Gastrointestinal foreign bodies

　　The types of foreign bodies swallowed are numerous and cannot be listed one by one. The most common ones are safety pins, sewing needles, hairpins, coins, buttons, round nails, screws, small toys, dentures, etc. Generally speaking, any foreign body that can pass through the esophagus and the cardia can also pass through the entire gastrointestinal tract. However, according to statistics, about 5% of foreign bodies may be retained at some part of the gastrointestinal tract, especially at the pylorus, duodenum, and terminal ileum. Any foreign body that is elongated, pointed, or sharp, and where there is inflammation or stenosis in the intestinal tract, is prone to be retained at that location.

　　Common complications caused by some gastrointestinal foreign bodies include:

　　1. Foreign bodies not excreted;

　　2. Gastrointestinal obstruction;

　　3. Gastrointestinal perforation;

　　4. Abscess formation;

　　5. Internal or external fistula;

　　6. Gastrointestinal bleeding.

　　Esophageal foreign bodies can cause swallowing pain or difficult vomiting. Foreign bodies in the stomach usually have no obvious symptoms, or may cause upper abdominal discomfort, loss of appetite, or can cause pyloric obstruction, produce spasm-like pain, and vomiting. After perforation, there are signs of peritonitis, with persistent abdominal pain, distension, tenderness, muscle tension, and rebound pain. Long-term retention of foreign bodies in a certain part can cause ulcer bleeding, and pointed foreign bodies can directly puncture the mucosa, causing obvious bleeding, such as hematochezia or hematemesis. Literature reports that duodenal foreign bodies can penetrate into the renal pelvis to form a duodenal renal pelvis fistula, causing the patient to have high fever and chills. Abdominal signs: small foreign bodies have no local signs, and large foreign bodies (such as spoons, toothbrushes) can be felt in the abdomen during palpation, with local tenderness. When gastrointestinal perforation occurs, there may be peritoneal irritation signs.

　　Foreign bodies in the gastrointestinal tract can be completely prevented. It is necessary to widely educate parents and caregivers, mainly to strengthen the care of infants and young children.

　　1. Children under 3 years of age who have not yet erupted their molars should not be given peanuts, melon seeds, beans, and other foods with seeds.

　　2. Do not choose toys with 'dangerous' features for children. For items that infants and young children may swallow, they should not be used as toys.

　　3. Do not run around or jump around while eating to prevent swallowing foreign bodies when falling.

　　4. Do not scare, amuse, or scold while eating to avoid crying or laughing and accidentally swallowing.

　　5. Educate children to get rid of bad habits such as holding pen caps, whistles, and small toys.

　　6. Pay special attention to eating for critically ill and unconscious patients to prevent accidental swallowing.

　　7. Develop good defecation habits. Faecalith obstruction often occurs due to children having poor defecation habits or ingesting a large amount of indigestible foods with seeds, causing them to accumulate in the small intestine or colon and cannot be excreted, leading to intestinal obstruction.

　　1. X-ray abdominal film: Pure metal foreign bodies can be diagnosed definitely through X-ray examination.

　　2. Barium meal imaging: Barium meal imaging is very helpful for non-metallic foreign bodies. If there is bleeding or perforation, barium meal examination is prohibited.

　　1. Millet: Warming the stomach, calming the mind. 2. Pumpkin: Pumpkin is warm in nature and sweet in taste. Detoxification: Pumpkin contains vitamins and pectin, which has a good adsorption property, can bind and eliminate bacteria toxins and other harmful substances in the body, such as lead, mercury, and radioactive elements in heavy metals, and play a detoxifying role. Protecting the gastric mucosa, aiding digestion: The pectin contained in pumpkin can also protect the gastrointestinal mucosa from the stimulation of rough food, promote the healing of the ulcer surface, and is suitable for patients with gastric diseases. The components contained in pumpkin can promote bile secretion, strengthen peristalsis of the gastrointestinal tract, and aid in food digestion. Eliminating carcinogens: Pumpkin can eliminate the mutagenic effect of carcinogenic substances such as nitrosamines, has anti-cancer effects, and can help restore liver and kidney function, enhance the regeneration ability of liver and kidney cells. 3. Spinach, carrots, onions, garlic, and spirulina have excellent therapeutic effects on gastritis. They can not only eliminate Helicobacter pylori but also repair the gastric mucosa. As long as it is taken for a long time, most cases of gastritis can be cured. The method of taking is as follows: take 3 times a day, 2-4 grams each time, 30 minutes before meals with 2 cups of warm water, and drink as much warm water as possible every day. Drinking yogurt can not only supplement nutrition but also avoid the side effects of antibiotics on the human body, because yogurt contains a large amount of active bacteria, which can help rebalance the intestinal flora disorder caused by antibiotic drugs and protect the gastric mucosa. Avoid spicy foods in diet: Frequent and large consumption of spicy and stimulating foods can stimulate the gastric mucosa, causing it to be in a state of congestion for a long time, which can trigger chronic gastritis. Therefore, it is necessary to avoid long-term and large consumption of spicy foods such as chili, garlic, and other stimulating foods. Chew slowly: Eat less rough and hard foods, fully chew the food to make it as broken as possible, which can reduce the workload of the stomach. The more you chew, the more saliva you will secrete. Saliva has the functions of digesting food and killing bacteria, and has a protective effect on the gastric mucosa. Therefore, it is advisable to chew slowly and not swallow food whole. Avoid stimulation: Do not smoke because smoking causes the contraction of gastric blood vessels, affects the blood supply to the gastric wall cells, reduces the resistance of the gastric mucosa, and triggers gastric diseases. It is advisable to drink less alcohol and eat less spicy foods such as chili and pepper.

