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Kumar, Rajesh
- A Case of Young Colon Cancer Presenting as Neck Mass
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Authors
Affiliations
1 Department of Gastroenterology IGMC- Shimla, IN
1 Department of Gastroenterology IGMC- Shimla, IN
Source
The Indian Practitioner, Vol 73, No 6 (2020), Pagination: 50-52Abstract
Colorectal adenocarcinoma, the third most diagnosed cancer in males and the second most diagnosed in females, commonly presents with changes in bowel habits, rectal bleeding, weight loss, fatigue, and abdominal pain. While non-regional lymphatic the involvement in colon primary is an uncommon finding, metastatic mediastinal and su-praclavicular lymph node without the involvement of major intermediary organs like liver or lungs is extremely rare. We report the case of a 25-year-old male with colorectal cancer who had an unusual initial presentation as a progres-sively increasing left-sided neck mass. Early age of onset of colorectal malignancy without any bowel symptoms and presentation as metastasis to left supraclavicular node (Virchow’s node) without solid end-organ involvement makes this case novel.Keywords
Colorectal Carcinoma, Contrast Enhanced Computed Tomography, FNAC, Carcinoembryonic Antigen.
References
- Lindsey A., et al.“Global Cancer Statistics, 2012”. Ca: A Cancer Journal for Clinicians 65.2 (2015): 87-108.
- K. M. Mohandas and D. C. Desai, “Epidemiology of digestive tract cancers in India. V. Large and small bowel,”Indian Journal of Gastroenterology, vol. 18, pp. 118–121, 1999.
- Speights VO, Johnson MW, Stoltenberg PH, Rappaport ES, Helbert B, Riggs M. Colorectal cancer: current trends in initial clinical manifestations. South Med J. 1991May; 84(5):575-578.
- El-Halabi MM, Chaaban SA, Meouchy J, Page S, Salyers WJ. Colon cancer metastasis to mediastinal lymph nodes without liver or lung involvement: a case report. Oncol Lett. 2014;8(5):2221–2224.
- Reddy RR, Das P, Rukmangadha N, Manilal B, Kalawat TC. Colonic carcinoma presenting with axillary lymphadenopathy-a very rare clinical entity. IJSR. 2017; 6(8):2015–2017.
- Venugopal, A., Stoffel, E.M. Colorectal Cancer in Young Adults. Curr Treat Options Gastro17, 89–98 (2019).
- Prachi S. Patil 1 & Avanish Saklani et al. Colorectal Cancer in India: An Audit from a Tertiary Center in a Low Prevalence Area. Indian J Surg Oncol (December 2017)8(4):484–490.
- Achmad H, Hanifa R. Supraclavicular lymphnodes: unusual manifestation of metastases adenocarcinoma colon. Acta Med Indones. 2015;47(4):333–339.
- Sundriyal D, Kumar N, Dubey SK, Walia M. Virchow’s node. Case Reports. 2013;2013(1):bcr2013200749–bcr2013200749.
- Aksel B, Dogan L, Karaman N, Demirci S. Cervical lymphadenopathy as the first presentation of sigmoid colon cancer. Middle East J Cancer. 2013;4(4):185–188.
- A Case of Dual Primary Gastric and Colonic Malignancy
Abstract Views :302 |
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Authors
Affiliations
1 Professor, Department of Gastroenterology IGMC- Shimla, IN
2 Assistant Professor, Department of Gastroenterology, IGMC - Shimla, IN
3 Associate Professor, Department of Gastroenterology, IGMC- Shimla, IN
4 Senior Resident, Department of Gastroenterology, IGMC- Shimla, IN
1 Professor, Department of Gastroenterology IGMC- Shimla, IN
2 Assistant Professor, Department of Gastroenterology, IGMC - Shimla, IN
3 Associate Professor, Department of Gastroenterology, IGMC- Shimla, IN
4 Senior Resident, Department of Gastroenterology, IGMC- Shimla, IN
Source
The Indian Practitioner, Vol 73, No 8 (2020), Pagination: 43-45Abstract
Incidence of multiple primary malignant neoplasm increases with age, mainly because of an improvement in diagnostic techniques and prolonged survival of patients treated for malignancy. Multiple tumors may develop synchronously or metachronously. If the time interval between the appearances of the two neoplasms is less than 6 months, they are defined as synchronous, and if the time interval is longer than 6 months, they are classified as metachronous. Gastric cancer associated with synchronous colon cancer is very rare. We report a case of 56 year old male who was presented with dyspepsia with associated alarm feature and during evaluation was found to have synchronous primary gastric and colonic cancer.Keywords
Esophagogastorduodenoscopy, Gastric Cancer, Double Primary Gastric and Colorectal Cancer, Histopathological Examination.References
- Watanabe S et al. Multiple primary cancers in 5,456 autopsy cases in the National Cancer Center of Japan. J Natl Cancer Inst 1984; 72(5): 1021−7.
