Ingestion of foreign bodies is common and conservative treatment can eliminated most particlesfrom the gastrointestinal tractunless peritoneal signs appear. A 22-year-old man presented to emergency department who had ingested glass particles of a crushed beverage bottle. He complained of epigastric and periumbilical pain. Physical examination did not revealany peritoneal signs. Abdominal X-ray showed stomach full of small glass particles. Conservative treatment, without any surgical intervention,resulted insafely eliminating glass particlesin this patient

Ebrahimi, Mohsen

Foroughian, Mahdi

Mahmoudi Gharaee, Azadeh

Malmir, Jafar

English

PubMed

Journals Portal, Shahid Beheshti University of Medical Sciences

Emergency. 2017; 5 (1): e44CASE REPORTA Rare Case of Gastrointestinal Tract Foreign Body; GlassyStomachMohsen Ebrahimi1, Jafar Malmir1, Azadeh Mahmoudi-Gharaee1, Mahdi Foroughian2∗1. Department of Emergency Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.2. Department of Emergency Medicine, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran.Received: May 2016; Accepted: July 2016; Published online: 14 January 2017Abstract: Ingestion of foreign bodies is common and conservative treatment can eliminated most particlesfrom the gas-trointestinal tractunless peritoneal signs appear. A 22-year-old man presented to emergency department whohad ingested glass particles of a crushed beverage bottle. He complained of epigastric and periumbilical pain.Physical examination did not revealany peritoneal signs. Abdominal X-ray showed stomach full of small glassparticles. Conservative treatment, without any surgical intervention,resulted insafely eliminating glass parti-clesin this patient.Keywords: Foreign bodies;glass;gastrointestinal tract; emergencies; case management© Copyright (2017) Shahid Beheshti University of Medical SciencesCite this article as: Ebrahimi M, Malmir J, Mahmoudi-Gharaee A, Foroughian M. A Rare Case of Gastrointestinal Tract Foreign Body; GlassyStomach. Emergency. 2017; 5 (1): e44.1. IntroductionForeign bodies may be ingested, inserted into a body cavity,or deposited into the body by a traumatic or iatrogenic injury.Most ingested foreign bodies pass through the gastrointesti-nal tract without any problem (1). However, ingested or in-serted foreign bodies may cause bowel obstruction or perfo-ration and lead to serious complications such as severe hem-orrhage, abscess formation, or septicemia. Most cases of for-eign body ingestions are seen amongchildren and those withpsychiatric disorders (2-4). Here we report a case of inten-tional foreign body ingestion and itsoutcome.2. Case presentationA 22-year-old male was brought to emergency departmentwith chief complaint of periumbilical and epigastric painsince 4 hours before. He explained that he had ingestedcrushed glasses of a beverage bottleafter a family argument.About 30 minutes after swallowing glass particles, the patienthad developed irritation and pain in epigastric and perium-bilical area without any other associated symptom.Hedenied∗Corresponding Author: Mahdi Foroughian ;Department of EmergencyMedicine, Kerman University of Medical Sciences, Kerman, Iran. Tel:03432235011; Email: mf2600@yahoo.com,history of other diseases including psychiatric problems.Onphysical examination normal vital signs were detected, nooral lesion or laceration or bleeding was seen. He had normalbreathing sounds. Abdomen had normal bowel sounds withmild epigastric tenderness without rebound tenderness orguarding. Chest X-ray and abdominal X-ray were performed.Chest X-ray was normal with no air under diaphragm orpneumomediastinum. Abdominal X ray (figure 1) showed astomach full of small glass particles. The patient was mon-itored continuously and carefully; surgical consultation wasdone, laparotomy was planned but patient did not agree toundergo surgical intervention. Thereafter, he was monitoredclosely and observed in emergency department with serialphysical exam. Serial abdominal radiography was done everyother day to evaluate the removal of the particles (figure 2).All glass particles were eliminated from the gastrointestinaltract of patient without any intervention. No complicationwas seen during the observation period. Eventually after 10days the patient was discharged and went home.3. Discussion:Cases of intentional glass ingestionare rare, so there is nospecial guideline to approach them. In these cases, it isexpected to see oral cavity laceration, drooling, inability toswallow, neck pain or chest pain. If the objects could pass theThis open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0).Downloaded from: www.jemerg.comM. Ebrahimi et al. 2Figure 1: Upright abdominal X-ray showing a stomachfull of glassparticles.Figure 