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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Cigarette Lighter Fluid Induced Gastric Ulcer: A Severe Complication of Delayed Foreign Body Removal</title>
<author><name sortKey="Harris, Ciel" sort="Harris, Ciel" uniqKey="Harris C" first="Ciel" last="Harris">Ciel Harris</name>
<affiliation><nlm:aff id="I1">University of Florida College of Medicine, Jacksonville, FL, USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Stemboroski, Lauren" sort="Stemboroski, Lauren" uniqKey="Stemboroski L" first="Lauren" last="Stemboroski">Lauren Stemboroski</name>
<affiliation><nlm:aff id="I1">University of Florida College of Medicine, Jacksonville, FL, USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Shuja, Asim" sort="Shuja, Asim" uniqKey="Shuja A" first="Asim" last="Shuja">Asim Shuja</name>
<affiliation><nlm:aff id="I1">University of Florida College of Medicine, Jacksonville, FL, USA</nlm:aff>
</affiliation>
</author>
</titleStmt>
<publicationStmt><idno type="wicri:source">PMC</idno>
<idno type="pmid">28894611</idno>
<idno type="pmc">5574267</idno>
<idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574267</idno>
<idno type="RBID">PMC:5574267</idno>
<idno type="doi">10.1155/2017/4041087</idno>
<date when="2017">2017</date>
<idno type="wicri:Area/Pmc/Corpus">001B64</idno>
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</publicationStmt>
<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Cigarette Lighter Fluid Induced Gastric Ulcer: A Severe Complication of Delayed Foreign Body Removal</title>
<author><name sortKey="Harris, Ciel" sort="Harris, Ciel" uniqKey="Harris C" first="Ciel" last="Harris">Ciel Harris</name>
<affiliation><nlm:aff id="I1">University of Florida College of Medicine, Jacksonville, FL, USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Stemboroski, Lauren" sort="Stemboroski, Lauren" uniqKey="Stemboroski L" first="Lauren" last="Stemboroski">Lauren Stemboroski</name>
<affiliation><nlm:aff id="I1">University of Florida College of Medicine, Jacksonville, FL, USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Shuja, Asim" sort="Shuja, Asim" uniqKey="Shuja A" first="Asim" last="Shuja">Asim Shuja</name>
<affiliation><nlm:aff id="I1">University of Florida College of Medicine, Jacksonville, FL, USA</nlm:aff>
</affiliation>
</author>
</analytic>
<series><title level="j">Case Reports in Emergency Medicine</title>
<idno type="ISSN">2090-648X</idno>
<idno type="eISSN">2090-6498</idno>
<imprint><date when="2017">2017</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><p>The majority of foreign bodies ingested pass uneventfully through the gastrointestinal tract without endoscopic intervention. Nevertheless, certain ingested objects pose a greater risk for complications and are more challenging to remove than others. This case report describes a 49-year-old male who swallowed a cigarette lighter causing a gastric ulcer. The lighter was successfully removed by flexible endoscopy using a polypectomy snare. Urgent removal is required due to the shape of the object and its hazardous contents. This is the first case report published in the United States describing cigarette lighter ingestion and management.</p>
</div>
</front>
<back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Trgo, G" uniqKey="Trgo G">G. Trgo</name>
</author>
<author><name sortKey="Tonkic, A" uniqKey="Tonkic A">A. Tonkic</name>
</author>
<author><name sortKey="Simunic, M" uniqKey="Simunic M">M. Šimunic</name>
</author>
<author><name sortKey="Puljiz, Z" uniqKey="Puljiz Z">Ž. Puljiz</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Asge Standards Of Practice Committee" uniqKey="Asge Standards Of Practice Committee">ASGE Standards of Practice Committee</name>
</author>
<author><name sortKey="Ikenberry, S O" uniqKey="Ikenberry S">S. O. Ikenberry</name>
</author>