- Billroth T. Die allgemeine chirurgische pathologie und therapie. In: Reimer G. (ed.) 14 Aufl. Berlin 1889; 908
- Warren S, Gates O. Multiple primary malignant tumors: a survey of the literature and statistical study. Am J Cancer. 1932; 16:1358–1414.
- Ha TK, An JY, Youn HG, et al. Surgical outcome of synchronous second primary cancer in patients with gastric cancer. Yonsei Med J 2007; 48: 981-987.
- Yano K, Yamashita T, Chishiki M, Osaki T, Sugio K, Yasumoto K. Two cases of synchronous superficial double cancers in the esophagus and stomach. J UOEH 2002. 24: 225-232.
- Onoue S, Katoh T, Chigira H, et al. Synchronous multiple primary cancers of the stomach and duodenum in aged patients: report of two cases. Sur Today 2000; 30: 735-738.
- Dinis-RM, Lomba VH, Silva R, Moreira L, Lomba VR. Associated primary tumours in patients with gastric cancer. J Clin Gastroenterol 2002; 34: 533-535.
- Mitsugu Kochi, Masashi Fujii, Noriaki Kanamori, Yoshiaki Mihara, Tomoya Funada, Hidenori Tamegai, Megumu Watanabe, Yuriko, Takayama, Hiroshi Suda, Tadatoshi Takayama. Metachronous Double Primary Gastric and Colorectal Cancer: Is Prognosis Better with Gastric or Colorectal Cancer Occurring First? Journal of Cancer Therapy, 2013, 4, 720-725
- Green PH, O’Toole KM, Weinberg LM, Goldfarb JP. Early gastric cancer. Gastroenterology. 1981; 81:247–256.
- Ikeguchi M, Ohfuji S, Oka A, Tsujitani S, Maeda M, Kaibara N. Synchronous and metachronous primary malignancies in organs other than the stomach in patients with early gastric cancer. Hepatogastroenterology. 1995;42:672–676
- Bozzetti F, Bonfanti G, Mariani L, Miceli R, Andreola S. Early gastric cancer: unrecognized indicator of multiple malignancies. World J Surg. 2000; 24:583–587.
- Ikeda Y, Saku M, Kawanaka H, Nonaka M, Yoshida K. Features of second primary cancer in patients with gastric cancer. Oncology. 2003; 65:113–117.
- Knekt P et al. Risk of colorectal and other gastro-intestinal cancers after exposure to nitrate, nitrite and N-nitroso compounds: a follow-up study. Int J Cancer. 1999; 80:852-6.
