RU2112445C1 - Method to remove piercing bodies from a lumen of hollow organ - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method deals with usage of an endoscope. Before foreign body is removed one of its dimensions is excluded by introduction of one of body's edges into mouth-piece situated at endoscopic edge. Then second edge of a body is introduced into a mouth-piece by applying a polypectomic loop over it. EFFECT: higher efficiency. 3 dwg

Description

 The invention relates to medicine, namely to endoscopy, and can be used for endoscopic extraction of foreign objects in the form of, for example, a cross or an open pin from a hollow organ.

 The problem of bloodless removal of foreign objects from the lumen of a hollow organ has always been relevant. With the introduction of endoscopic equipment in surgical practice, the possibilities of removing foreign objects without surgery have expanded significantly. In some cases, endoscopic removal of objects has become an alternative surgical tool for this pathology. However, in endoscopic practice there are foreign bodies with sharp ends and edges, large size and complex geometry. This forces doctors to come up with various devices for their extraction. In this case, two main objectives are pursued: reliable capture and fixation of the subject and safety at the time of removal of the subject using an endoscope.

 It is known that to remove open pins from the esophagus, a method of introducing two rigid esophagoscopes simultaneously into the esophagus is used. The ends of the pins are inserted into the gaps of esophagoscopes, they are fixed and two esophagoscopes and a pin are removed from the esophagus simultaneously. (Kaydash A.N., Yakovenko I.I. On the removal of foreign bodies from the esophagus. Clinical Surgery, 1964, N 3, pp. 84-85. An unusual way to remove foreign bodies from the esophagus. Journal of ear, nose and throat diseases, 1963, N 3, p. 84). The disadvantage of this method is that it is not applicable to other hollow organs and is bulky, traumatic in connection with the introduction of two esophagoscopes into the esophagus. There is a method of endoscopic removal of foreign objects having sharp edges and a complex configuration, characterized in that using a flexible endoscope manipulators a plastic bag is thrown onto a foreign object in the lumen of a hollow organ and then it is removed together with an endoscope (Mainguet PD new Procedure forthe removal of gastric polips and foreign bodiesll Endoscopy. - 1976, vol. 8, p. 88 - 89). The disadvantage of this method is that with its help it is impossible or difficult to remove a foreign object having a considerable length.

 For the prototype, we took the use of Schlemmer's tongs in combination with a rigid esophagoscope to remove open pins from the esophagus (Feldman A.I. Diseases of the esophagus and stomach. - M .: Medgiz, 1949, p. 105-112). The method is carried out by introducing into the esophagoscope one end of the pin, fix it. The second end of the pin is inserted into the lumen of the esophagoscope, fixed and rotated with Schlemer's forceps.

 The disadvantage of this method is the impossibility of its use for removing pins from the distal stomach and lower digestive tract.

 In order to remove foreign objects bound together by an elastic band and representing a cross, an endoscopic intervention method is used, characterized in that the binding gum is crossed with endoscopic scissors and the parts of the foreign body are removed separately (A. Greenblat, A. I. Kartavenko, Medvedkov V.P. et al. Foreign bodies of the esophagus in adults, Surgery, 1980, N 3, p. 91-94).

 The disadvantage of this method is that it is not always possible to cross the gum with scissors, as well as the fact that in order to remove all parts of a foreign object, the endoscope is introduced again and again into the lumen of the hollow organ.

 The aim of the invention is to increase the reliability of the method of endoscopic removal of foreign objects in the form of a cross and pins of significant size, reducing injuries during manipulations with a foreign body.

 The essence of the invention is the use of a flexible endoscope to remove stitching flexible objects, including a nozzle on the end of the endoscope and polypectomy loop. An endoscope with a nozzle is inserted into the lumen of a hollow organ, one end of the object (1 in Fig. 1) is inserted into the nozzle (2 in Fig. 1) of the endoscope, and the other end of the object (1 in Fig. 2) is captured by a polypectomy loop (2 in Fig. 2) and is pulled to the endoscope lens with a nozzle (2 in Fig. 3). In this case, the overall dimensions of the object are reduced and under the control of vision, a safe removal of a foreign body occurs (1 in Fig. 2).

 Subject 1. Patient S., born in 1959, was admitted to the surgical department of a special hospital on 09/20/1988 with complaints of recurring pain in the epigatric region. 2 days ago, a foreign object, a “cross” of two pieces of steel wire of 6 cm each, which are fastened together in the middle with an elastic band, swallowed a folded and coated with bread crumb. During X-ray examination, a foreign body in the form of a "cross" is projected in the pyloric region of the stomach. The EGBD VO-4 endoscope with the nozzle is inserted into the stomach. Foreign body - the "cross" in the pyloric department of the stomach. Attempts to cross the gum connecting the pieces of wire were unsuccessful. By manipulating the endoscope, it was possible to insert one end of the “cross” into the nozzle, the other end of the foreign object was captured by a polyectomic loop and pulled to the endoscope end - thus the “cross” formed. Removing it went without complications.

 Example 2. Patient Ch., Born in 1964, was admitted to the surgical department of a special hospital on 10/15/1988 with complaints of cramping pain in the epigastrium, which intensifies after eating. 4 days ago, he swallowed a "cross" of aluminum wire 8 cm long. A fluoroscopic foreign body is not detected. On the x-ray is a weak shadow of a foreign body in the form of a "cross" in the right hypochondrium. The EGBD VO-4 endoscope with the nozzle is inserted into the stomach. Superficial gastritis detected. It was established that the foreign body was infringed in the gatekeeper, from which two ends of the "cross" stand. One end of the foreign body is inserted into the nozzle, the other is captured by a polypectomy loop and pulled to the lens. It was possible to fold the "cross" and remove it without complications. After conservative therapy of gastritis, the patient was discharged in satisfactory condition.

 The medical and social effectiveness of the present invention consists in replacing the surgical aid for piercing foreign objects with endoscopic intervention. This leads to savings in narcotic drugs, dressings, electricity, medical oxygen and to a reduction in the patient’s stay in bed from 10 to 1 day, as well as in cases of intentional swallowing of piercing foreign objects, the very idea of swallowing objects is discredited in order to receive surgical treatment.

Claims (1)

 A method of removing foreign objects from a hollow organ in the form of a cross or a large pin, including the use of an endoscope with a nozzle, characterized in that after introducing one end of the object into the nozzle at the endoscope end, a polypectomy loop is placed at the other end and introduced into the same nozzle .

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