Diagnosis and Management of Ingested Foreign Bodies in Unusual Localizations: A Case Series

Öz

Abstract Background: This study aimed to evaluate the clinical presentations associated with ingested foreign bodies located in unusual regions of the gastrointestinal tract and to highlight the diagnostic challenges and management strategies encountered in such cases. Materials and Methods: This retrospective study included 96 patients who presented to the Department of General Surgery at Van Yuzuncu yıl University between January 2015 and December 2022 and were found to have foreign bodies in the gastrointestinal tract outside the esophagus and stomach. Demographic and clinical characteristics, type and localization of the foreign body, diagnostic methods, treatment approaches, and clinical outcomes were analyzed. Direct radiography and computed tomography were used for diagnostic evaluation. Treatment strategies were determined according to the patient’s clinical condition and included conservative follow-up, endoscopic removal, or surgical intervention. Results: The most common presenting symptoms were abdominal pain (52.1%) and nausea or vomiting (34.4%). Foreign bodies were most frequently located in the terminal ileum (31.3%) and jejunum (22.9%). Metallic objects (28.1%) and bone fragments (22.9%) were the most commonly identified foreign bodies. Conservative management was applied in 40.6% of cases, endoscopic removal in 21.9%, and surgical intervention in 37.5%. Among surgically treated patients, the most common indications were perforation (44.4%) and mechanical obstruction (30.6%). No mortality occurred, and the early complication rate was 14.6%. Conclusions: Foreign bodies located in unusual gastrointestinal sites may present with atypical symptoms and lead to delayed diagnosis. Early recognition and timely intervention remain essential for reducing morbidity and preventing complications.

Anahtar Kelimeler

• Foreign body ingestion
• Endoscopic management
• Surgical intervention
• İntestinal obstruction

Alışılmadık Lokalizasyonlardaki Yabancı Cisimlerin Tanısı ve Yönetimi: Olgu Serisi

Öz

Özet Amaç: Bu çalışma, yutulan yabancı cisimlerin sıra dışı lokalizasyonlarda oluşturduğu klinik tabloları değerlendirmeyi, tanı süreçlerindeki zorlukları ve yönetim stratejilerini ortaya koymayı amaçlamaktadır. Materyal ve Metod: Ocak 2015 – Aralık 2022 tarihleri arasında Van Yuzuncu yıl Üniversitesi Genel Cerrahi Anabilim Dalı’na başvuran ve gastrointestinal sistemde özofagus ve mide dışı lokalizasyonda yabancı cisim saptanan 96 hasta retrospektif olarak incelenmiştir. Demografik ve klinik veriler, yabancı cismin tipi ve lokalizasyonu, tanısal yöntemler, tedavi yaklaşımları ve klinik sonuçlar analiz edilmiştir. Tanısal değerlendirmede direkt grafi ve bilgisayarlı tomografi kullanılmış, tedavi yaklaşımı klinik duruma göre konservatif, endoskopik veya cerrahi olarak belirlenmiştir. Bulgular: En sık başvuru semptomları abdominal ağrı (%52,1) ve bulantı/kusmaydı (%34,4). Yabancı cisimlerin en sık lokalizasyonu terminal ileum (%31,3) ve jejunum (%22,9) olarak saptandı. Metalik cisimler (%28,1) ve kemik parçaları (%22,9) en sık görülen yabancı cisimlerdi. Konservatif izlem %40,6, endoskopik çıkarım %21,9 ve cerrahi müdahale %37,5 oranında uygulandı. Cerrahi gerektiren olgularda perforasyon (%44,4) ve mekanik obstrüksiyon (%30,6) en sık endikasyonlardı. Mortalite gözlenmedi ve erken dönem komplikasyon oranı %14,6 olarak belirlendi. Sonuç: Sıra dışı lokalizasyonda yer alan yabancı cisimler genellikle atipik semptomlarla seyrederek tanıda gecikmeye neden olabilir. Keskin ve distal ince bağırsak lokalizasyonlu cisimler cerrahi müdahale gerektirirken, üst gastrointestinal sistem yabancı cisimleri endoskopik olarak güvenle çıkarılabilir. Erken tanı, uygun görüntüleme ve zamanında müdahale morbiditeyi azaltmada kritik öneme sahiptir.