- Evaluation of the Gastrointestinal Tract in a Young Patient with Iron Deficiency Anemia – A Case Report
Abstract Views :169 |
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Authors
Affiliations
1 Assistant Professor, Department of Gastroenterology, IGMC- Shimla, IN
2 Professor, Department of Gastroenterology IGMC- Shimla, IN
3 Associate Professor, Department of Gastroenterology IGMC- Shimla, IN
4 Senior Resident, Department of Gastroenterology IGMC- Shimla, IN
1 Assistant Professor, Department of Gastroenterology, IGMC- Shimla, IN
2 Professor, Department of Gastroenterology IGMC- Shimla, IN
3 Associate Professor, Department of Gastroenterology IGMC- Shimla, IN
4 Senior Resident, Department of Gastroenterology IGMC- Shimla, IN
Source
The Indian Practitioner, Vol 73, No 8 (2020), Pagination: 46-48Abstract
Iron deficiency anemia is not a disease in itself, but may be a manifestation of a serious underlying disease such as malignancy. The incidence of colorectal and gastric cancer in younger individuals is low. Therefore, the yield of upper and lower gastrointestinal tract examinations in young men with IDA to evaluate for the presence of GI pathology may also be lower than that in older men. So evidence for the necessity of endoscopy in young men with IDA is significantly lacking. Here we present a case of chronic iron deficiency anemia in a young 25 year old male patient, who on evaluation was found to have sporadic stage IV colonic carcinoma.Keywords
Iron Deficiency Anemia, Esophagogastroduodenoscopy, Contrast Enhanced Tomography, PET, Gastrointestinal, FNAC.References
- Short MW, Domagalski JE. Iron deficiency anemia: evaluation and management. Am Fam Physician 2013; 87:98–104.
- Johnson-Wimbley TD, Graham DY. Diagnosis and management of iron deficiency anemia in the 21st century. Therap Adv Gastroenterol 2011; 4:177–184.
- Goddard AF, James MW, McIntyre AS, Scott BB, British Society of Gastroenterology. Guidelines for the management of iron deficiency anaemia. Gut 2011;60:1309–1316
- Kim NH, Park JH, Park DI, et al. Should asymptomatic young men with iron deficiency anemia necessarily undergo endoscopy? Korean J Intern Med. 2018 Jan 5.
- Rockey DC, Cello JP. Evaluation of the gastrointestinal tract in patients with iron-deficiency anemia. N Engl J Med 1993; 329:1691–1695.
- Ioannou GN, Rockey DC, Bryson CL, Weiss NS. Iron deficiency and gastrointestinal malignancy: a population- based cohort study. Am J Med 2002; 113:276–280.
- Inra JA, Syngal S. Colorectal cancer in young adults. Dig Dis Sci 2015; 60:722–733.
- Karimi P, Islami F, Anandasabapathy S, Freedman ND, Kamangar F. Gastric cancer: descriptive epidemiology, risk factors, screening, and prevention. Cancer Epidemiol Biomarkers Prev 2014; 23:700–713.
- Venugopal, A., Stoffel, E.M. Colorectal Cancer in Young Adults. Curr Treat Options Gastro 17, 89–98 (2019).
- Dysphagia as a Presenting Complaint in Carcinoma Lung: A Case Report
Abstract Views :185 |
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Authors
Affiliations
1 Department of Gastroenterology, IGMC- Shimla, IN
2 Department of Gastroenterology ,IGMC- Shimla, IN
1 Department of Gastroenterology, IGMC- Shimla, IN
2 Department of Gastroenterology ,IGMC- Shimla, IN
Source
The Indian Practitioner, Vol 73, No 9 (2020), Pagination: 38-40Abstract
Carcinoma lung classically present with symptoms of cough, hemoptysis, chest pain and weight loss. Lung cancer presenting with sole manifestation of difficulty swallowing as the initial presenting complaint is very uncommon. Literature reports 1-2 % patients with lung cancer had dysphagia at presentation. We report a case of 45 years male, who is initially evaluated for the complaints of difficulty swallowing and eventually diagnosed to have carcinoma lung with mediastinal lyphadenopathy as the cause of his symptoms.Keywords
Lymphadenopathy, Extrinsic Compression, Carcinoma.References
- Zannini G, Coseri A. Dysphagia in lung cancer. Riforma Med. 706 (1962) 708.
- Le Roux BT. The presentation of bronchial carcinoma. Scott Med J. 1968; 13: 31-7.
- Hyde L, Hyde C. Clinical manifestations of lung cancer. Chest. 1974; 65: 299-306.
- Maguire PD, Sibley GS, Zhou S-M, et al. Clinical and dosimetric predictors of radiation-induced oesophageal toxicity.Int J Rad Onc Biol Phys. 1999; 45: 97-103.
- Stankey RM, Roshe J, Sogocio RM. Carcinoma of the lung and dysphagia. Dis Chest. 1969; 55: 13-17.