2: Upright abdominal X ray, 48 hours after glass ingestion(the glass particles are in the large intestine).esophagus, mild abdominal pain or even signs of acute ab-domen may appear. Based on the routine approach, in orderto identify the location, number and size of the ingested par-ticles, and also evaluate the presence of any kind of compli-cations, radiography could be suggested as an initial screen-ing method(5). Although glass foreign bodies are opaque onradiographs, but it was indicated that the size of the glass for-eign body is often the limiting factor for radiographic detec-tion and that 0.5- to 2.0-mm fragments represent a “limiteddetection” size range(1, 6).Endoscopic extraction is well ac-cepted and recommended as a form of treatment for swal-lowed foreign body in upper gastrointestinal tract, however,conservative approach with proper management is also ef-fective and preferable when foreign bodies have passed theesophagus within days without any difficulty (7). This isthe treatment of choice for blunt, short (<6 cm), and nar-row (<2.5 cm diameter) foreign bodies, especially once theyhave passed the pylorus(8). Emergency esophagogastroduo-denoscopy is suggested in cases of sharp or pointed foreignbodies. They can result in complications such as gastroin-testinal bleeding, abscess formation, mediastinitis or peri-tonitis due to perforation of the gastrointestinal tract (9, 10).Surgical intervention is required in such cases, which makeup less than 1% of ingested foreign body cases (11).4. Appendix4.1. AcknowledgementsThe authors appreciate the cooperation of emergency de-partment staff of Imam Reza Hospital, Mashhad, Iran.4.2. Author contributionAll authors passed four criteria for authorship contributionbased on recommendations of the International Committeeof Medical Journal Editors.4.3. Conflict of interestThe authors declarethat there is noconflict of interest regard-ing the publication of this manuscript.4.4. FundingNone.References1. Hunter TB, Taljanovic MS. Foreign bodies. Radiographics: a review publication of the Radiological Society of NorthAmerica, Inc. 2003;23(3):731-57.2. Woolley SL, Smith DR. History of possible foreign bodyingestion in children: don’t forget the rarities. EuropeanJournal of Emergency Medicine. 2005;12(6):312-6.3. Safari S, Karimi E, Baratloo A, Alavi-Moghaddam M,Kalantarimeibodi M. A 16-Year-Old Girl with Acute On-set Respiratory Distress. Emergency. 2014;2(1):50.4. Haghighi M, Shoaei SD. Pharyngeal aspiration of com-plete upper denture in 90-year-old man; a case report.Emergency. 2015;3(3):117.This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0).Downloaded from: www.jemerg.com3 Emergency. 2017; 5 (1): e445. Mosca S, Manes G, Martino R, Amitrano L, Bottino V,Bove A, et al. Endoscopic management of foreign bodiesin the upper gastrointestinal tract: report on a series of414 adult patients. Endoscopy. 2001;33(08):692-6.6. Courter BJ. Radiographic screening for glass foreignbodies–what does a “negative” foreign body series reallymean? Annals of emergency medicine. 1990;19(9):997-1000.7. Ng K. Retention of an ingested small blunt foreign body.Journal of the Belgian Society of Radiology. 2011;94(6).8. Al Shehri GY, Al Malki TA, Al Shehri MY, Ajao OG, Jasta-niah SA, Haroon KS, et al. Swallowed foreign body: Is in-terventional management always required? Saudi Jour-nal of Gastroenterology. 2000;6(2):84.9. Allotey J, Duncan H, Williams H. Mediastinitis andretropharyngeal abscess following delayed diagno-sis of glass ingestion. Emergency Medicine Journal.2006;23(2):e12-e.10. Gattai R, Migliaccio ML, Bonizzoli M, Peris A, Bechi P.Upper GI hemorrhage from glass fragments’ ingestion ina patient with jejunal diverticula–Case report. Interna-tional journal of surgery case reports. 2015;6:191-3.11. Ambe P, Weber SA, Schauer M, Knoefel WT. Swal-lowed foreign bodies in adults. Dtsch Arztebl Int.2012;109(50):869-75.This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0).Downloaded from: www.jemerg.com

A Rare Case of Gastrointestinal Tract Foreign Body; Glassy Stomach

Ingestion of foreign bodies is common and conservative treatment can eliminated most particlesfrom the gastrointestinal tractunless peritoneal signs appear. A 22-year-old man presented to emergency department who had ingested glass particles of a crushed beverage bottle. He complained of epigastric and periumbilical pain. Physical examination did not revealany peritoneal signs. Abdominal X-ray showed stomach full of small glass particles. Conservative treatment, without any surgical intervention,resulted insafely eliminating glass particlesin this patient.</p

A Rare Case of Gastrointestinal Tract Foreign Body; Glassy Stomach

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