Minimally Invasive Management of Gastrointestinal Foreign Bodies

Abstract

Purpose:

Laparoscopy can be utilized for diagnostic exploration as well as for management of abdominal conditions. Therapeutic laparoscopic management of gastrointestinal foreign bodies (FB), especially in the pediatric population, has not been reported extensively.

Methods:

Since March 2001, three children have undergone laparoscopic management of gastrointestinal foreign bodies. Clinical cases and surgical approaches were reviewed.

Results:

All three patients were successfully managed laparoscopically. The mean operative time was ninety minutes. Patient 1 presented with an 18-month history of symptoms consistent with intermittent small bowel obstruction. A coin was visualized on the abdominal films. At laparoscopy, a jejunal web was identified. Web resection with coin removal was performed. Patient 2 underwent computed tomography scanning of the abdomen and pelvis for abdominal pain, and a mass suspicious for a FB was seen near the falciform ligament. At laparoscopy, the transverse colon was adhered to the abdominal wall. Laparoscopic colon resection was performed after identification of a colonic perforation due to a toothpick. A gastric FB was incidentally discovered in patient 3 during laparoscopic Nissen fundoplication for gastroesophageal reflux disease. The FB, a coin, was laparoscopically manipulated into the distal esophagus where a Foley catheter was used to remove it, through the mouth.

Conclusions:

Laparoscopy can be a valuable tool in the management of gastrointestinal foreign bodies. The combination of short operative times and hospitalization warrants its consideration when a gastrointestinal FB does not pass.