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Corps étrangers du tractus gastrointestinal supérieur

Foreign bodies in the upper gastrointestinal tract

  • 2 Citations

Résumé

Les recommandations courantes concernant la conduite à tenir en présence d’une ingestion de corps étrangers sont fondées sur un nombre restreint de publications, chacune souvent limitée à quelques cas. On ne dispose pas de publications donnant des recommandations et une ligne de conduite unanimement acceptées. Les pièces de monnaie sont les corps étrangers le plus souvent en cause. L’impaction œsophagienne d’un bolus alimentaire s’observe le plus souvent chez les patients porteurs d’une sténose œsophagienne et peut être, soit enlevée par voie endoscopique, soit «digérée» par absorption de coca-cola. D’après notre expérience, bien que la majorité des objets parvenus à l’estomac soient évacués par les voies naturelles, ils peuvent séjourner dans cet organe durant des semaines. L’extraction endoscopique est un procédé sûr et constitue la méthode de choix du traitement des corps étrangers œsophagiens et gastriques. Les corps étrangers métalliques, tels que les piles peuvent être aisément retirés grâce à un aimant.

Selon nous, et en plein accord avec la littérature, les corps étrangers impactés dans l’œsophage ou les voies respiratoires supérieures doivent être retirés aussi tôt que possible, en fonction des symptômes et de l’état de jeûne du patient. Comme l’extraction magnétique des piles de batterie est relativement aisée, et que leur fuite, pourtant rare, est susceptible d’entraîner des complications à risque vital, nous préconisons leur extraction de l’estomac dès l’arrivée de l’enfant aux Soins d’Urgence. Pour tous les autres corps étrangers, la règle d’or est la patience puisqu’en général, les objets ayant atteint l’estomac sont évacués par la voie naturelle. Exceptionnellement, il est préférable de retirer de l’estomac des corps étrangers très gros et tranchants (tels que des «pins» ouverts) en utilisant un endoscope recouvert d’un capuchon protecteur distal. En cas de séjour du corps étranger dans l’estomac durant plusieurs semaines, nous préconisons l’extraction endoscopique afin d’éviter cette présence prolongée et les complications qui peuvent en résulter.

Summary

Current recommendations for the management of ingested foreign bodies are based on a limited number of series containing sometimes only a few cases. Unequivocally accepted guidelines and recommendations have not been published. Coins are by far the most frequently ingested. Esophageal impaction of a food bolus occurs most often in patients with an esophageal stenosis, and can be removed endoscopically or «digested» by Coca-Cola. Although most objects reaching the stomach are evacuated through the natural way, it is our experience that they can also remain in the stomach during weeks. Fiberendoscopic extraction is a safe procedure, and is the method of choice in the management of esophageal and gastric foreign bodies. Metal foreign objects, such as button batteries, can easily be extracted with a magnet.

In our opinion, and in accordance to literature, foreign bodies impacted in the esophagus or the airways should be removed as urgently as possible, depending on the symptoms and whether the patient is fasted or not. Since magnetic extraction of batteries is very easy, and leakage, although extremely rare, would result in life threatening complications, it is our attitude to extract batteries if they are still in the stomach at the first Heath Care contact. For all the other foreign bodies, the golden rule is «patience» since normally all objects reaching the stomach will be evacuated through the natural way. under exceptional conditions, it might be preferable to extract very large and sharp foreign bodies (such as open pins) from the stomach, using endoscopic protector hoods. If a foreign body is still present in the stomach after several weeks, we recommend endoscopic removal to avoid life long presence and possibly related complications.

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Correspondence to Y. Vandenplas.

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Cite this article

Vandenplas, Y., De Pont, S. Corps étrangers du tractus gastrointestinal supérieur. Acta Endosc 24, 363–369 (1994). https://doi.org/10.1007/BF02970061

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Mots-clés

  • corps étranger
  • endoscopie
  • extraction
  • piles de batterie

Key-words

  • button battery
  • endoscopy
  • extraction
  • foreign body