Tringali Alberto, Bonato Giulia, Dioscoridi Lorenzo, Mutignani Massimiliano
Digestive Endoscopy Unit, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy.
BMJ Case Rep. 2018 Sep 1;2018:bcr-2018-226348. doi: 10.1136/bcr-2018-226348.
Colorectal foreign bodies (FB) are challenging issues for the endoscopist especially if the mostly used methods (polypectomy snare, biopsy forceps or wire-guided 40 mm dilation balloon) failed. We report a case of a 31-year-old man who was admitted in the emergency department for the impaction of a 60 cm long and large-size FB in the sigmoid colon. We failed to remove the FB using several different standard technique because of the rigidity, the smoothness and the size of the object. After all these attempts, we built up a 'home-made' device inserting a 0.035 inch non-hydrophilic guidewire (Metro WireGuide, Cook Medical) doubled into an 8.5 Fr stent-pusher-catheter (Cook Medical) serving as an outer sheet in order to create a noose and we finally succeeded in the endoscopic extraction of the device. We suggest this new technique as a valid option to remove large FBs from the colon and rectum when standard endoscopic methods for FB's extraction fail.
结直肠异物对内镜医师来说是具有挑战性的问题,尤其是当最常用的方法(息肉切除圈套器、活检钳或导丝引导的40毫米扩张球囊)失败时。我们报告一例31岁男性病例,该患者因一枚60厘米长的大型异物嵌顿于乙状结肠而入住急诊科。由于异物的硬度、光滑度和尺寸,我们使用几种不同的标准技术均未能取出该异物。在所有这些尝试均失败后,我们制作了一个“自制”装置,将一根0.035英寸的非亲水导丝(Metro WireGuide,库克医疗公司)对折后插入一根8.5 Fr的支架推送导管(库克医疗公司)作为外层,以形成一个套索,最终成功地通过内镜取出了该装置。我们建议,当用于取出结直肠异物的标准内镜方法失败时,这种新技术是从结肠和直肠取出大型异物的有效选择。