Evaluation of the risk factors for severe complications and surgery of intestinal foreign bodies in adults: a single-center experience with 180 cases.

Background: Foreign bodies (FBs) lodged in the intestine or causing intestinal complications are uncommon in clinical practice but may pose diagnostic difficulties and prove life-threatening. This study aimed to evaluate the risk factors for severe complications and surgery to aid clinicians in the diagnosis and management of intestinal FBs. Methods: We performed a retrospective analysis of patients in whom FBs were lodged in the intestine or caused complications from 2010 to 2020 in the First Affiliated Hospital of Wenzhou Medical University (Zhejiang, China). The characteristics of the patients and FBs, symptoms, imaging findings, diagnostics, treatment strategies, and clinical outcomes were analysed. Furthermore, the risk factors for complications and surgery were investigated. Results: In total, 180 patients were included in our study. Most patients (76.1%) were unable to provide a history of ingestion. Bezoars were the most common FBs (35.6%). The FBs were mainly located in the duodenum (32.8%) and the ileum (27.8%). Surgical removal of FBs was successful in 89 (49.4%) patients and endoscopic removal in 54 (30.0%) patients. Eleven with perforations were treated conservatively. FBs located in the jejunum or ileum were more likely to cause severe complications than those located in the duodenum. FBs located in the jejunum, ileum, or sigmoid colon were more likely to undergo surgery, and severe complications were an independent risk factor for surgery. Conclusion: Intestinal FBs, often localized in angulation, are likely to be misdiagnosed because most patients do not provide a history of FB ingestion. Surgery and endoscopic therapy are the most commonly used treatment modalities. Surgery is not mandatory in clinically stable patients with small and contained perforations. FBs located in the jejunum or ileum are risk factors for both complications and surgery.

Silence by the LAMS: Primary lumen-apposing metal stent for a colorectal anastomotic stricture (with video).

Lumen-opposing metal stents (LAMS) are evolving as novel treatment options in postsurgical strictues. Data on lower GI tract applications, however, are still limited, and technical procedural details need to be refined. This singular clinical report adds to the emerging experience in colorectal stricture treatment by LAMS.

Cholangitis-related biliary pneumatosis cysts in the dawning era of routine direct endoscopic visualization of biliary diseases.

Biliary pneumatosis has recently been reported in intrahepatic amd extrahepatic bile ducts complicating bacterial cholangitis, as characterized by cholangioscopy. This clinical report adds another case of small-scale pneumatosis cysts in the common bile duct to the literature. Similary to previously reported cases, the recent patient likewise had a history of acute cholangitis. It might be tempting to speculate that this finding might prove more common than expected in the dawning era of routine use of cholangioscopic characterization of biliary tract diseases.