71个经手术取出，106个自行排出。异物的大小、形状和数量不能预测其通过胃肠道的能力。监狱服刑人员摄入异物是个问题。采用保守治疗，大多数异物会自行排出。内镜检查失败率高且伴有严重并发症。手术干预应保留给那些有腹部急症或大粪石的患者。
