Mohamed Aboulkacem Bourguiba, Ghalleb Montassar, Khemir Alaeddine, Souai Faten, Gharbi Maroua, Ben Safta Yacine, Sayari Sofiene, Ben Moussa Mounir
General Surgery Department A, Charles Nicolle Hospital, Tunisia.
Int J Surg Case Rep. 2017 Sep 9;41:283-286. doi: 10.1016/j.ijscr.2017.08.047. eCollection 2017.
Foreign body ingestion is a commonly seen accident in emergencies, only 1% of them will finally need surgery. Historically, exploratory laparotomy has been the mainstay of treatment for patients requiring surgery. However surgeons are more and more tempted to use laparoscopy in emergency setting.Through this case report we wanted to show in some selected cases the feasibility of laparoscopic assisted foreign body extraction from the small bowel leaving the patient with smaller scar, less morbidity and faster recovery.
A 30 year old male Inmate, ingested 40 days prior to his visit a bottom part of plastic bottle.Physical examination found an afebrile patient with a whole abdominal tenderness but no signs of peritonitis.The Abdominal Computed Tomography found a small bowel obstruction caused by a foreign body. No Radiological sign of perforation or peritonitis was found.First therapeutic strategy was to wait and see, for 24 h with no sign of improvement and the patient was taken to surgery. We opted for a laparoscopic approach y. The patient had bowel and gas movement the day after surgery. In the third day, the patient had developed a parietal abscess Treated medically. In the 10th day, after surgery the patient was discharged.Fourteenth month after the surgery, the patients is doing well with no late complication.
Laparoscopic assisted foreign body extraction from the small bowel is a good therapeutic option however Large scale randomized controlled trials are needed before this can be used as a standard of care.
异物吞食是急诊中常见的意外事件，其中仅有1%最终需要手术治疗。从历史上看，剖腹探查术一直是需要手术治疗患者的主要治疗方式。然而，外科医生越来越倾向于在急诊情况下使用腹腔镜。通过本病例报告，我们想在一些特定病例中展示腹腔镜辅助从小肠取出异物的可行性，使患者留下更小的疤痕、更低的发病率并更快康复。
一名30岁男性囚犯，在就诊前40天吞食了塑料瓶底部。体格检查发现患者无发热，全腹压痛，但无腹膜炎体征。腹部计算机断层扫描发现异物导致小肠梗阻。未发现穿孔或腹膜炎的放射学迹象。首要治疗策略是观察，24小时后无改善迹象，遂将患者送去手术。我们选择了腹腔镜手术方式。患者术后第一天有肠道蠕动和排气。第三天，患者出现腹壁脓肿，进行了药物治疗。术后第十天，患者出院。术后第十四个月，患者情况良好，无晚期并发症。
腹腔镜辅助从小肠取出异物是一种很好的治疗选择，然而在将其用作标准治疗方法之前，还需要进行大规模随机对照试验。
