Dan McEntire, MD, Jeffrey S. Bank, MD
University of Utah School of Medicine, Salt Lake City, UT
Introduction: Ingestion of bread bag clips has been described as a surprisingly common cause of GI bleeding or bowel perforation.
Case Description/Methods: A 21-year-old man with no previous medical history or known foreign body ingestion presented after several episodes of acute onset coffee-ground and bright red hematemesis and hematochezia. Vital signs were notable for hypotension (90/65 mmHg) and tachycardia (120 bpm). Hemoglobin decreased from 15.5 to 12.2 mg/dL over four hours, and he received two units of pRBCs without an appropriate response in his hemoglobin concentration. During his EGD, we identified a 14 mm cratered ulcer with a visible vessel and an adjacent foreign body in the duodenal sweep. The object was grasped by rat-tooth forceps, but each attempt to remove it was complicated by hypotension and tachycardia. He then underwent urgent duodenotomy, where a bread-bag clip was identified and removed. Post-operative recovery was uneventful.
Discussion: Ingestion of foreign bodies poses a significant risk of GI bleeding or perforation. Guidelines generally recommend timely endoscopic removal of disk batteries in the esophagus, sharp objects, objects >6cm in length, or in patients with severe esophageal obstructive symptoms. Various retrieval devices are available, and an overtube may be used to protect the esophagus. Surprisingly, there are already several described cases of bread bag clip ingestion that describe esophageal, small bowel, or large bowel bleeding or perforation. The unique shape of these clips leads to snaring of mucosal tissue which may ultimately lead to progressive ulceration. Interestingly, described cases of bread bag clip ingestion occur after unknown or accidental ingestion and occurs most commonly in cognitively impaired patients. Identification of these objects is difficult due to radiolucency, and often goes unnoticed until symptoms begin. Some are amenable to endoscopic removal, while others require surgical resection.
Citation: Dan McEntire, MD, Jeffrey S. Bank, MD. P0443 - UNINTENTIONAL BREAD BAG CLIP INGESTION LEADING TO HIGH RISK DUODENAL ULCER. Program No. P0443. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.