Gastric foreign body removal with a lithotriptor.

A 40-year-old man who had ingested a rubber ball accidentally while drinking a glass of orange juice presented with abdominal pain and 2 bouts of emesis. He underwent EGD for removal of the foreign body in his stomach. Initial attempts included the use of rat-tooth forceps and a snare, both which were unsuccessful because the rubber ball could not be retrieved through the gastroesophageal junction. He was referred to our advanced GI endoscopy center.

During repeated endoscopy, foreign body extraction by use of a snare was unsuccessful. Next, we decided to use mechanical lithotripsy to break the ball and remove it in pieces. The 40-mm foreign body was retrieved with a snare after mechanical lithotripsy and after it was fragmented into 4 smaller pieces (Fig. 1 and Video 1, available online at www.VideoGIE.org). The patient recovered without any adverse events and was discharged from the hospital.

Figure 1

Capture of foreign body in stomach.

About 80% of foreign bodies accidentally ingested are eliminated without adverse events. According to the guidelines of the American Society for Gastrointestinal Endoscopy, objects bigger than 2.5 cm are usually unable to pass through the pyloric canal or the ileocecal valve and should be removed within 72 hours. In this case report, early removal was performed because the patient had abdominal pain.

The endoscopic management of foreign bodies may vary according to the available material. In this patient’s case, the size and endurance of the material led the endoscopist to choose lithotripsy. In some cases, such as that related by Conway et al, bezoar removal is impossible without shattering it. For that reason, a mechanical lithotriptor was used to make removal feasible. Kedia et al used the same procedure to tear a partially eroded gastric band that had extruded into the gastric lumen. Other authors report different techniques, such as guidewire and snare-assisted techniques. However, capturing a spherical object with a snare would be a real challenge.

A literature search revealed several publications reporting the removal of various types foreign bodies classified as sharp, long, and rhombus types and food bolus impaction. However, we were unable to find a report of mechanical lithotripsy for removal of a large rubber ball from the stomach.

Disclosure

All authors disclosed no financial relationships relevant to this publication.