Duodenal dislodgement of an ingested sharp foreign body by mucosal unfolding "Gilan maneuver"; A novel surgical approach. (January 2022)

• Record Type: Journal Article
• Authors: Baghi, Iraj; Pirooz, Amir; Ebrahimian, Ramin; Hajian, Abbas
• Is Part Of: International journal of surgery case reports. Volume 90(2022)
• Publication Date: 2022-01
• Subjects: Duodenal loop -- Foreign body -- Needle -- Pediatric -- Sharp object; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2021.106721
• Languages: English
• ISSNs: 2210-2612

Abstract

Abstract: Introduction and importance: Foreign body (FB) ingestion is a common challenge for pediatric health care providers globally. Although endoscopic approach for FB extraction is recommended, surgery remains life giving specifically in developing countries. We presented a novel surgical approach called 'Gilan maneuver' for removal of FB which lodged in duodenal loop. Case presentation: An eighteen months old male infant referred to emergency department while he lied on his mother's arm. Parents stated their son has ingested a sharp metallic pointy thick needle which applies for cattle injection. On examination mid epigastric tenderness was remarkable. Laboratory finding was normal. Plain thoracoabdominal radiologic study confirmed the diagnosis. Patient underwent explorative laparotomy and the needle was removed through 'Gilan maneuver' in which mucosal unfolding of duodenal loop facilitated dislodgement of the FB and it was extracted on the jujenal side. Clinical discussion: Duodenal lodge of sharp FB is rare and could be masked by gastric deposition diagnosis. Mucosal folding, narrow luminal diameter, retroperitoneal adherence, and hard surgical anatomy of the duodenal loop make both sharp and large FBs spontaneous dislodgement and favorable surgical outcome relatively unanticipated. Conclusion: Despite rarity of duodenal deposition of FB it is possible and could be harmful due to adjacent unforgiving organs. Although endoscopic extraction of FB is generally recommended in guidelines, surgical approach is safe and could be considered. Highlights: Thick metazlic sharp needle ingestion although is rare, could lodge in duodenal mucosal fold. Mucosal unfolding of duodenum could safely dislodge foreign body and prevent major complication. Gilan maneuver facilitates intraluminal passage of foreign body by pyloric valve extraction and jujenal pulling gently.