Hu Tingting, Zhang Jie, Liu Yang, Chen Lifang, Cen Wei, Wu Wenzhi, Huang Qingke, Sun Xuecheng, Stock Simon, Zippi Maddalena, Zimmer Vincent, Basharat Zarrin, Hong Wandong
Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P. R. China.
Department of Otolaryngology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P. R. China.
Gastroenterol Rep (Oxf). 2022 Aug 11;10:goac036. doi: 10.1093/gastro/goac036. eCollection 2022.
Foreign bodies (FBs) lodged in the intestine or causing intestinal complications are uncommon in clinical practice but may pose diagnostic difficulties and prove life-threatening. This study aimed to evaluate the risk factors for severe complications and surgery to aid clinicians in the diagnosis and management of intestinal FBs.
We performed a retrospective analysis of patients in whom FBs were lodged in the intestine or caused complications from 2010 to 2020 in the First Affiliated Hospital of Wenzhou Medical University (Zhejiang, China). The characteristics of the patients and FBs, symptoms, imaging findings, diagnostics, treatment strategies, and clinical outcomes were analysed. Furthermore, the risk factors for complications and surgery were investigated.
In total, 180 patients were included in our study. Most patients (76.1%) were unable to provide a history of ingestion. Bezoars were the most common FBs (35.6%). The FBs were mainly located in the duodenum (32.8%) and the ileum (27.8%). Surgical removal of FBs was successful in 89 (49.4%) patients and endoscopic removal in 54 (30.0%) patients. Eleven with perforations were treated conservatively. FBs located in the jejunum or ileum were more likely to cause severe complications than those located in the duodenum. FBs located in the jejunum, ileum, or sigmoid colon were more likely to undergo surgery, and severe complications were an independent risk factor for surgery.
Intestinal FBs, often localized in angulation, are likely to be misdiagnosed because most patients do not provide a history of FB ingestion. Surgery and endoscopic therapy are the most commonly used treatment modalities. Surgery is not mandatory in clinically stable patients with small and contained perforations. FBs located in the jejunum or ileum are risk factors for both complications and surgery.
肠道内异物（FBs）或引起肠道并发症在临床实践中并不常见，但可能造成诊断困难并危及生命。本研究旨在评估严重并发症和手术的危险因素，以帮助临床医生诊断和处理肠道FBs。
我们对2010年至2020年在温州医科大学附属第一医院（中国浙江）肠道内有FBs或出现并发症的患者进行了回顾性分析。分析了患者和FBs的特征、症状、影像学表现、诊断、治疗策略及临床结局。此外，还研究了并发症和手术的危险因素。
本研究共纳入180例患者。大多数患者（76.1%）无法提供摄入异物史。胃石是最常见的FBs（35.6%）。FBs主要位于十二指肠（32.8%）和回肠（27.8%）。89例（49.4%）患者成功进行了FBs手术切除，54例（30.0%）患者进行了内镜下切除。11例穿孔患者接受了保守治疗。位于空肠或回肠的FBs比位于十二指肠的FBs更易引起严重并发症。位于空肠、回肠或乙状结肠的FBs更有可能接受手术，严重并发症是手术的独立危险因素。
肠道FBs常位于肠管拐角处，由于大多数患者未提供FBs摄入史，很可能被误诊。手术和内镜治疗是最常用的治疗方式。对于临床稳定、穿孔较小且局限的患者，并非必须进行手术。位于空肠或回肠的FBs是并发症和手术的危险因素。
