Duodenum - Foreign Body (Toothpick)
Comments: This 56 year old lady was referred with several months of abdominal pain despite PPI therapy and treatment for a positive H. Pylori serology. The gastric antrum was normal but the upper endoscopy revealed this foreign body lodged in the second portion of the duodenum. Inflammatory changes were seen at both ends of the foreign body's insertion into the wall of the duodenum. Attempts to remove the object using a standard biopsy forceps were unsuccessful. The biopsy forceps is not designed to retrieve foreign material such as this. This rat-toothed forceps, however, easily grasps the material which is then removed. An over tube or hood can be used to protect the esophagus from injury during object withdrawal. Because of the folding of this object, the use of an overtube was not felt to be indicated. Inspection of the duodenal wall reveals ulcerations at both insertion sites. The object proved to be a toothpick, and this clean, unstained portion suggests a penetration depth into the duodenal wall of approximately 1-1.5cm.
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Peter B. Kelsey, M.D. Assistant Professor of Medicine Harvard Medical School Massachusetts General Hospital |
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Citation: Kelsey, PB (Dec 04 2003). Duodenum - Foreign Body (Toothpick). The DAVE Project. Retrieved Sep, 4, 2010, from http://daveproject.org/viewfilms.cfm?film_id=42 Times viewed since Feb 2006: 7899 |
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