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Journal of Indian Association of Pediatric Surgeons
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Table of Contents   
CASE REPORT
Year : 2016  |  Volume : 21  |  Issue : 4  |  Page : 184-186
 

Laparoscopic retrieval of unusual intra-abdominal foreign bodies in children


Department of Pediatric Surgery, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Date of Web Publication19-Jul-2016

Correspondence Address:
Ravi Prakash Kanojia
Department of Pediatric Surgery, APC, Block 3-A, PGIMER, Sector 12, Chandigarh - 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9261.186549

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   Abstract 

Foreign body (FB) ingestion is a common problem among the pediatric population. On numerous occasions, the FB is left to pass out spontaneously without expecting any harm. There are instances when the FB is either to dangerous to be left alone, that is a button battery or a sharp object. There may be FB, which is either stuck in GIT or have migrated. The situation in these instances demand active intervention. The traditional option has been laparotomy and retrieval. We present here three cases where two needles and a belt buckle were removed by laparoscopy thus avoiding a laparotomy. These cases prove that laparoscopy should be the first choice for such kind of retrieval. These cases had a successful outcome with full recovery.


Keywords: Laparoscopic extraction, pediatric foreign body ingestion, unusual foreign bodies


How to cite this article:
Lone YA, Kanojia RP, Samujh R, Rao KL. Laparoscopic retrieval of unusual intra-abdominal foreign bodies in children. J Indian Assoc Pediatr Surg 2016;21:184-6

How to cite this URL:
Lone YA, Kanojia RP, Samujh R, Rao KL. Laparoscopic retrieval of unusual intra-abdominal foreign bodies in children. J Indian Assoc Pediatr Surg [serial online] 2016 [cited 2019 Sep 17];21:184-6. Available from: http://www.jiaps.com/text.asp?2016/21/4/184/186549



   Introduction Top


Foreign body (FB) ingestion is a common problem in pediatric age group. Most ingested foreign bodies will pass the gastrointestinal tract without any harm but a small number of unusual foreign bodies get impacted in the gut. These unusual foreign bodies have to be surgically removed because either they are stuck or are dangerous, as in case of a pointed needles, fish bones, and button batteries that have been known to cause bowel perforation, infection, and even death. [1],[2] Sometimes FB may migrate from their original entry point and pose a danger to major structures as a blood vessels or solid viscera. Removal is straight forward through open laparotomy after localization. [3] With the surge of laparoscopy, these unusual foreign bodies can be easily removed by minimal access surgery, avoiding a laparotomy scar and giving faster recovery to the child who is otherwise healthy. We describe three cases of unusual foreign bodies that were removed laparoscopically and highlight the advantages of laparoscopy for these instances.


   CASE REPORTs Top


Case 1

An 8-year-old boy presented to our emergency with a history of diffuse nonspecific pain in the upper abdomen after accidentally swallowing a sewing needle 20 days back. Local treatment had advised soft diet and waiting for spontaneous expulsion with stools. When the parents failed to find it in the fecal matter for 20 days, and the child continued to have pain and persistence of needle in the stomach on serial X-rays, the patient was referred. Endoscopy confirmed the presence of needle, and it was decided not to attempt removal as the sharp tip may cause esophageal perforation during retrieval. The patient underwent laparoscopy, and the needle was made to pierce the stomach wall under the vision and extracted through one of the ports in a single short attempt [4] [Figure 1]. No ostomy was required, and a single suture repair was done at the site of piercing. The postoperative period was uneventful, and the patient was discharged in 2 days.
Figure 1: Sewing needle retrieval after piercing through stomach wall

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Figure 2: Retrieval of belt buckle from small bowel

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Case 2

A 3-year-old boy presented to outpatient department with a history chronic abdominal pain after having swallowed a belt buckle about 18 months back. Serial X-rays done at a local hospital showed the persistence of FB in the lower abdomen with failure to pass spontaneously and to cause increasing anxiety for the parents. On laparoscopy, after a bowel walk the belt buckle was identified in the distal small bowel and extracted via an enterotomy that was closed after removal [5] [Figure 2]. The patient recovered uneventfully and was discharged on the 5 th day.

Case 3

An 8-year-old female child presented to our emergency with a history of continuous low-grade right flank pain after accidentally being pierced by a needle in the right flank 1-week back. There was a small bruise in the right flank at the entry site, but no part of the needle could be seen or palpated superficially. X-ray and computed tomography scan of the abdomen done at a local hospital showed the needle completely crossing the abdominal wall and stuck in the superficial part of the right lobe of the liver. The patient was referred to our hospital where laparoscopy revealed the needle partially embedded in the liver substance superficially with adhesion of this part of liver to the peritoneum at the site of entry. The needle was successfully removed via one of the ports without disturbing the liver adhesion for fear of causing bleeding. [6] The patient was observed for a day and then discharged.


