Liquid concrete as a gastrointestinal tract foreign body

Case report

A 58-year-old male construction worker fell into liquid concrete during his work and swallowed a small amount of it. Upon admission, he experienced dyspnoea and abdominal pain. Following gastric lavage in the emergency department, he was admitted to an intensive care unit for further management. An abdominal computed tomography scan revealed multiple hyperdense opaque lesions within the gastrointestinal lumen. We performed a gastroscopy and found that some concrete had solidified and formed a lump obstructing the pylorus (Fig. 1). The solidified concrete segments were snared and dissected into several sections. Thereafter, an integrated stone fragmentation retrieval basket was used to ensure safe endoscopic extraction. Finally, oral liquid paraffin was administered for gastric mucosal protection and gastrointestinal lubrication. Additionally, a cellulose-based enteral formula was employed to encapsulate the residual particulates, while prokinetic agents were incorporated to enhance gastrointestinal transit. Following three days, complete evacuation of the ingested concrete without discernible long-term sequelae was achieved.

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Figure 1.

A-C The concrete solidified and got stuck in the pylorus. D-F Concrete has been crushed by the snare.

Discussion

The ingestion of concrete can lead to several main types of injury:

Gastric burns induced by the alkaline components of cement during concrete solidification. 1 Chemical burns caused by wet cement are usually insidious and take an average of 6 h from exposure to injury. One hour of wet cement exposure may lead to third-degree burns with liquefactive necrosis. ²

Abrasion of the mucosa by sand and stones in the concrete. ³ The degree of damage depends on the contact time, and early removal is critical to the prognosis.

Concrete solidification may cause gastrointestinal obstruction. ⁴ Uncured concrete or small pieces of concrete can be crushed and removed by endoscopy. Solidified cement retained in the stomach will not degrade, so chemical dissolution is not recommended. Cement fragments in the stomach become rougher after 20 days. ⁴ Therefore, early surgical removal is the only safe and effective treatment for large cement fragments.

Heavy metal poisoning. The additives in concrete contain heavy metals, which may cause poisoning, but there are currently no such relevant reports. ⁵

Evacuation of the concrete from the gastrointestinal tract is the key to treatment. Emergency endoscopy is associated with improved patient outcomes. ⁶ In our case, we used a large amount of water for gastric lavage after the patient was admitted. This can wash out most of the uncured concrete and delay its solidification. Secondly, a large amount of water can carry away the heat generated during the solidification of the concrete, reducing tissue damage. After endoscopic relief of gastrointestinal obstruction, lubricants, and drugs that promote gastrointestinal motility are given to accelerate the discharge of concrete debris. The use of acid suppressants is worth discussing. When cement solidifies, its pH can rise to 10–12. Alkaline substances dissolve proteins and collagen, dehydrate cells, and saponify fats, causing tissue damage. ⁷ Gastric acid can neutralise alkaline substances and reduce this damage. However, gastric acid can also cause further damage to the already damaged gastric mucosa. We believe that early application of a large amount of paraffin oil can protect the gastric mucosa and have a lubricating effect. Upon definite confirmation of the completed cement hardening reaction, acid suppression therapy may then be administered in order to mitigate further injury to the impaired gastric mucosa. Interestingly, there was no significant damage to our patient's gastric mucosa at gastroscopy, presumably related to early treatment. The use of cellulose-containing enteral nutrition may be beneficial as it can provide energy and encapsulate fragmented concrete, reducing gastrointestinal abrasion.