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Navigating a Complex Extraction: A Case Report on the Colonoscopic Management of Dual Rectal Foreign Bodies and a Proposed Treatment Algorithm Addy Saputro; Sigit Adi Prasetyo; Dimas Erlangga Nugrahadi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i9.1392

Background: The management of retained rectal foreign bodies (RFBs) constitutes a significant and escalating challenge in clinical practice. While general management principles exist, there is a paucity of literature detailing the specific biomechanical and pathophysiological complexities of cases involving dual, large-bodied foreign bodies of differing materials. The optimal instrumentation and the role of adjuvant maneuvers in these specific scenarios remain under-reported. Case presentation: A 60-year-old male presented with a three-day history of rectal pain and acute urinary retention after inserting a plastic bottle (18 cm x 7 cm) and a silicone dildo (20 cm x 6 cm) into his rectum. An initial attempt at manual extraction under sedation failed. The patient was subsequently managed under general anesthesia with a successful colonoscopic extraction. A 10-mm toothed alligator jaw grasper, used in conjunction with synchronized external abdominal compression, proved critical for retrieving both objects sequentially. The total procedural time was 60 minutes, and the patient was discharged after a 3-day hospital stay without complications. Conclusion: This case provides powerful validation for colonoscopic extraction as a safe, effective, and definitive minimally invasive technique for complex, high-lying RFBs when manual methods fail. It highlights the indispensable role of general anesthesia for achieving complete pelvic floor relaxation and the biomechanical superiority of specific retrieval tools. The successful outcome underscores the value of a systematic, stepwise management algorithm that prioritizes patient safety and minimizes the need for surgical intervention.

Laparoscopic Primary Crural Repair for Acute-on-Chronic Organoaxial Gastric Volvulus Secondary to a Type II Paraesophageal Hernia: A Case Report and Review of Surgical Strategy Danu Adi Prakosa Darmawan; Agung Aji Prasetyo; Ahmad Fathi Fuadi; Dimas Erlangga Nugrahadi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i9.1393

Background: Gastric volvulus, an abnormal rotation of the stomach, is a rare surgical emergency that can lead to life-threatening gastric ischemia and perforation, particularly when associated with a large paraesophageal hernia (PEH). While paraesophageal hernias are the most common predisposing factor in adults, the optimal surgical management, especially regarding the use of fundoplication and gastropexy, remains a subject of debate. Case presentation: We present the case of a 46-year-old male with a six-month history of intermittent epigastric pain and early satiety, who presented with a three-week history of acute-on-chronic gastric outlet obstruction. His symptoms included intractable postprandial vomiting. Laboratory findings were significant for hemoconcentration and a hypochloremic, hypokalemic metabolic state, indicative of severe dehydration. A contrast-enhanced computed tomography scan confirmed a Type II PEH with an organoaxial gastric volvulus, causing complete obstruction. Following aggressive resuscitation, the patient underwent successful laparoscopic surgery. The procedure involved reduction of the herniated and volvulized stomach, complete excision of the hernia sac, and a primary posterior crural repair with pledgeted, non-absorbable sutures. A fundoplication or gastropexy was not performed. Intraoperative endoscopy confirmed successful de-rotation, a patent pylorus, and viable gastric mucosa. The patient had an uneventful recovery and remained asymptomatic with no evidence of reflux at a six-month follow-up. Conclusion: This case highlights the classic "acute-on-chronic" presentation of gastric volvulus secondary to a PEH. It underscores the efficacy and safety of a laparoscopic approach, which facilitates rapid recovery. Furthermore, it suggests that in carefully selected cases with a moderate-sized hiatal defect and preserved anatomy post-reduction, a meticulous primary crural repair without routine fundoplication or gastropexy can be a sufficient and durable treatment, avoiding the potential morbidity of these additional procedures.

