Internal Medicine

0521779407-07 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10

Foreign Bodies and Bezoars 591

➣Endoscopic extraction if the object is narrow, and can be grasped

with a snare or forceps

➣Extraction of large objects require general or spinal anesthesia

and larger instruments such as obstetrics forceps

■For a foreign body proximal to the recto-sigmoid junction (high-

lying):

➣Goal is to move object to a low-lying position in the rectum

Consider sedation and a 12-hour observation period followed

by radiographs

If there is no spontaneous descent: anesthesia, bimanual

manipulation and possible laparotomy to move object to a

more distal position where it can removed endoscopically

■For bezoars treatment varies depending on their composition and

size

■Phytobezoars (plant bezoars):

➣Endoscopic treatment:

Mechanical fragmentation using

Jet water through the scope

Nd-YAG laser

Electrohydraulic lithotripsy

Endoscopic lithotriptor

Saline lavage through a large overtube and suctioning

➣Enzymatic therapy with cellulase or N-acetylcysteine

■Trichobezoars (hair balls):

➣Surgery is the standard approach

➣Endoscopic treatment with Nd-YAG laser is less successful

■Concretions of medicines

➣Can be removed by lavage or by endoscopy

➣If these methods fail, surgery is necessary

Complications

■Endoscopic removal of a foreign body or a bezoar can result in per-

foration, peritonitis, bleeding, mucosal damage, and death

Contraindications

■Known perforation

follow-up

■Following removal of a foreign body, the patient should be observed

for the possibility of perforation

■Removal of objects from the rectum require immediate rigid or flex-

ible sigmoidoscopy to check for lacerations