Zeinab Bakhshizarrinabadi, MD, Elie chahla, MD St. Luke's Hospital, St. Louis, MO
Introduction: Foreign body ingestion is a common occurrence in individuals with developmental disorders, such as Down syndrome, due to behaviors like pica. These patients often present with complex medical histories and communication challenges, making diagnosis and management difficult. Gastric outlet obstruction, a potential consequence of foreign body ingestion, requires prompt and often invasive intervention, such as endoscopy, to resolve the obstruction and prevent further complications.
Case Description/Methods: A 30-year-old female patient with a past medical history of hypothyroidism, hyperlipidemia, Down syndrome, non-verbal status, and a history of gastroesophageal reflux disease (GERD) as a newborn presented to the GI clinic. She was accompanied by her mother, who provided the medical history.
The patient had been experiencing vomiting for the past five weeks, accompanied by difficulties in swallowing. She reported that lying down triggered regurgitation, and post-meal gag was also noted although food generally stayed down.
The patient attends daycare, where a recent vomiting incident prompted a visit to the emergency room. The initial evaluation at the ER was unremarkable, leading to a diagnosis of gastritis or viral illness, and she was discharged. However, symptoms of dysphagia, vomiting, and chronic constipation persisted, unresponsive to anti-nausea medication or proton pump inhibitors (PPI).
Due to non-cooperation with abdominal imaging, endoscopy was performed, revealing a large foreign body (sponge) lodged in the pyloric canal and duodenal bulb, causing gastric outlet obstruction (Image 1, a). The sponge was successfully removed, and several ulcers were noted at the obstruction site (Image 1b&c).
The patient was discharged with a prescription for pantoprazole, 80 mg for six weeks, followed by 40 mg for another six weeks. She tolerated the diet well post-procedure.
Educational message: This case highlights the importance of maintaining a high index of suspicion for foreign body ingestion in patients with developmental disorders, especially when symptoms persist or initial evaluations are inconclusive. Additionally, it emphasizes the necessity of further investigation and the crucial role of endoscopy in diagnosing and treating such cases when standard medical management fails.
Discussion: This case underscores the importance of comprehensive evaluation and the utility of endoscopic intervention in managing complex gastrointestinal cases in patients with developmental disorders.
Figure: Image-1 (a)Sponge in the pylorus, causing complete outlet obstruction, (b)sponge was cut into pieces, (c)ulceration where foreign body was logged
Disclosures:
Zeinab Bakhshizarrinabadi indicated no relevant financial relationships.
Elie chahla indicated no relevant financial relationships.
Zeinab Bakhshizarrinabadi, MD, Elie chahla, MD. P2430 - Silent Swallow: Gastric Outlet Obstruction in a Young Girl With Down Syndrome Following Sponge Ingestion, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
