Endoscopy Brief: Gastric foreign body removal with laparoscopy

Endoscopy Brief: Gastric foreign body removal with laparoscopy

Oct 01, 2004

Figure 1
A 9-month-old intact male Labrador retriever was presented two weeks after it swallowed a Ping-Pong ball. The dog was asymptomatic, but the owner was concerned about any potential complications from the ingestion. The physical examination findings were normal, and a ventrodorsal and lateral abdominal radiographic examination revealed an air-filled spherical structure in the stomach (Figure 1). Gastroscopy was recommended to remove the ball. The results of preanesthetic blood tests were normal, and the dog was anesthetized. Supportive care and monitoring were routine. Gastroscopy was performed, but the ball was too large and too slippery to grasp with any available endoscopic foreign-body grasping instruments, including a snare, a basket, and rat-tooth forceps.

Figure 2
The dog was then prepared for laparoscopy. Laparoscopy was performed with a 1-cm umbilical telescope portal and a 1-cm right paracostal operative portal 3 cm caudal to the last rib at the lateral margin of the rectus abdominis muscle. Pneumoperitoneum was established by insufflating carbon dioxide, and the results of a systematic examination of the abdomen were normal. The pyloric antrum was grasped and elevated to the right paracostal operative portal (Figure 2). The operative portal was then enlarged to allow exteriorization of a small segment of the gastric wall, and a 3- to 4-cm gastrotomy incision was made in the exposed portion of the stomach. The laparoscope and vulsellum forceps were placed into the stomach through the gastrotomy incision. When the ball was located, it was grasped with the forceps (Figure 3) and removed. The pneumoperitoneum was decompressed, and the gastrotomy incision, abdominal wall, and skin incisions were closed in a routine manner.

The patient's recovery was rapid and uneventful. Food was withheld for 24 hours, and cefazolin sodium and butorphanol tartrate were administered. The dog was discharged the day after the procedure.