Anahtar Kelimeler

• Yabancı cisim yutulması
• Endoskopik yönetim
• Cerrahi girişim
• İntestinal obstrüksiyon

Kaynakça

1. Velitchkov NG, Grigorov GI, Losanoff JE, Kjossev KT. Ingested foreign bodies of the gastrointestinal tract: retrospective analysis of 542 cases. World J Surg. 1996;20(8):1001-5.
2. D’Auria F, Consalvo V, Canero A, Russo M, Rescigno C, Lombardi D. Management of small bowel perforation by a bizarre foreign body in a 55-year-old woman. Case Rep Surg. 2018;2018:2781353.
3. Ikenberry SO, Jue TL, Anderson MA, Appalaneni V, Banerjee S, Ben-Menachem T, et al. Management of ingested foreign bodies and food impactions. Gastrointest Endosc. 2011;73(6):1085-91.
4. Ong LWL, Kabir T, Kam JH. Unusual location for an ingested foreign body. ANZ J Surg. 2020;91(5):1024-6.
5. Goh BK, Chow PK, Quah HM, Ong HS, Eu KW, Ooi LL, et al. Perforation of the gastrointestinal tract secondary to ingestion of foreign bodies. World J Surg. 2006;30(3):372-7.
6. Coulier B, Tancredi MH, Ramboux A. Spiral CT and multidetector-row CT diagnosis of perforation of the small intestine caused by ingested foreign bodies. Eur Radiol. 2004;14(10):1918-25.
7. Deniz MA, Turmak M. CT evaluation of swallowed foreign bodies located in the gastrointestinal system. Cureus. 2022;14(6):e26355.
8. Lai ATY, Chow TL, Lee DTY, Kwok SPY. Risk factors predicting the development of complications after foreign body ingestion. Br J Surg. 2003;90(12):1531-5.

9. Rodriguez-Hermosa JI, Codina-Cazador A, Sirvent JM, Martin A, Girones J, Garsot E. Surgically treated perforations of the gastrointestinal tract caused by ingested foreign bodies. Colorectal Dis. 2008;10(7):701-7.
10. Al-Darwish AS, Alasheikh M, AlSaeed HS, Hijan EA, Essa MS, AlNujaidi A, et al. Beyond childhood curiosity: foreign body ingestion as a diagnostic blind spot in adolescent small bowel obstruction—a single-center case series and review of the literature. J Surg Case Rep. 2025;2025(11):rjaf901.
11. Demiroren K. Management of gastrointestinal foreign bodies with brief review of the guidelines. Pediatr Gastroenterol Hepatol Nutr. 2023;26(1):1.
12. Henderson CT, Engel J, Schlesinger P. Foreign body ingestion: review and suggested guidelines for management. Endoscopy. 1987;19(2):68-71.
13. Bekkerman M, Sachdev AH, Andrade J, Twersky Y, Iqbal S. Endoscopic management of foreign bodies in the gastrointestinal tract: a review of the literature. Gastroenterol Res Pract. 2016;2016:8520767.
14. Negoita LM, Ghenea CS, Constantinescu G, Sandru V, Stan-Ilie M, Plotogea O, et al. Esophageal food impaction and foreign object ingestion in gastrointestinal tract: a review of clinical and endoscopic management. Gastroenterol Insights. 2023;14(1):131-43.
15. Pulat H, Damar S, Zihni I, Ozcelik K, Eken H, Karakose O. Ileus after ingestion of foreign bodies: a case report. Gazi Med J. 2017;28(3).
16. Sugawa C, Ono H, Taleb M, Lucas CE. Endoscopic management of foreign bodies in the upper gastrointestinal tract: a review. World J Gastrointest Endosc. 2014;6(10):475-81.
17. Geng C, Li X, Luo R, Cai L, Lei X, Wang C. Endoscopic management of foreign bodies in the upper gastrointestinal tract: a retrospective study of 1294 cases. Scand J Gastroenterol. 2017;52(11):1286-91.
18. Senturk M, Ozer H, Yavuz Y. Approach to foreign bodies in the upper gastrointestinal system. Ortadogu Med J. 2019;11(4):504-8.
19. Versaci A, Saladino E, Rossitto M, Leonello G, Caminiti R, Rivoli L, et al. La complicanza perforativa da ingestione di corpi estranei alimentari: una patologia insidiosa sempre attuale. G Chir. 2010;31(8):379-82.
20. Al Hosein M, Eghtedari A. Small intestine perforation due to foreign body: case report. Dubai Med J. 2023;6(1):57-60.