<author><name sortKey="Jue, T L" uniqKey="Jue T">T. L. Jue</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Katsinelos, P" uniqKey="Katsinelos P">P. Katsinelos</name>
</author>
<author><name sortKey="Kountouras, J" uniqKey="Kountouras J">J. Kountouras</name>
</author>
<author><name sortKey="Paroutoglou, G" uniqKey="Paroutoglou G">G. Paroutoglou</name>
</author>
<author><name sortKey="Zavos, C" uniqKey="Zavos C">C. Zavos</name>
</author>
<author><name sortKey="Mimidis, K" uniqKey="Mimidis K">K. Mimidis</name>
</author>
<author><name sortKey="Chatzimavroudis, G" uniqKey="Chatzimavroudis G">G. Chatzimavroudis</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Tonkic, A" uniqKey="Tonkic A">A. Tonkic</name>
</author>
<author><name sortKey="Bogdanovic, Z" uniqKey="Bogdanovic Z">Z. Bogdanovic</name>
</author>
<author><name sortKey="Grandi, L" uniqKey="Grandi L">L. Grandić</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Webb, W A" uniqKey="Webb W">W. A. Webb</name>
</author>
</analytic>
</biblStruct>
</listBibl>
</div1>
</back>
</TEI>
<pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Case Rep Emerg Med</journal-id>
<journal-id journal-id-type="iso-abbrev">Case Rep Emerg Med</journal-id>
<journal-id journal-id-type="publisher-id">CRIEM</journal-id>
<journal-title-group><journal-title>Case Reports in Emergency Medicine</journal-title>
</journal-title-group>
<issn pub-type="ppub">2090-648X</issn>
<issn pub-type="epub">2090-6498</issn>
<publisher><publisher-name>Hindawi</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">28894611</article-id>
<article-id pub-id-type="pmc">5574267</article-id>
<article-id pub-id-type="doi">10.1155/2017/4041087</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject>
</subj-group>
</article-categories>
<title-group><article-title>Cigarette Lighter Fluid Induced Gastric Ulcer: A Severe Complication of Delayed Foreign Body Removal</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0002-2529-7889</contrib-id>
<name><surname>Harris</surname>
<given-names>Ciel</given-names>
</name>
<xref ref-type="aff" rid="I1"></xref>
<xref ref-type="corresp" rid="cor1"><sup>*</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Stemboroski</surname>
<given-names>Lauren</given-names>
</name>
<xref ref-type="aff" rid="I1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Shuja</surname>
<given-names>Asim</given-names>
</name>
<xref ref-type="aff" rid="I1"></xref>
</contrib>
</contrib-group>
<aff id="I1">University of Florida College of Medicine, Jacksonville, FL, USA</aff>
<author-notes><corresp id="cor1">*Ciel Harris: <email>ciel.harris@jax.ufl.edu</email>
</corresp>
<fn fn-type="other"><p>Academic Editor: Serdar Kula</p>
</fn>
</author-notes>
<pub-date pub-type="ppub"><year>2017</year>
</pub-date>
<pub-date pub-type="epub"><day>15</day>
<month>8</month>
<year>2017</year>
</pub-date>
<volume>2017</volume>
<elocation-id>4041087</elocation-id>
<history><date date-type="received"><day>24</day>
<month>4</month>
<year>2017</year>
</date>
<date date-type="accepted"><day>5</day>
<month>7</month>
<year>2017</year>
</date>
</history>
<permissions><copyright-statement>Copyright © 2017 Ciel Harris et al.</copyright-statement>
<copyright-year>2017</copyright-year>
<license xlink:href="https://creativecommons.org/licenses/by/4.0/"><license-p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
</license>
</permissions>
<abstract><p>The majority of foreign bodies ingested pass uneventfully through the gastrointestinal tract without endoscopic intervention. Nevertheless, certain ingested objects pose a greater risk for complications and are more challenging to remove than others. This case report describes a 49-year-old male who swallowed a cigarette lighter causing a gastric ulcer. The lighter was successfully removed by flexible endoscopy using a polypectomy snare. Urgent removal is required due to the shape of the object and its hazardous contents. This is the first case report published in the United States describing cigarette lighter ingestion and management.</p>
