Perforation of the gastrointestinal tract secondary to ingestion of foreign bodies
Perforation of the gastrointestinal tract secondary to ingestion of foreign bodies
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DOI：
10.1007/s00268-005-0490-2
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发表时间：
2006-03-01
影响因子：
2.6
通讯作者：
Wong, WK
中科院分区：
文献类型：
--
作者：
Goh, BKP;Chow, PKH;Wong, WK
简介：摄入异物并不少见。大多数患者顺利通过胃肠道，穿孔很少见。这项研究的目的是报告我们在我们机构接受手术治疗的进食性胃肠道FB穿孔的经验。方法：回顾1990-2005年间连续62例因进食性FB穿孔而接受手术的患者。结果：患者平均年龄58岁，其中男性37例(60%)。在回收的59个FBS中，55个(93%)是牙签和饮食FBS，如鱼骨或骨头碎片。只有两名患者获得了明确的术前FB摄取史，52名患者中有36名(69%)戴了假牙。共有18个穿孔(29%)发生在肛门或直肠远端，44个穿孔发生在腹内，最常见的腹部部位是回肠远端(39%)。胃、十二指肠和大肠FB穿孔的患者与空肠和回肠FB穿孔的患者相比，更有可能无热(P=0.043)，有慢性症状(P<；3天)(P<；0.001)，白细胞总数正常(P<；0.001)，无症状或出现腹部肿块或脓肿(P<；0.001)。结论：成人进食性FB穿孔最常见于无意识的意外摄入，常由饮食中的FBS，尤其是鱼骨引起。因此，尽管戴假牙是常见的危险因素，但术前摄取FB的历史很少获得。胃、十二指肠和大肠的FB穿孔往往比空肠或回肠穿孔表现出更长、更无害的临床表现。
Introduction: Ingesting a foreign body (FB) is not an uncommon occurrence. Most pass through the gastrointestinal (GI) tract uneventfully, and perforation is rare. The aim of this study was to report our experience with ingested FB perforations of the GI tract treated surgically at our institution.Methods: A total of 62 consecutive patients who underwent surgery for an ingested FB perforation of the GI tract between 1990 and 2005 were retrospectively reviewed. Three patients with no definite FB demonstrated intraoperatively were included.Results: The patients had a median age of 58 years, and 37 (60%) were male. Of the 59 FBs recovered, 55 (93%) were toothpicks and dietary FBs such as fish bones or bone fragments. A definitive preoperative history of FB ingestion was obtained for only two patients, and 36 of 52 patients (69%) wore dentures. Altogether, 18 (29%) perforations occurred in the anus or distal rectum, and 44 perforations were intraabdominal, with the most common abdominal site being the distal ileum (39%). Patients with FB perforations in the stomach, duodenum, and large intestine were significantly more likely to be afebrile (P = 0.043), to have chronic symptoms (> 3 days) (P < 0.001), to have a normal total white blood cell count (P < 0.001), and to be asymptomatic or present with an abdominal mass or abscess (P < 0.001) compared to those with FB perforations in the jejunum and ileum.Conclusions: Ingested FB perforation in the adult population is most commonly secondary to unconscious accidental ingestion and is frequently caused by dietary FBs especially fish bones. A preoperative history of FB ingestion is thus rarely obtained, although wearing dentures is a common risk factor. FB perforations of the stomach, duodenum, and large intestine tend to present with a longer, more innocuous clinical picture than perforations in the jejunum or ileum.