Hospital Clínic, Barcelona – Spain
Case
A 24 years old female with history of mild mental retardation, psychotic crisis and Pica syndrome who has required four previous surgical interventions to remove foreign bodies (enterotomy and gastrotomy two by open approach and two by laparoscopic approach) was brought to the emergency room because she ate a knife. No exact data regarding the time of ingestion was available.
On physical examination the patient had stable vital signs, the abdomen was soft and the had the a scars from a inferior laparotomy, a superior laparotomy and from two 12mm ports, one at each flank. Blood test was normal.
An abdominal X-Ray (FIG1) revealed a radiopaque foreign body compatible knife at the level of the stomach, without pneumoperitoneum.
Treatment
A gastroscopy was attempted (FIG2) but the endoscopy were unable to retrieve the knife safely so surgical treatment was performed. An umbilical trocar was placed at the level of the umbilicus with Hasson’s technique. Few adhesions were found. Two ports were placed under laparoscopic surveillance a 5mm at the right flank and a 12mm a the left flank.
The tip of the knife was in contact with the fundus a small gastrotomy was performed and the knife was placed in a protective bag that was extracted through the wound of the 12mm port. The gastrotomy was closed with a running suture of 2-0 Vicryl and sealed with an epiploon patch.
Outcome
Surgery took 45 minutes and was uneventful. The patient resumed oral intake the next day and left the hospital two days after the procedure due to psychiatric evaluation.
FIG 1. Knife at the level of the stomach
FIG 2. Endoscopic view of the foreign body
