Sorbonne Paris Cité Paris 7, University, Paris, France; APHP, Lariboisière Hospital, Department of Gastroenterology, Paris, France.
Best Pract Res Clin Gastroenterol. 2013 Oct;27(5):679-89. doi: 10.1016/j.bpg.2013.08.009. Epub 2013 Sep 5.
Foreign body ingestions, food bolus impactions, and caustic agent injuries are frequent but specific situations. Although most foreign bodies will naturally pass through the digestive tract, practitioners should recognize specific situations were endoscopic management is required. In such cases, timing and adequate equipment are critical. Endoscopic treatment is successful in about 95% of patients. Severe complications (including oesophageal perforations) are rare. Underlying diseases (including eosinophilic oesophagitis) must be investigated after food bolus impaction. Accidental or suicidal ingestion of corrosive agents may result in severe upper gastrointestinal tract injuries requiring a multidisciplinary approach including gastroenterologists, surgeons, otorhynolaryngologists, anaesthesiologists and psychiatrists. Treatment includes conservative management of patients with mild injuries, while patients with severe injuries undergo emergency surgical exploration. At distance of the ingestion episode, oesophageal reconstruction is required in patients who underwent oesophageal resection and in patients who developed oesophageal strictures that failed dilatation.
异物摄入、食物团块嵌塞和腐蚀性物质损伤较为常见,但具有一定特征。尽管大多数异物会自然通过消化道,但医生应识别出需要内镜处理的特定情况。在这些情况下,时间和适当的设备至关重要。内镜治疗在约 95%的患者中取得成功。严重并发症(包括食管穿孔)较为罕见。在食物团块嵌塞后,必须调查潜在疾病(包括嗜酸性食管炎)。意外或自杀性腐蚀性物质摄入可能导致严重的上消化道损伤,需要包括胃肠病学家、外科医生、耳鼻喉科医生、麻醉师和精神科医生在内的多学科方法进行治疗。治疗包括对轻度损伤的患者进行保守管理,而对严重损伤的患者进行紧急手术探查。对于接受食管切除的患者以及发生食管狭窄且扩张失败的患者,在摄入事件发生后,需要进行食管重建。