- Makker HK, Chisholm R, Rate AJ, Bancewicz J, Bernstein A. Dysphagia due to secondary achalasia as an early manifestation of squamous cell carcinoma. Postgrad Med J. 1995;71: 505-6
- Fleishner F.C. The esophagus and mediastinal lymphadenopathy in bronchial carcinoma. Radiology. 58(1952) 48.
- Kaasa S, Mastekaasa A, Thorud E. Toxicity, physical function and everyday activity reported by patients with inoperable non-small cell lung cancer in a randomized trial (chemotherapy versus radiotherapy). Acta oncol. 1988; 27 (4): 343–349.
- Horwich A, Lokich JJ, Bloomer WD. Doxorubicin, radiotherapy, and oesophageal stricture. Lancet. 1975 Sep 20; 2(7934):561–562.
- Hassan WA, Darwish K, Shalan IM, Elbaki LA, Elmohsen EA, Sayed WH. Aetiologic mechanisms of dysphagia in lung cancer: A case series. Egyptian Journal of Chest Diseases and Tuberculosis. 2014; 63(2): 435–442.
- Camidge D.R. The cause of dysphagia in carcinoma of the lung. J R Soc Med. 2001; 94:567-572.
- ‘Downhill’ Varices as a Surrogate Marker for Mediastinal or Lung Pathology: A Case Report
Abstract Views :218 |
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Authors
Affiliations
1 Department of Gastroenterology ,IGMC- Shimla, IN
1 Department of Gastroenterology ,IGMC- Shimla, IN
Source
The Indian Practitioner, Vol 73, No 10 (2020), Pagination: 26-28Abstract
‘Downhill’ varices are dilated veins resulting from SVC obstruction whose blood flow is directed caudally towards azygous vein or inferior vena cava. Their etiology differs from that of the usual “uphill” varices secondary to portal hypertension. We report a case of 63 year old male that was suspected to have mediastinal / lung pathology based on finding of downhill varix on diagnostic esophagogastroduodenoscopy despite normal chest X- ray. Subsequently, the lung pathology was confirmed on contrast enhanced tomography of chest and on bronchoscopy. So findings of ‘downhill’varices on endoscopy can suggest lung/medistinal pathology which needs to be confirmed on subsequent testing.Keywords
Esophagogastroduodenoscopy, Red color sign, Contrast Enhanced Computed Tomography, Endoscopic Band Ligation.References
- Felson B, Lessure AP. “Downhill” varices of the esophagus. Dis Chest. 1964; 46:740-46.
- Rosenblatt ML, Rabinowitz M. Downhill esophageal varices (EV) secondary to fibrosingmediastinitis. (FM) AJG. 2000; 95:2602-03.
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- Tavakkoli H, Asadi M, Haghighi M, Esmaeili A. Therapeutic approach to downhill esophageal varices bleeding due to superior vena cava syndrome in Behcet’s disease: a case report. BMC Gastroenterol. 2006 ; 6: 43.
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- Vorlop E, Zaidman J, Moss SF. Clinical challenges and images in GI. Downhill esophageal varices secondary to superior vena cava occlusion. Gastroenterology.2008; 135(6): 1863, 2158.
- Management of Post-ERCP Air Leak: A Case Report
Abstract Views :155 |
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Authors
Affiliations
1 Department of Gastroenterology, IGMC - Shimla, IN
2 Department of Gastroenterology, IGMC- Shimla, Himachal Pradesh, IN
1 Department of Gastroenterology, IGMC - Shimla, IN
2 Department of Gastroenterology, IGMC- Shimla, Himachal Pradesh, IN
Source
The Indian Practitioner, Vol 73, No 11 (2020), Pagination: 37-38Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is associated with retroperitoneal perforation in approximately 2.1% patients, but not infrequently, retroperitoneal air, pneumoperitoneum, pneumomediastinum, pneumothorax, and subcutaneous emphysema are also reported which may or may not be associated with retroperitoneal perforation. We report the case of a female patient with post-ERCP air leak into different compartments without iatrogenic gastrointestinal perforation and which was managed conservatively.Keywords
Endoscopic Retrograde Cholangiopancreatography, Contrast Enhanced Computed Tomography, Side Viewing Esophagogastroduodenoscope.References
- Ferrara F, Luigiano C, Billi P, Jovine E, Cinquantini F, D’Imperio N. Pneumothorax, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and subcutaneous emphysema after ERCP. Gastrointest Endosc 2009; 69:1398-401.
