Rezan KARAALİ, Ahmet KAYALI, Osman Sezer ÇINAROĞLU, Zeynep KARAKAYA, Firdevs TOPAL

Yabancı Cisim Alımı ile Acil Servise Başvuran Hastaların Retrospektif Değerlendirilmesi

Amaç:beslenme ya da solunum yolunda yabancı cisim olması erişkinlerde acil başvurularının sık bir nedenidir. Hastalar ve Yöntem:bu çalışma 3. Basamak acil servise başvuran hastalarla, tek merkezli, retrospektif olarak yapıldı.18 yaş üzeri, gebe olmayan, travması olmayan ve dosyalarında yeterli veriye ulaşılabilen hastalar çalışmaya alındı. Hastaların yaşı, cinsiyeti, alımın nedeni (yanlışlıkla, suicid amaçlı, cinsel amaçlı), cismin türü, yapılan tetkikler, uygulanan tedavi yöntemi, komplikasyon ve mortalite durumu kaydedildi. Bulgular:Çalışmaya alınan 189 hastanın yaş ortalaması 36, hastaların %59,2’si kadın olarak bulundu. Hastaların %86,2’si yanlışlıkla, %10,6’sı suicidal amaçlı ve %3,2’si cinsel amaçlı almıştı. Yanlışlıkla alımlar kadınlarda fazla saptanırken, self harm amaçlı alımlara sadece erkeklerde rastlandı. Yanlışlıkla alımlarda en fazla kılçık, iğne, gıda, sarımsak ve diş e rastlandı. Self harm amaçlı alımlarda en fazla kullanılan maddeler jilet, çivi gibi keskin cisimlerdi. Olguların %40,7’sine fleksiblelaringoskopi, %57,6’sına endoskopik girişim yapıldı. %61,3’ünden yabancı cisim fleksiblelaringoskopi ve endoskopik girişim ile çıkarılırken; %6,9’una cerrahi işlem yapıldı. Yabancı cisimlerin en sık rastlandığı yerler ise en sık larenks- farenks, ösefagus ve midede olarak bulundu. komplikasyona rastlanmadı. hastalardan hiçbiri ölmedi. Sonuç:Yabancı cisimlerin yutulması dünya çapında yaygın bir klinik problemdir. Hastanemize yabancı cisim yutulma şikayetiyle başvuruların çok olması nedeniyle acil servis ve gastroentereoloji klinikleri bu konuda tecrübeli ve deneyimlidir. Çalışmamızın sonucunda, yüksek başarı ve düşük komplikasyon oranı nedeniyle Endoskopik yaklaşım en güvenilir ve efektif yöntem olarak değerlendirilmiştir.

Retrospective Analysis of Management of Ingested Foreign Bodies in Emergency Department

Purpose:A foreign body in the airway or gastrointestinal system is a common cause of emergency presentations in adults. Patients and Methods:This single center, retrospective study involved patients presenting to a third-tier emergency department with foreign bodies in the airway or gastrointestinal system. Non-traumatic, non-pregnant patients aged 18 or over were scanned through the ICD-10 diagnostic code. Age and sex, reasons for ingestion/insertion (unintentional, for suicide, or for sexual gratification), the type of object, test data, treatment, complications and mortality were recorded. Results:The mean age of the 189 patients included was 36, and 59.2% were women. Ingestion was unintentional in 86.2%, for suicide in 10.6%, and for sexual gratification in 3.2%. Unintentional ingestion was more common in women, while ingestion for self-harm was unique to men. Fish bones, pins, garlic, and teeth were most frequently encountered in unintentional ingestions. The most commonly ingested objects for self-harm were sharp items such as razor blades and nails. Flexible laryngoscopy was employed in 40.7% of cases and endoscopic interventions in 57.6%. Foreign bodies were removed with flexible laryngoscopy or endoscopy in 61.3% of cases, and surgery was performed on 6.9%. Foreign bodies were most encountered in the larynx-pharynx, esophagus, and stomach.None of the patients died. No complications were detected. Conclusion:Foreign body ingestion is a widespread, global clinical problem. Our hospital receives many presentations involving foreign body ingestion, and the emergency and gastroenterology departments have considerable experience in this area. The endoscopic approach was the safest and most effective method due to its high success and low complication rates.

Keywords:

emergency department, foreign body, diagnose, emergency management,

PDF

___

1- Hong KH, Kim YJ, Kim JH, Chun SW, Kim HM, Cho JH Risk Factors For Complications Associated With Upper Gastrointestinal Foreign Bodies. World J Gastroenterol 2015;21(26):8125-31.
2- Choi PW, Surgical Removal of Multiple Gastric Foreign Bodies. Case Report. American Journal of Medical Case Reports 2019;7(1):1-4.
3- Nicolodi GC, Trippia CR,. Caboclo MFFS, de Castro FG, Miller WP, de Lima RR et al. Intestinal Perforation By An İngested Foreign Body. Radiol Bras 2016;49(5):295–9.
4- Kızıltan R, Yılmaz Ö, Aras A, Toktaş O, Batur A, Ağar F et al. Ingested Intraabdominal Foreign Bodies That Require Surgical Intervention. Ulus Travma Acil Cerrahi Derg 2016;22(3):269–272.
5- Birk M, Bauerfeind P, Deprez PH, Häfner M, Hartmann D, Hassan C et al. Removal Of Foreign Bodies in The Upper Gastrointestinal Tract in Adults: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2016; 48: 489–96
6- Palta R, Sahota A, Bemarki A, Salama P, Simpson N, Laine L. Foreign-Body Ingestion: Characteristics And Outcomes in A Lower Socioeconomic Population With Predominantly Intentional Ingestion. Gastrointestinal Endoscopy 2009;69(3):1-2.
7- Geraci G , Sciume C, Di Carlo G, Picciurro A, Modica G. Retrospective Analysis Of Management Of Ingested Foreign Bodies And Food Impactions in Emergency Endoscopic Setting in Adults. BMC Emergency Medicine 2016;16:42.
8- Li ZS, Sun ZX, Zou DW, Xu GM, Wu RP, Liao Z. Endoscopic Management Of Foreign Bodies in The Upper-GI Tract: Experience With 1088 Cases in China. Gastrointestinal Endoscopy. 2006;64(4): 485-92.
9- Okan İ, Akbaş A, Küpeli M, Yeniova AÖ, Esen M, Özsoy Z. Management Of Foreign Body Ingestion And Food Impaction in Adults: A CrossSectional Study. Ulus Travma Acil Cerrahi Derg 2019;25(2):159-66.
10- Robertson AR. Self-harm by Sharp Foreign Body Ingestion. Suicide Life Threat Behav 2019;49(3):735-8.
11- Coskun A, Erkan N, Yakan S, Yıldirim M, Cengiz F. Management of rectal foreign bodies. World Journal of Emergency Surgery 2013; 8(11):2-5.
12- Yildiz SY, Kendirci M, Akbulut S, Ciftci A, Turgut HT, Hengirmen S. Colorectal Emergencies Associated With Penetrating Or Retained Foreign Bodies. World Journal of Emergency Surgery 2013; 8(25):2-5.
13- Principe DR, Rubin J, Narbutis M, Cabrera J ,Mitsiev I. Repeat Presentation Of Large Rectal Foreign Body Requiring Surgical Intervention. Journal of Surgical Case Reports 2019;4:1–3.