</abstract>
</article-meta>
</front>
<body><sec id="sec1"><title>1. Introduction</title>
<p>Foreign body ingestion cases occur commonly, the majority of which result in benign spontaneous passage through the gastrointestinal tract [<xref rid="B1" ref-type="bibr">1</xref>
–<xref rid="B3" ref-type="bibr">3</xref>
]. Endoscopic removal is necessary in 20% of cases; however two recent studies have shown a much higher rate of intervention (63–76%) in the setting of intentional ingestion [<xref rid="B2" ref-type="bibr">2</xref>
]. Endoscopic removal is highly successful and mortality rate is low; a study performed by Katsinelos et al. had successful endoscopic management in 98.6% of cases [<xref rid="B3" ref-type="bibr">3</xref>
]. Foreign objects longer than 6 cm should be endoscopically removed because they may not pass through the pylorus and remain in the stomach [<xref rid="B1" ref-type="bibr">1</xref>
]. This can lead to complications such as pressure necrosis, stricture formation, perforation, and bleeding, in which case the first-line therapy is endoscopic extraction [<xref rid="B1" ref-type="bibr">1</xref>
, <xref rid="B4" ref-type="bibr">4</xref>
]. If endoscopic intervention fails, laparoscopic gastrostomy should be performed [<xref rid="B4" ref-type="bibr">4</xref>
]. Foreign body ingestion occurs most commonly in the pediatric population [<xref rid="B2" ref-type="bibr">2</xref>
]. Adults with psychiatric disorders, developmental delay, and alcohol intoxication and incarcerated individuals seeking secondary gain present more frequently with true foreign body ingestion [<xref rid="B1" ref-type="bibr">1</xref>
, <xref rid="B2" ref-type="bibr">2</xref>
]. Edentulous adults are at greater risk of swallowing a food bolus and their dental prosthesis [<xref rid="B2" ref-type="bibr">2</xref>
]. Ingestion of multiple objects and repeated episodes are also common [<xref rid="B2" ref-type="bibr">2</xref>
].</p>
</sec>
<sec id="sec2"><title>2. Case Report</title>
<p>A 49-year-old African American male with a history of anxiety and schizophrenia presented to the Emergency Department complaining of epigastric pain. He reported the abdominal pain as aching in nature and associated with nausea and vomiting. He endorsed a 5-pack-year smoking history. Upon chart review, he was noted to have a history of foreign body ingestion requiring laparotomy for spoon removal. Physical examination was unremarkable and his stool was guaiac negative. His laboratory investigations including blood cell counts, biochemical markers, and urinalysis were normal. Plain abdominal radiographs demonstrated a foreign body resembling a cigarette lighter visualized within the stomach (<xref ref-type="fig" rid="fig1">Figure 1</xref>
). No abnormal air fluid levels, free intraperitoneal air, or pathologic calcifications were seen.</p>
<p>He underwent emergent upper endoscopy for foreign body removal. The examined esophagus was normal. Diffuse moderate inflammation characterized by congestion, erythema, and friability was found in the entire examined gastric mucosa. One nonbleeding cratered gastric ulcer, 5 mm in largest diameter, was found at the incisura (<xref ref-type="fig" rid="fig2">Figure 2</xref>
). Diffuse mild duodenitis was found in the first and second part of the duodenum. A small handheld cigarette lighter was found in the gastric fundus. It was successfully removed endoscopically with polypectomy snare (<xref ref-type="fig" rid="fig3">Figure 3</xref>
). The patient tolerated the procedure well; he was treated with pantoprazole 40 mg twice daily for eight weeks. Psychiatry consult and<italic> H. pylori</italic>
serology was recommended. He was scheduled for a repeat endoscopy two months later to monitor treatment response.</p>
</sec>
<sec id="sec3"><title>3. Discussion</title>