- Seymann GB, Savides T, Richman KM. Massive subcutaneous emphysema after endoscopic retrograde cholangiopancreatography. Am J Med 2010; 123:e15-6.
- Kaul S, Koul S, Singh H, Kachroo SL, Chrungoo RK. Post ERCP Surgical Emphysema. J K Science 2008; 10:18990.
- Stapfer M, Selby RR, Stain SC, et al. Management of duodenal perforation after endoscopic retrograde cholangiopancreatography and sphincterotomy. Ann Surg 2000; 232:191-8.
- Jaiswal SK, Sreevastava DK, Datta R, Lamba NS. Unusual occurrence of massive subcutaneous emphysema during ERCP under general anaesthesia. Indian J Anaesth 2013; 57:615-7.
- Seymann GB, Savides T, Richman KM. Massive subcutaneous emphysema after endoscopic retrograde cholangiopancreatography. Am J Med. 2010; 123:e15–6.
- Kaul S, Koul S, Singh H, Kachroo SL, Chrungoo RK. Post ERCP Surgical Emphysema. J K Science. 2008; 10:18990.
- Extranodal Histiocytic Sarcoma Rectum: A Case Report
Abstract Views :158 |
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Authors
Affiliations
1 Department of Gastroenterology, IGMC- Shimla, Himachal Pradesh, IN
2 Department of Surgery, IGMC - Shimla, IN
1 Department of Gastroenterology, IGMC- Shimla, Himachal Pradesh, IN
2 Department of Surgery, IGMC - Shimla, IN
Source
The Indian Practitioner, Vol 73, No 11 (2020), Pagination: 39-41Abstract
Histiocytic sarcoma (HS) is an exceedingly rare but aggressive hematopoietic tumor, showing morphologic and immunophenotypic features of mature tissue histiocytes. Diagnosis of HS is based on histological and immunohistochemical evidence of histiocytic differentiation supported by an extensive immunophenotypic analysis that excludes other large cell malignancies in the differential diagnosis. Search of world literature revealed only three previous reports of extranodal histiocytic sarcoma (ENHS) involving rectum specifically. We report a case of ENHS of rectum in a 65 year old man presenting with hematochezia. Radiological findings were indicative of polypoidal soft tissue mass lesion in rectum. Histopathology and immunohistochemical studies of the resected specimen confirmed the uncommon diagnosis ENHS.Keywords
Histiocytic Sarcoma, Extranodal Histiocytic Sarcoma, Magnetic Resonance Imaging.References
- Takahashi E, Nakamura S. Histiocytic Sarcoma : An Updated Literature Review Based on the 2008 WHO Classification. J Clin Exp Hematop. 2013; 53(1): 1-8.
- Skala S L, Lucas D R, Dewar R. Histiocytic Sarcoma: Review, Discussion of Transformation From B-Cell Lymphoma, and Differential Diagnosis. Arch Pathol Lab Med. 2018;142:1322– 1329
- Hornick JL, Jaffe ES, Fletcher CD. Extranodal histiocytic sarcoma: Clinicopathologic analysis of 14 cases of a rare epithelioid malignancy. Am J Surg Pathol 2004; 28:1133 44.
- Vos JA, Abbondanzo SL, Barekman CL, Andriko JW, Miettinen M, Aguilera NS. Histiocytic sarcoma: A study of five cases including the histiocyte marker CD163. Mod Pathol 2005; 18:693 704.
- Park MI, Song KS, Kang DY. Histiocytic sarcoma of rectum – A case report. Korean J Pathol 2006; 40:156 9.
- Jiang QM, Zhou WW, Song R, Ye XZ, Li J. [Histiocytic sarcoma: A clinicopathologic study of 4 cases]. Zhonghua Xue Ye Xue Za Zhi 2012; 33:751 5.