Navigating a Complex Extraction: A Case Report on the Colonoscopic Management of Dual Rectal Foreign Bodies and a Proposed Treatment Algorithm Addy Saputro; Sigit Adi Prasetyo; Dimas Erlangga Nugrahadi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i9.1392

Background: The management of retained rectal foreign bodies (RFBs) constitutes a significant and escalating challenge in clinical practice. While general management principles exist, there is a paucity of literature detailing the specific biomechanical and pathophysiological complexities of cases involving dual, large-bodied foreign bodies of differing materials. The optimal instrumentation and the role of adjuvant maneuvers in these specific scenarios remain under-reported. Case presentation: A 60-year-old male presented with a three-day history of rectal pain and acute urinary retention after inserting a plastic bottle (18 cm x 7 cm) and a silicone dildo (20 cm x 6 cm) into his rectum. An initial attempt at manual extraction under sedation failed. The patient was subsequently managed under general anesthesia with a successful colonoscopic extraction. A 10-mm toothed alligator jaw grasper, used in conjunction with synchronized external abdominal compression, proved critical for retrieving both objects sequentially. The total procedural time was 60 minutes, and the patient was discharged after a 3-day hospital stay without complications. Conclusion: This case provides powerful validation for colonoscopic extraction as a safe, effective, and definitive minimally invasive technique for complex, high-lying RFBs when manual methods fail. It highlights the indispensable role of general anesthesia for achieving complete pelvic floor relaxation and the biomechanical superiority of specific retrieval tools. The successful outcome underscores the value of a systematic, stepwise management algorithm that prioritizes patient safety and minimizes the need for surgical intervention.

Laparoscopic Primary Crural Repair for Acute-on-Chronic Organoaxial Gastric Volvulus Secondary to a Type II Paraesophageal Hernia: A Case Report and Review of Surgical Strategy Danu Adi Prakosa Darmawan; Agung Aji Prasetyo; Ahmad Fathi Fuadi; Dimas Erlangga Nugrahadi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i9.1393

Background: Gastric volvulus, an abnormal rotation of the stomach, is a rare surgical emergency that can lead to life-threatening gastric ischemia and perforation, particularly when associated with a large paraesophageal hernia (PEH). While paraesophageal hernias are the most common predisposing factor in adults, the optimal surgical management, especially regarding the use of fundoplication and gastropexy, remains a subject of debate. Case presentation: We present the case of a 46-year-old male with a six-month history of intermittent epigastric pain and early satiety, who presented with a three-week history of acute-on-chronic gastric outlet obstruction. His symptoms included intractable postprandial vomiting. Laboratory findings were significant for hemoconcentration and a hypochloremic, hypokalemic metabolic state, indicative of severe dehydration. A contrast-enhanced computed tomography scan confirmed a Type II PEH with an organoaxial gastric volvulus, causing complete obstruction. Following aggressive resuscitation, the patient underwent successful laparoscopic surgery. The procedure involved reduction of the herniated and volvulized stomach, complete excision of the hernia sac, and a primary posterior crural repair with pledgeted, non-absorbable sutures. A fundoplication or gastropexy was not performed. Intraoperative endoscopy confirmed successful de-rotation, a patent pylorus, and viable gastric mucosa. The patient had an uneventful recovery and remained asymptomatic with no evidence of reflux at a six-month follow-up. Conclusion: This case highlights the classic "acute-on-chronic" presentation of gastric volvulus secondary to a PEH. It underscores the efficacy and safety of a laparoscopic approach, which facilitates rapid recovery. Furthermore, it suggests that in carefully selected cases with a moderate-sized hiatal defect and preserved anatomy post-reduction, a meticulous primary crural repair without routine fundoplication or gastropexy can be a sufficient and durable treatment, avoiding the potential morbidity of these additional procedures.