<p>The incidence of lighter ingestion is not well known. Literature review yielded only 2 case reports on cigarette lighter ingestion, both of which were in other countries and both of which led to bowel obstruction. This is the only case published in the United States to our knowledge that demonstrates cigarette lighter ingestion. The patient may identify and localize the discomfort; however often it does not correlate with the site of impaction [<xref rid="B2" ref-type="bibr">2</xref>
]. Foreign body ingestion includes a wide spectrum of clinical presentation, and the patient may be completely asymptomatic, presenting with refusal to eat, vomiting, drooling, wheezing, blood stained saliva, or respiratory distress [<xref rid="B2" ref-type="bibr">2</xref>
]. It is also important to note that patients can remain asymptomatic for many months [<xref rid="B1" ref-type="bibr">1</xref>
]. It is imperative that the clinician evaluate for peritonitis or small bowel obstruction [<xref rid="B2" ref-type="bibr">2</xref>
]. Diagnosis can be made by abdominal X-rays, barium swallow, noncontrast CT scan, MRI, or direct endoscopy (flexible or rigid) if suspicion is high and imaging is unyielding [<xref rid="B2" ref-type="bibr">2</xref>
]. Current recommendations for emergent endoscopy include complete esophageal obstruction, disk batteries, and sharp objects but not to mention cigarette lighters [<xref rid="B2" ref-type="bibr">2</xref>
]. For successful removal the foreign body should be aligned correctly to accommodate endoscopic removal using current retrieval devices. The forward-viewing flexible panendoscope has become the instrument of choice in managing foreign bodies in most tertiary medical centers as well as in the community hospitals [<xref rid="B5" ref-type="bibr">5</xref>
]. If this cannot be facilitated proceeding to more invasive methods of removal should be pursued. Cigarette lighters pose a unique problem given that not only its shape can lead to obstruction but also leakage of its contents can be disastrous. Harmful substances contained in lighter fluid include benzene, butane, hexamine, lacolene, naphtha, and propane [<xref rid="B1" ref-type="bibr">1</xref>
]. The chemical properties of the individual hydrocarbon determine the specific toxicity, while the dose and route of ingestion affect which organs are exposed to the toxicity. Quite commonly the lungs are reported as most affected as the chemicals are frequently inhaled. However in our case the patient ingested the material leading to direct destruction of the stomach mucosa by the chemical irritant. Complications from this direct damage may have included perforation of the gastric wall, abscess formation, internal fistula, and hemorrhage. Indirectly hydrocarbons absorbed could lead to multisystem toxicity. In conclusion, due to this combination we recommend immediate removal of cigarette lighters and all other foreign bodies that contain hazardous material regardless of size and shape.</p>
</sec>
</body>
<back><sec><title>Conflicts of Interest</title>
<p>No relevant conflicts of interest exist.</p>
</sec>
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<floats-group><fig id="fig1" orientation="portrait" position="float"><label>Figure 1</label>
<caption><p>Cigarette lighter on abdominal X-ray.</p>
</caption>
<graphic xlink:href="CRIEM2017-4041087.001"></graphic>
</fig>
<fig id="fig2" orientation="portrait" position="float"><label>Figure 2</label>
<caption><p>Cigarette lighter seen on endoscopy and removed via polypectomy snare.</p>
</caption>
<graphic xlink:href="CRIEM2017-4041087.002"></graphic>
</fig>
<fig id="fig3" orientation="portrait" position="float"><label>Figure 3</label>
<caption><p>Gastric ulcer secondary to cigarette lighter fluid.</p>
</caption>
<graphic xlink:href="CRIEM2017-4041087.003"></graphic>
</fig>
</floats-group>
</pmc>
</record>
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