- Mitra S, Jhunjhunwala A, Mukherjee P. Extranodal histiocytic sarcoma mimicking colorectal lymphoma: Case report and review of literature. Indian J Pathol Microbiol 2019; 62:467-9.
- Swerdlow SH, Campo E, Harris NL, et al. (eds). WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Revised 4th ed. Lyon, France: International Agency for Research on Cancer; 2017.
- Retrospective Study of Sociodemographic, Endoscopic, and Histopathologic Features of Esophageal Cancer at a Tertiary Care Hospital of Himachal Pradesh, India
Abstract Views :165 |
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Authors
Affiliations
1 Department of Gastroenterology, IGMC-Shimla, IN
2 Department of Gastroenterology, IGMC- Shimla, Himachal Pradesh, IN
1 Department of Gastroenterology, IGMC-Shimla, IN
2 Department of Gastroenterology, IGMC- Shimla, Himachal Pradesh, IN
Source
The Indian Practitioner, Vol 73, No 12 (2020), Pagination: 30-34Abstract
Background: Esophageal Cancer (EC) is one of the least responsive tumors to cancer therapy with overall poor prognosis. Published data from different regions in India have indicated their observations on the local risk factors. Presently, as there seems little prospect of early detection and effective management of this cancer, understanding the etiology of EC may suggest opportunities for its primary prevention.
Material & Methods: A retrospective hospital record-based study was carried out for the period of five years (2014-2019) in Department of Gastroenterology of Indira Gandhi Medical College Shimla- a tertiary care hospital located in Sub – Himalyan ranges of North India in Himachal Pradesh.
Results: A total of 363 patients were diagnosed to have EC, 58.68% were male and 41.32% were female with male to female ratio of 1.42:1. Most patients come from rural areas (82.09%) and belonged to low socioeconomic status (38.01%). Most patients were illiterate (41.87%) and were involved in farming works (52.06%). Majority (76.03%) had a history of smoking bidi followed by alcohol consumption (29.20%). The most common primary location of the malignancy was middle third of the esophagus in 44.63% followed by lower third 35.54% and upper third 19.83%. Squamous cell histology was identified in 70.24% patients, while 29.75% patients had adenocarcinoma.
Conclusion: EC is one of the important cancers in northern Indian state of Himachal Pradesh. Squamous cell carcinoma is the most common type followed by adenocarcinoma. The most common primary location of the malignancy was middle third of the esophagus followed by lower and upper third. The major risk factors associated with EC included tobacco and alcohol consumption besides low socioeconomic status, illiteracy, rural background and occupation of farming.
Keywords
Esophageal Cancer, Human Development Index, Adenocarcinoma, Squamous Cell Carcinoma, World Health Organization.References
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- Endoscopic Removal of an Ingested Mercury Glass Thermometer: A Case Report
Abstract Views :201 |
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Authors
Affiliations
1 Associate Professor, Department of Gastroenterology, IGMC- Shimla, IN
2 Professor, Department of Gastroenterology IGMC- Shimla, IN
3 Senior Resident, Department of Gastroenterology IGMC- Shimla, IN
1 Associate Professor, Department of Gastroenterology, IGMC- Shimla, IN
2 Professor, Department of Gastroenterology IGMC- Shimla, IN
3 Senior Resident, Department of Gastroenterology IGMC- Shimla, IN
Source
The Indian Practitioner, Vol 74, No 6 (2021), Pagination: 54-56Abstract
Foreign body ingestion is a potentially lethal condition and the wide variety of ingested foreign bodies poses a challenge in the management of these patients. Endoscopic removal is the first-line treatment for ingested foreign bodies that need to be removed either due to their harmful potential or because they will most likely fail to pass per anus. We report the retrieval of an ingested thermometer from the stomach of a young schizophrenic male by endoscopic means.Keywords
Foreign body, thermometer, endoscopy, esophagusReferences
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- Dokas S, Koliouskas D, Masmanidou M, Ziakas G. Endoscopic removal of an ingested thermometer. Case Rep Clin Pract Rev. 2003; 4(3): 193-195
- Feldman M, Friedman LS, Brandt LJ, Chung RT, Rubin DT. Wilcox CM. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 11th edition. Philadelphia, PA: Elsevier, 2021.
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