QJM: An International Journal of Medicine, 2017, 329–330
doi: 10.1093/qjmed/hcx018
Advance Access Publication Date: 17 January 2017
Clinical picture
CLINICAL PICTURE
Successful removal of multiple long foreign bodies: an
unusual neck hyperextension technique
A 22-year-old female with a background of depression and personality disorder underwent an emergency endoscopy after
swallowing multiple long foreign bodies (FB). She had a previous
history of several instances of ingesting FB, requiring a laparotomy a year previously.
The patient was sedated with 5 mg midazolam and remained awake during the procedure. A total of 6 FB
were visualized in the stomach (two toothbrushes, a lip gloss,
eyeliner, a pencil and a finger splint; Figure 1a). Using a snare
and roths net at the FB narrowest point, each object was gently
disimpacted and orientated vertically. An overtube was not
used as the objects were too wide to be removed with this
device.
Upon reaching the upper oesophageal sphincter, a modified
technique of FB removal was used. The patient was given instructions to actively hyperextend her neck (a technique used
in sword swallowing). By extending the atlanto-axial joint and
thus aligning the axis of the oropharynx and oesophagus, this
aided visualisation and safe removal.
All six FB were removed successfully and with minimal resistance (Figure 1b). A post procedure endoscopy check showed
no mucosal bleeding or trauma. She remained well post procedure and discharged the same day.
Ingestion of FB is not an uncommon scenario faced by
gastroenterologists. Conversely, the ingestion of multiple and
long FB is rare. FB ingestion can be either incidental or intentional with 90% of objects passing spontaneously.1 Certain patient populations have a greater tendency to ingest objects,
including children, those with a psychiatric condition, those
wishing to gain access to medical institutions or those under
the influence of alcohol.2
When sharp objects are ingested, endoscopic retrieval
should be attempted, as prolonged lodgement can lead to pressure necrosis, perforation or fistula formation.3 In the 5% of patients requiring removal via an emergency endoscopy, this is
successful in 99% of cases and remains the method of choice.4
Complications during removal such as obstruction and perforation can occur and usually depends on type, size and composition of the objects that have been ingested. Long and multiple
FB however are particularly challenging to remove. At areas of
anatomical narrowing or acute angulations such as the upper
oesophageal sphincter the risk of perforation is higher.5 It is
Figure 1. (a) Endoscopic photograph of both adult toothbrushes in the stomach. (b) All six removed foreign bodies using endoscopy.
C The Author 2017. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved.
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suggested that retrieval nets are superior to using baskets or
forceps in such instances.6 Other cases have reported the use of
anaesthesia and additional practitioners to assist removal of
the long FBs with grasping forceps.3 Here we describe a safe and
effective technique of removing multiple long FBs that can be
performed by a single endoscopist without the need for forceps.
Photographs and text from: H. Aladin, Department of
Gastroenterology, Sandwell Hospital, Sandwell and West
Midlands NHS Trust, Lyndon, West Bromwich, B18 7QH, West
Midlands, UK; N.N. Than, Department of Gastroenterology and
Hepatology, Royal Free Hospital, Pond St, London NW3 2QG, UK;
B. Theron, Department of Gastroenterology, Northern Devon
Healthcare NHS Trust, Raleigh Park, Barnstaple EX31 4JB, Devon,
UK; I. Mohammed, Department of Gastroenterology, Sandwell
Hospital, Sandwell and West Midlands NHS Trust, Lyndon,
West Bromwich, B18 7QH, West Midlands, UK. email:
[email protected]
Conflict of interest: None declared
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