New Delhi: Doctors at the Sir Ganga Ram Hospital (SGRH) here successfully removed a tablet and its aluminum blister foil stuck in the food pipe of a man using an innovative endoscopic technique, a statement said on Friday.
The use of upper gastrointestinal endoscopy for removal of foreign objects in the stomach is a common practice, especially in children. Infants and toddlers often swallow coins, toy batteries, small magnets, and drawing pins which are removed endoscopically, it said. Cases of inadvertently swallowed dentures are reported among the elderly. This requires emergency endoscopic intervention.
According to Anil Arora, Chairman, Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, SGRH, a 61-year-old man came to the emergency room with severe chest discomfort after accidentally swallowing a tablet with aluminium blister foil cover. It got stuck in the upper esophagus and he was unable to swallow anything. An endoscopy was immediately done which revealed a complicated situation, the statement said.
Dr. Shrihari Anikhindi, Consultant Gastroenterologist and Therapeutic Endoscopist, said, The tablet-intact foil was stuck in the narrowest portion of the upper esophagus which did not allow any room for endoscopic manoeuvring and removal.” The aluminium foil was very rigid and had sharp edges. Hence, any forceful removal could have easily injured the esophagus leading to devastating complications like perforation, bleeding, mediastinal infection and sepsis which would have required emergency surgery with its attendant complications, he said.
Since direct removal from the site of impaction (esophagus) was dangerous, we gently and slowly pushed the tablet with intact foil into the stomach. This gives us ample room for maneuvering special accessories,” said Dr Shrihari Anikhindi.
“Once it was inside the stomach, we punctured the aluminium foil using a special endoscopic needle and pushed saline under pressure which dissolved the tablet and all the contents came out of the foil in the stomach cavity,” the doctor said.
As the foil contents were now emptied, it allowed the doctors folded it. This reduced the diameter and inverted the dangerous sharp edges. Using a special accessory called endoscopic mucosal resection (EMR) cap attached to the endoscope, they were able to safely remove the folded aluminum foil out through the mouth, it said.
Surprisingly, this is the second time we encountered such a case, and have successfully used this approach on both occasions. Such cases have not been reported in the literature,” Arora said. “Since there is no standardized approach to such rare impacted foreign bodies, we had to think out of the box,” Arora added.