Intraoperative Endoscopy as a Navigational Adjunct in Laparoscopic Heller Myotomy for Achalasia: A Consecutive Case Series Jonathan Alvin Nugraha Halim; Ahmad Fathi Fuadi; Dimas Erlangga Nugrahadi; Agung Aji Prasetyo
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i1.1479

Background: Laparoscopic Heller myotomy (LHM) is a primary surgical treatment for esophageal achalasia. Achieving a complete myotomy while avoiding mucosal perforation is paramount for success, yet intraoperative challenges persist. Intraoperative endoscopy (IOE) is recommended by guidelines but remains underutilized. This study aims to illustrate the methodological application and clinical utility of a standardized IOE protocol in LHM. Methods: This study was a retrospective analysis of a prospectively maintained database of a consecutive series of patients who underwent LHM with routine IOE for achalasia at our institution in 2023. We present three consecutive cases. Preoperative evaluation included esophagography, upper endoscopy, and high-resolution manometry (HRM). The primary outcomes were the adequacy of myotomy, incidence of mucosal perforation, and postoperative symptomatic relief measured by the Eckardt score at three months. Results: Three female patients (aged 19, 30, and 65) with achalasia (Type I and II) underwent LHM with IOE. The mean preoperative Eckardt score was 9.3 ± 1.5. IOE was successfully used in all cases to: (1) precisely identify the gastroesophageal junction (GEJ) via transillumination, (2) facilitate submucosal dissection through controlled insufflation, (3) confirm mucosal integrity with an air leak test, and (4) verify a patulous GEJ post-myotomy. No mucosal perforations occurred. At three-month follow-up, the mean Eckardt score significantly improved to 0.3 ± 0.6 (p < 0.05). All patients reported resolution of dysphagia and significant improvement in nutritional status. Conclusion: Our experience with this consecutive series supports the utility of systematic IOE during LHM. It appears to be a valuable tool for enhancing procedural safety, ensuring myotomy adequacy, and achieving optimal short-term functional outcomes. These findings reinforce existing guidelines and should encourage wider adoption of this critical surgical adjunct.

Intraoperative Endoscopy as a Navigational Adjunct in Laparoscopic Heller Myotomy for Achalasia: A Consecutive Case Series Jonathan Alvin Nugraha Halim; Ahmad Fathi Fuadi; Dimas Erlangga Nugrahadi; Agung Aji Prasetyo
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i1.1479

Background: Laparoscopic Heller myotomy (LHM) is a primary surgical treatment for esophageal achalasia. Achieving a complete myotomy while avoiding mucosal perforation is paramount for success, yet intraoperative challenges persist. Intraoperative endoscopy (IOE) is recommended by guidelines but remains underutilized. This study aims to illustrate the methodological application and clinical utility of a standardized IOE protocol in LHM. Methods: This study was a retrospective analysis of a prospectively maintained database of a consecutive series of patients who underwent LHM with routine IOE for achalasia at our institution in 2023. We present three consecutive cases. Preoperative evaluation included esophagography, upper endoscopy, and high-resolution manometry (HRM). The primary outcomes were the adequacy of myotomy, incidence of mucosal perforation, and postoperative symptomatic relief measured by the Eckardt score at three months. Results: Three female patients (aged 19, 30, and 65) with achalasia (Type I and II) underwent LHM with IOE. The mean preoperative Eckardt score was 9.3 ± 1.5. IOE was successfully used in all cases to: (1) precisely identify the gastroesophageal junction (GEJ) via transillumination, (2) facilitate submucosal dissection through controlled insufflation, (3) confirm mucosal integrity with an air leak test, and (4) verify a patulous GEJ post-myotomy. No mucosal perforations occurred. At three-month follow-up, the mean Eckardt score significantly improved to 0.3 ± 0.6 (p < 0.05). All patients reported resolution of dysphagia and significant improvement in nutritional status. Conclusion: Our experience with this consecutive series supports the utility of systematic IOE during LHM. It appears to be a valuable tool for enhancing procedural safety, ensuring myotomy adequacy, and achieving optimal short-term functional outcomes. These findings reinforce existing guidelines and should encourage wider adoption of this critical surgical adjunct.

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