　　The treatment of gastrointestinal foreign bodies has made great progress in recent years due to the application of fiberoptic endoscopes. Foreign bodies in the esophagus and stomach can all be removed through endoscopy. Only a few patients with complications may need to be removed surgically.

　　First, endoscopic removal of foreign bodies

　　1. Timing of removal:

　　Approximately 80% to 90% of foreign bodies that accidentally enter the stomach can be naturally excreted, but the natural excretion rate for children is only 60% to 80%. Therefore, for pointed foreign bodies (such as chicken bones, toothpicks) or toxic foreign bodies (such as items containing lead), active treatment is needed to prevent mucosal injury or poisoning. Other foreign bodies in the stomach (except pointed, toxic, large, or long) are allowed to be observed for a period of time, waiting for natural excretion. It is reported that the average natural excretion time for foreign bodies is 5.1 days.

　　Spitz believes that if foreign bodies in the esophagus are not excreted within 12 hours, and foreign bodies in the stomach and duodenum are not excreted within 10 to 12 days, active endoscopic removal is needed. It is advisable to remove difficult-to-excrete foreign bodies as soon as possible using endoscopy.

　　2. Selection of endoscopes:

　　Foreign bodies in the esophagus should be removed using an esophagoscope or a forward oblique gastroscopy. For foreign bodies in the descending duodenum, it is best to use a duodenoscope. For foreign bodies in the stomach, any type of gastroscopy can be used, and it is preferable to remove them in an oblique forward manner.

　　The double-channel surgical gastroscopy has two biopsy channels with diameters of 3.7mm and 2.8mm, which can insert two surgical instruments simultaneously, making operation more convenient. For children with foreign bodies in the stomach, a thin-bore gastroscopy such as the GIF-P2 model should be used.

　　3. Selection of forceps instruments:

　　(1) Long, rod-like objects: such as pens, bamboo chopsticks, thermometers, silicone rubber tubes, toothbrushes, keys, etc. These types of foreign bodies are most suitable for removal with a snare device. For rod-like objects with a thin outer diameter and smooth surface, it is more suitable to use tools such as triple-jaw pliers, rat's mouth pliers, alligator mouth pliers, and V-shaped flat pliers.

　　(2) Spherical objects: such as nuclei, it is difficult to remove these foreign bodies with forceps, and it is easy to slip off when using a basket-type stone removal instrument or a net-type retrieval tool.

　　(3) Flat-shaped foreign bodies: such as coins, knives, etc. Most of these foreign bodies can be removed using a foreign body retrieval forceps or a biopsy forceps. Smaller iron foreign bodies can be removed by inserting a specialized magnet rod through the endoscope to attract them, and then removing them together with the endoscope.

　　(4) Remaining sutures in the stomach: they can be cut with biopsy forceps and then removed with forceps, or cut with a special surgical scissors, and then removed with a grasping forceps. The suture ends can also be directly removed with a suture remover.

　　After determining the instruments for removing foreign bodies, a simulation test should be performed before surgery to verify whether they can effectively grasp foreign bodies, and the lubricating effect of gastric juice during operation should also be considered.

　　4. Precautions for operation:

　　(1) Perform X-ray examination before surgery: determine the nature, size, and location of the foreign body.

　　(2) When lying flat, foreign bodies in the stomach are often located in the mucous layer of the stomach base and upper body, which affects the operation. During surgery, try to aspirate the gastric juice as much as possible to facilitate the removal of foreign bodies.

　　(3) When grasping the proximal end of a long rod-shaped foreign body or removing glass objects with forceps, avoid applying excessive force.

　　(4) For sharp and pointed foreign bodies, when removing them with forceps, the tip should be pointing downwards to avoid mucosal injury during retraction of the scope.

　　(5) The oropharynx and hypopharynx have a certain angle. When removing a long rod-shaped foreign body, the assistant helps to fix it in a backward position to make the oropharynx and hypopharynx a straight line, which is convenient for removing the foreign body.

　　II. Surgical removal of foreign bodies

　　For larger, longer, sharper, and more numerous foreign bodies, surgery may sometimes be required.

　　1. Indications for surgery:

　　(1) For those who fail to remove foreign bodies conservatively or endoscopically, have severe symptoms, and find it difficult to expel them.

　　(2) For those with signs of peritonitis.

　　(3) For those with X-ray evidence of foreign body impaction at a certain location, with no movement for a week and a risk of piercing an important organ.

　　(4) For those with gastrointestinal bleeding or obstruction.

　　(5) For those with internal fistula or abscess caused by foreign bodies.

　　2. Precautions:

　　Attention should be paid to the operation of removing foreign bodies: (1) Perform abdominal fluoroscopy or take X-rays before surgery to determine the position of the foreign body.

　　(2) Insert a gastric tube before surgery to remove all gastric contents.

　　(3) The incision is determined by the position of the foreign body. Whether the foreign body is in the stomach or intestines, it is best to remove the foreign body by directly cutting the gastrointestinal wall.

　　(4) If a foreign body enters the duodenum and is accompanied by an obstruction, it is best to push the foreign body into the stomach and then remove it through a small incision in the gastric wall.

　　(5) For a large number of foreign bodies, attention should be paid to removing all foreign bodies, and it is best to perform X-ray examination during surgery if possible.

　　(6) For patients with complications such as hemorrhage, perforation, and peritonitis, in addition to removing foreign bodies, appropriate treatment for the complications should be given.