S2062 A Wrench in Time
Notice bibliographique
Résumé
INTRODUCTION: Foreign body ingestion is a common scenario that is encountered by gastroenterologist. We describe a rare case of ingestion of a wrench in a patient with history of psychiatric illness. CASE DESCRIPTION/METHODS: 25-year-old male with depression presented to hospital with hematemesis and reported swallowing nails, screws, and a wrench. On exam, he was febrile (39°C), tachycardic, normotensive with tender abdomen. Labs showed anemia (hemoglobin 7.6 gm/dl), INR of 1.2, and lactic acidosis. X-ray chest/abdomen showed a metallic wrench (20 × 3.8 cm) in lower esophagus/proximal stomach with smaller objects in epigastric/pelvic region. CT scan of abdomen and pelvis confirmed the findings and no perforation seen. Upper endoscopy was performed in the OR following endotracheal intubation with surgery team as backup which showed a wrench stuck in distal esophagus and tip extending to stomach body. Superficial tears were seen in distal esophagus and stomach noted to have large amount of clots/blood products which could not completely suctioned. A 20 mm snare was used to grab the wrench and passage from oropharynx facilitated with McGill forceps. High dose acid suppression therapy was initiated. Repeat endoscopy performed for ongoing hematemesis which revealed large gastric ulcer with densely adherent clot, active spurting was seen following removal of the clot from ulcer base. Conventional endoscopic methods failed to achieve hemostasis. Interventional radiology consulted and selective celiac artery angiography showed large splenic artery pseudo-aneurysm and active extravasation from the artery. Coil embolization of splenic artery was performed with successful hemostasis. Psychiatry team advised neuropsychiatric testing for intellectual disability. Patient was discharged with outpatient treatment plan. DISCUSSION: Foreign body ingestion is more common in pediatric population and when it occurs in adults it’s often associated with psychiatric illness or intellectual disability, alcohol intoxication or secondary gain in those who are incarcerated. Our patient had recurrent foreign body ingestions with concern for underlying intellectual delay and psychiatric disorder. The object ingested was relatively large and resulted in gastrointestinal bleeding due to likely pressure related gastric ulcer and pseudo-aneurysm formation. This case has been a rare occurrence of a successful endoscopic removal of a large metal wrench.Figure 1.: X-ray chest and abdomen showing the radiopaque wrench in the esophagus and extending to the stomach (note other metallic objects).Figure 2.: CT scan abdomen and pelvis showing the wrench in the lower portion of the esophagus and the proximal stomach.Figure 3.: Upper endoscopy revealing the wrench in the esophagus and successful retrieval.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».