foreign body in stomach
Introduction
Introduction to foreign bodies in the stomach Foreign bodyinstomach is divided into exogenous, endogenous and foreign body formed in the stomach, namely stomach stone disease. Persimmons, hair stones and various foreign bodies swallowed are common in clinical practice. Exogenous foreign bodies swallow foreign bodies into the stomach, and there are various foreign bodies. Common buttons, dentures, coins, animal bone spurs, etc. The endogenous foreign body is a mites that pass through the pylorus, and the gallbladder is perforated into the duodenum to move the gallstone into the stomach. Gastric stones can be divided into plant, animal, drug and mixture according to different ingredients. It is more common in the clinic to eat persimmons, black dates, hawthorn and so on. basic knowledge The proportion of children: the incidence rate of children is about 0.001% - 0.002%, more common under 3 years old Susceptible people: no special people Mode of infection: non-infectious Complications: gastric perforation, gastric ulcer
Cause
Cause of foreign body in the stomach
Inadvertently or deliberately swallowed (35%):
Mistaken to take children as more common, such as mistaking small toys, small hairpins, keys and coins, etc., adults with dentures, animal bones, etc., deliberately swallowing common criminals, mental disorders, swallowing foreign bodies Such as pens, sewing needles, lighters, nails, broken glass and toothbrushes.
Iatrogenic factors (20%):
It belongs to medical accidents caused by the loss of the operator in the hospital, including surgical residual sutures, drainage tubes, etc.
Gastrolithic factor (20%):
Including plant, animal, drug and mixed 4, clinically eaten persimmon, black dates, hawthorn and other plant-based gas stones are more common, prone to indigestion, gastroparesis, partial gastrectomy In patients with reduced gastric motility, when a large number of persimmons are eaten on an empty stomach, the citric acid in the persimmon is in the stomach, and the protein is bound to a protein that is densely soluble in water and precipitates in the stomach. Protein, gum, and fruit acid bind persimmon skin, persimmon nucleus, and plant fiber to form stomach persimmon.
Prevention
Intragastric foreign body prevention
Prevent foreign objects (such as buttons, dentures, pins, coins, pushpins, keys, etc.) from entering the stomach (especially children) and causing stomach problems.
Complication
Gastric foreign body complications Complications, gastric perforation, gastric ulcer
Foreign body in the stomach often combined with massive hemorrhage, perforation, severe gastric ulcer.
Symptom
Symptoms of foreign body in the stomach Common symptoms Abdominal pain, bloating, vomiting, granuloma, nausea, peritonitis, abscess, gastrointestinal bleeding
20% to 30% of the foreign body swallowed is blocked and retained in the esophagus, and more than 80% of the foreign body in the stomach can be discharged from the stomach cavity, excreted from the bowel from the intestine, rarely causing discomfort or only a slight upper abdomen. Pain, fullness, nausea and other symptoms, when the foreign body is large, can be embedded in the pylorus, duodenal jejunum, ileocecal valve and other parts, when the foreign body is blocked in the pylorus, the patient often feels abdominal pain, bloating, vomiting, foreign body Direct damage to the gastrointestinal mucosa, or long-term impaction, causing local mucosal erosion ulcers, can lead to gastrointestinal bleeding, when the foreign body caused by perforation, the patient will have peritonitis, needle sharp foreign body can pierce the gastrointestinal wall and form a limitation Small abscess or granuloma may also penetrate the gastrointestinal wall and move to the abdominal cavity and other parts.
Examine
Examination of foreign bodies in the stomach
Check for any foreign matter in the stool.
X-ray inspection
Metal foreign objects and stomach foreign bodies with metal parts, X-ray examination can determine the shape, size, quantity and position of foreign bodies, and can dynamically observe the migration of foreign bodies. Large metal foreign bodies can be found under fluoroscopy, but Small metal foreign bodies are easily missed by X-ray fluoroscopy. It is necessary to check the film. Whether using X-ray fluoroscopy or radiography to check foreign bodies in the stomach, you should pay attention to the patient's removal of the top, and to understand the shape, size and size of the stomach foreign body under fluoroscopy. Approximate position, and rotate the position to observe whether the foreign body is in the stomach. If there is doubt, check the abdominal wall and back skin of the patient to avoid the metal foreign body in the back and back skin being mistaken for foreign body in the stomach.
Non-metallic gastric foreign body X-ray examination should use contrast or contrast angiography, which can show the contour and position of gastric foreign body.
2. Fiber endoscopy
Since fiber endoscopy has been widely used in clinical practice, fiber endoscopy can be used as long as it does not cause esophageal damage or incarceration when foreign matter is swallowed, especially X-rays cannot be displayed. Non-metallic foreign bodies, where there is a reliable history of foreign body swallowing, should be routine fiber endoscopy, so as not to delay the timing of diagnosis and treatment.
Some patients have a history of swallowing of foreign bodies, but no X-ray and fiber endoscopy equipment, patients have no obvious signs and symptoms, can be closely observed, and carefully check the stool for foreign body discharge, if 5 to 7 days still no Foreign body discharge, the patient has obvious signs of abdominal symptoms, should be promptly transferred to the higher level hospital for further examination to confirm the diagnosis.
Diagnosis
Diagnosis and identification of foreign bodies in the stomach
The diagnosis of gastric foreign body is not difficult. The foreign body that is swallowed often has a history of accidentally ingesting the item in the mouth. The metal foreign object can be X-rayed to determine whether there is any foreign matter and its position. Non-metallic foreign objects can only be used with X-ray. Confirmed by barium meal or gastroscopy.
Gastric foreign body is generally diagnosed according to medical history and X-ray or gastroscopy. Patients with chronic gastric persimmon have a long course of disease, and the symptoms are often similar to chronic gastritis, ulcer disease or gastric cancer, but it is easy to X-ray barium or gastroscopy. It is distinguished from the above diseases.