   Discussion Top


FB ingestion is a common problem among pediatric populations. A variety of foreign bodies is ingested, ranging from coins, which are the most common, to toy parts, metal pieces, earth material. Most of the time these foreign bodies are innocuous and do not pose any danger and they can be allowed to pass through the gastrointestinal tract without any problem. In instances where the FB is sharp, it is advised to retrieve it as it may get stuck, perforate or migrate. [7] We have described three such cases where the FB was removed laparoscopically avoiding a laparotomy.

Fujiwara et al. classified the four routes of entry of a FB into the peritoneal cavity as percutaneous, penetration after swallowing, either by accident or intentionally, iatrogenic after surgery or examination, and via natural orifice. A variety of gastrointestinal symptoms such pain vomiting as well as respiratory symptoms such as coughing and stridor are associated with FB ingestion. The esophagus, in particular, the upper third, is the common site of FB obstruction. Objects in the stomach and intestine are spontaneously passed more frequently than at any other sites in the gastrointestinal system. Esophageal and gastric foreign bodies are often amenable to endoscopic removal whereas small bowel foreign bodies more often require surgical intervention in case they fail to pass spontaneously. Complications such as bowel perforations, infection, and death are sometimes the worst outcome with ingestion of objects such as batteries and sharp objects such as bones and needles. [1]

Surgery, though rarely required, is the only alternative when endoscopic extraction fails in case of esophageal or gastric foreign bodies and more distally impacted foreign bodies that fail to pass spontaneously or cause complications. There have been reports of laparotomy being done for such foreign bodies and some cases even requiring extreme measures like partial hepatectomy. [3],[8] Laparoscopy is a much easier, quicker, safer, and cosmetically acceptable alternative. The three cases presented here emphasize the fact that laparoscopy should be the standard practice in such cases. Surgery may also be required for the rare cases with non-ingested intraperitoneal foreign bodies migrated from the surface either accidentally. Child abuse with needles has been described and so has been the need for laparotomy in such cases. [9] However, the case presented here (case 3) is only the second reported in the literature of a noningested intraperitoneal/visceral FB extracted with laparoscopy. [10] A timely laparoscopy in these cases should be the standard practice to avoid potentially fatal complications.


   Conclusion Top


Laparoscopy is very effective in retrieving intraluminal and intraperitoneal foreign bodies, helping to avoid laparotomy. Laparoscopy should be the first-hand approach for these unusual situations prior to open exploration.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Fujiwara T, Mitsunori Y, Kuramochi J. Laparoscopic removal of a foreign body (a piece of wire) from the abdominal cavity: A case report and review of thirty two cases in Japan. J Jpn Endosc Surg 2007;12:415-9.  Back to cited text no. 1
    
2.
Lupascu C, Dabija M, Ursulescu C, Andronic D, Vasiluta C, Ursaru M. Removal of an intraperitoneal foreign body using a single port laparoscopic procedure. JSLS 2011;15:257-60.  Back to cited text no. 2
    
3.
Riani EB, Tancredi I, Sempoux C, Hubert C, Goffette P, Gigots JF. From interventional radiology to laparoscopic liver resection as complementary strategies in the treatment of hepatic abscess caused by ingested foreign bodies. Hepatogastroenterology 2012;59:558-60.  Back to cited text no. 3
    
4.
Youtube.com. San Bruno, California. FB Stomach Needle. Available from: https://www.youtu.be/QCifGhIpalM. [Last accessed on 2015 Apr 29].  Back to cited text no. 4
    
5.
Youtube.com. San Bruno, California. Impacted Foreign Body Removal from Jejunum Removed Laparoscopically. Available from: https://www.youtu.be/U1t8uXNOYYo. [Last accessed on 2015 Apr 29].  Back to cited text no. 5
    
6.
Youtube.com. San Bruno, California. Sewing Needle in Liver. Available from: https://www.youtu.be/8-oZuKxwUBI. [Last accessed on 2015 Apr 29].  Back to cited text no. 6
    
7.
Jayachandra S, Eslick GD. A systematic review of paediatric foreign body ingestion: Presentation, complications, and management. Int J Pediatr Otorhinolaryngol 2013;77:311-7.  Back to cited text no. 7
    
8.
Chong LW, Sun CK, Wu CC, Sun CK. Successful treatment of liver abscess secondary to foreign body penetration of the alimentary tract: A case report and literature review. World J Gastroenterol 2014;20:3703-11.  Back to cited text no. 8
    
9.
Alshamrani H, Bakhswain A, Habib Z, Kattan H. Intra-abdominal insertion of sewing needles: A rare method of child abuse. Ann Saudi Med 2013;33:505-7.  Back to cited text no. 9
    
10.
Aarabi S, Stephenson J, Christie DL, Javid PJ. Noningested intraperitoneal foreign body causing chronic abdominal pain: A role for laparoscopy in the diagnosis. J Pediatr Surg 2012;47:e15-7.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2]



 

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    Abstract
   Introduction
   CASE REPORTs
   Discussion
   Conclusion
    References
    Article Figures

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