Impacted sharp foreign bodies in the gastrointestinal tract can be
very difficult to manage, with different methods described in literature for
their safe removal [1]
[2]
[3]
[4]. With the flexible endoscope, a
foreign-body protector hood or overtube is generally used to protect the
esophagus when removing a sharp foreign body. However, the size of the overtube
precludes removal of foreign body more than 16.7 mm in size. This report
illustrates an unusual modification of a commercial overtube in order to
facilitate the safe withdrawal of a sharp foreign body that would not otherwise
have been possible with the standard equipment available.
A 26-year-old female was admitted to our hospital after swallowing a
razor blade. Her past medical history was significant for bipolar disorder and
prior exploratory laparoscopy for removal of ingested foreign bodies. The razor
blade was visualized in the distal esophagus on esophagoduodenoscopy and easily
grasped, but was larger than the 16.7-mm-internal-diameter tapered end of the
US Endoscopy Guardus overtube (US Endoscopy, Mentor, Ohio, USA) ([Fig. 1]).
Fig. 1 Dimensions of the
single-edge razor blade shown against a scale. Each blade measures 40 mm
in length × 18 mm in height × 0.22 mm
in width.
The patient was taken to the operating room, where a plain film
showed that the razor blade had migrated to the stomach. A decision was made to
incise the distal 2-mm tapered end of the overtube and to flatten the distal
3 cm of the overtube to provide a wider oval shape in order to allow the
razor blade to be pulled into the overtube ([Fig. 2]).
Fig. 2 Maximum diameter of
overtube before and after flattening of the distal end.
The modified overtube was backloaded over the scope and introduced
into the stomach where the razor blade was pulled into the overtube and removed
successfully. Re-endoscopy showed no evidence of laceration in the esophagus.
This modification of the overtube is safe, effective, and can be easily applied
for removal of larger sharp foreign bodies without incurring any additional
costs.
Endoscopy_UCTN_Code_TTT_1AO_2AL
