intrapancreatic foreign body-case presentation.pptx

intrapancreatic foreign body

1. CASE PRESENTATION 13 years old male who presented for a 5 days history of abdominal discomfort, with nausea,. PMH, PSH; Negative Pain is constant not related to food, increasing in intensity (7/10), and associated with low-grade fever. No relieving or worsening factors.

2. CASE PRESENTATION 1 month PTP , episode of abdominal discomfort, diagnosed to be if viral etiology after a nonsignificant physical exam and normal Lab results

3. CASE PRESENTATION P/E ; Soft Abdomen His vitals were within normal range. Lab results showed an elevated CRP (133.56) and lipase (620), WBC (10 000)

4. Foreign body pancreatitis IV Hydrtion + Antibiotic Surgical vs endoscopic management?

5. IMPROVEMENT

6. Foreign body ingestion Common phenomenon especially in the pediatric population.  represents a challenging clinical scenario.  Increased morbidity is the price for the delayed diagnosis of complications and timely treatment

7. Foreign body ingestion The vast majority of pediatric ingestions are accidental.  Intentional ingestion especially occurs in individuals beyond the age of adolescence  toy’s parts and batteries are the most commonly encountered objects in children,  meat and fish bones represent the most often accidentally ingested foreign bodies in adults. 

8. Foreign body ingestion; Management The size, shape, and the material of the foreign body as well as the patient’s age determine the natural history of this condition A conservative approach to foreign body ingestions is generally justified, The success of nonoperative management depends on the absence of symptoms in a patient with a clear history

9. Foreign body ingestion; Management Urgent endoscopy (24 hours) Sharp-pointed objected in the stomach or duodenum Objects >5 cm in length at or above the proximal duodenum Magnets within endoscopic reach Upper endoscopy (72 hours) for foreign bodies that are unlikely to pass through the gastrointestinal tract. Blunt objects in the stomach that are >2 cm in diameter Disk batteries and cylindrical batteries remaining in the stomach longer than 24 hours

10. Sharp foreign bodies fish bone, chicken bone, tooth pick and sewing needle increase the risk for complications,higher risk of perforation possibility of successful observational management declines Patients are usually unaware of ingestion rendering preoperative diagnosis a real challenging process. The time interval between the ingestion and the possible perforation can be rather prolonged, making the “cause and effect” correlation between the two events especially difficult 

11. Sharp foreign bodies Most patients cannot remember any accidental swallowing of foreign bodies. Symptoms can mimic other diseases such as gastroesophageal reflux and gastritis, just like in our patient. Standing x-rays are used widely for diagnosis but may not provide exact localization like abdominal CT

12. Sharp foreign bodies Common perforation sites are crycopharyngeal ring, cardia, pylorus, C-loop duodenum, ligament of Treitz , Meckel diverticulum, ileocecal valve, appendix, and rectosigmoid junction . In some cases, these sharp foreign bodies can perforate the walls of stomach or duodenum and reach the liver. Foreign bodies reaching pancreas and liver parenchyma can cause abscess, pseudoaneurysm , pancreatitis, and high-mortality-risk complications

13. Sharp foreign bodies;Treatment Endoscopic removal, surgical removal, abscess drainage if necessary, and administration of appropriate antibiotics. If pancreatic injuries are suspected, surgical removal may be required to evaluate the pancreas and manage pancreatic injuries  

14. Sharp foreign bodies;Treatment An endoscopic removal has also been shown to be effective If there was no evidence of free air, abscess formation, migration of the foreign body into the pancreas, or pancreatitis, An endoscopic examination would be attempted first not only for the diagnosis but also for the removal of the detected foreign body

15. Foreign body induced pancreatits Foreign bodies may reach pancreas and liver in 1% of patients, through penetration of small intestine or stomach wall Foreign bodies in pancreas might cause serious complications such as pancreatitis, pancreatic abscess, and pseudoaneurysm

16. Foreign body induced pancreatits ; Literature review

17. Ingested toothpicks are a relatively rare event, poses the greatest risk of perforation may cause serious gut injuries with peritonitis, sepsis, or death. The aim of thestudy was to develop practical guidelines to aid clinicians in the diagnosis and management of acute tooth pick ingestion.

18. 54 %not aware of having swallowed a toothpick 27 % ingested the toothpick accidently while chewing on it. 85 % admitted that they had enjoyed chewing toothpicks on a regular basis. 67 % ingested the toothpick during food intake. 34 %, ;sandwiches that were fixed with a toothpick. 50 %Accompanied by an alcoholic beverage. 12 % of patients were wearing dentures during ingestion

19. 80 % perforation 100%esophagus 67 %stomach, 84 %duodenum 83 %small bowel 80 %of the colon 55 %of the rectum 29 %migration 40 % liver 10 %retroperitoneal space 7 %IVC 7 %free peritoneal space 5 % pericardium 5 %the urinary bladder 1case ,the aorta, the coronary artery, the pancreas, the ureter, the hepatoduodenal ligament, the vena portae, the lung, the kidney, the perianal space, and the right hip.