A case of successful endoscopic full-thickness resection for removal of a metal spring buckle penetrating the gastric antral wall A 26-year-old male patient with depression was admitted after intentionally swallowing a circular metal buckle for 2 days.The patient shows no signs of peritonitis.Abdominal X-ray and computed tomography indicated a foreign body in the gastric antrum ( Fig. 1 a,b).Gastroscopy showed a circular metallic foreign body embedded in the gastric wall at the antrum.Erosions and ulcers were observed in the gastric mucosa surrounding the foreign body ( Fig. 2 a,b).Multiple attempts to remove the foreign body with rat-tooth forceps revealed that its both ends were fully transmurally embedded, resulting in unsuccessful extraction ( Fig. 2 c).Endoscopic ultrasonography showed no significant large vessels surrounding the impacted foreign body Fig. 1 a The X-ray reveals a circular foreign object in the upper abdomen.b The computed tomography suggests a circular foreign body embedded in the gastric antral wall with no clear signs of gastrointestinal perforation. Fig. 2 a A circular metallic foreign body is embedded within the gastric antral wall.b Erosion and ulcers are observed on the gastric mucosa at both ends of the impacted foreign body.c Attempted removal of the foreign body using rat-toothed forceps.d An endoscopic ultrasound shows no significant large blood vessels around the impacted foreign body.e Gradual dissection of the metal ring using a dual knife combined with an IT2 knife.f Blurred boundaries between the buckle portion of the metal ring and the muscularis propria of the stomach, with the resulting wound after full-thickness gastric wall incision.g Closure of the wound using metal clips combined with a nylon loop.h The retrieved circular metal spring buckle, approximately 3.6 cm in diameter.
Ma et al. (Sun,) studied this question.