Question
A 16 year old boy with a long history of self harm was admitted for the third time in four weeks with a history of ingestion of a number of shaving blades (fig 1 ▶). On previous occasions, endoscopic intervention with the use of an overtube under general anaesthesia had been successful in their safe retrieval. However, on the third occasion, a delay to endoscopy of 36 hours (due to a combination of late presentation and lack of access to the operating theatre) allowed the blades to progress beyond the pylorus into the small bowel, beyond the reach of a standard upper gastrointestinal endoscope (fig 2 ▶).
Figure 1.
X ray showing the razor blades in the stomach.
Figure 2.
X ray showing the razor blades in the small bowel, beyond the reach of a standard upper gastrointestinal endoscope.
How should this young man now be managed?
Push enteroscopy with the use of an overtube and removal of the blades?
Laparotomy and surgical removal of the blades?
Conservative management?
See page 486 for answer