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PubMed2006

[Vesicovaginal fistula after removal of neglected intravaginal foreign body].

Long duration intravaginal foreign bodies are a rare entity and are generally seen in the practice of Emergency departments where they are removed. We describe the case of a patient with the diagnosis of a bladder mass caused by a long duration intravaginal foreign body complicated by perforation into the bladder cavity. After the retrieval of the foreign body the patient developed a vesicovaginal fistula which was subsequently repaired using a suprapubic transvesical approach.

Female↗
PubMed2005

Pediatric foreign bodies and their management.

Ingestion of foreign bodies is a common pediatric problem, with more than 100,000 cases occurring each year. The vast majority of pediatric ingestions are accidental; increasing incidence of intentional ingestions starts in the adolescent age group. In the United States, the most common pediatric foreign bodies ingested are coins, followed by a variety of other objects, including toys, toy parts, sharp objects, batteries, bones, and food. In adolescents and adults, meat or food impactions are the most common accidental foreign body ingestion. Esophageal pathology underlies most cases of food impaction. Management of foreign body ingestions varies based on the object ingested, its location, and the patient's age and size. Esophageal foreign bodies as a group require early intervention because of their potential to cause respiratory symptoms and complications, esophageal erosions, or even an aortoesophageal fistula. Ingested batteries that lodge in the esophagus require urgent endoscopic removal even in the asymptomatic patient due to the high risk of complications. Sharp foreign bodies increase the foreign body complication rate from less than 1% to 15% to 35%, except for straight pins, which usually follow a relatively benign course unless multiple pins are ingested. Magnets are increasingly ingested, due to their ubiquitous nature and the perception that they do not pose a risk. Ingestion of multiple magnets creates a significant risk of obstruction, perforation, and fistula development. Methods to deal with foreign bodies include the suture technique, the double snare technique, and the combined forceps/snare technique for long, large, and sharp foreign bodies, along with newer equipment, such as retrieval nets and a variety of specialized forceps.

Child↗
PubMed1987

Problematic diagnosis of bronchial foreign bodies in children.

Bronchial foreign bodies by children are dangerous and require immediate therapeutic measures. Findings and significance of chest film in the diagnosis of bronchial foreign bodies in 24 children were analysed. All patients were symptomatic. 18 patients had an abnormal and 6 normal auscultation finding. In three cases the physician did not suspect aspiration, and the diagnosis was delayed, which caused the death of one child. Roentgenpositive foreign bodies were found in 8 and -negative in 16 cases. Secondary changes (obstructive emphysema, atelectasis, pneumonia) were seen in 16 cases. In emergency cases the chest films were analysed by physician and later by a radiologist, who found 88% of them to be abnormal. Fluoroscopy of expiratory chest film helps to detect the unilateral emphysema more distinctly. The diagnosis must always be confirmed with bronchoscopy and extraction thereby is the adequate treatment of bronchial bodies.

Adolescent↗
PubMed1998

Case series of bronchoscopic removal of tracheobronchial foreign body in six adults.

Tracheobronchial foreign body is rare in adults. Diagnosis is difficult and requires a high index of suspicion. We report 6 cases of tracheobronchial foreign bodies in adults and their removal, as well as a literature review of this topic. Case records, chest radiographs and computed tomographies (CT) of the thorax were reviewed. There were 5 males and 1 female with a median age of 63.5 years. One patient could not protect his airway (tracheostomy). Foreign bodies were sutures (2), vegetable matter like peanuts, vegetables and popcorn (3), and a voice prosthesis. Main symptoms were cough, haemoptysis and breathlessness. There were few signs on physical examination and chest X-rays were not helpful in diagnosis. All patients had fibreoptic bronchoscopy although 3 subsequently required rigid bronchoscopy for foreign body removal. All foreign bodies were successfully removed without any complications.

Aged↗
PubMed2000

Sino-orbital foreign body in a child.

Foreign bodies of the sinuses are uncommon. Few reports exist in the English literature. Among these, the frontal and maxillary sinuses are most often involved. Ethmoid and sphenoid foreign bodies are rare and tend to present with chronic symptoms due to delayed diagnosis. We present a case of an acute presentation of a foreign body involving the orbit and ethmoid sinus in a 12-year-old male.

Accidental Falls↗
PubMed2004

[Stones and foreign bodies of the urethra].

Foreign bodies in the bladder and urethra have been already largely described either by their nature itself as well as by the circumstances of their introduction. If their presence often reveals dubious psychiatric behaviours, one must also evoke possible accidental introductions during transvesical surgery or migration from spaces adjacent to the bladder. The treatment of those foreign bodies can be sorted out through endoscopy or surgical approach.

Foreign Bodies↗
PubMed1998

High levels of expression of collagenase-3 (MMP-13) in pathological conditions associated with a foreign-body reaction.

A foreign-body-type host response can contribute to the induction and release of collagenolytic tissue-destructive enzymes of pathogenetic significance. Our aim was to analyse collagenase-3 in two conditions with putative involvement of foreign-body reactions. Synovial membrane-like tissue samples were obtained from cases of aseptic loosening of a total hip replacement (THR) and osteoarthritis (OA). The reverse transcription polymerase chain reaction (RT-PCR) disclosed that all the samples from patients contained collagenase-3 mRNA compared with only three out of ten control samples. The identity of the RT-PCR amplification product was confirmed by nucleotide sequencing. Immunohistochemical staining showed that collagenase-3 was present in endothelial cells, macrophages and fibroblasts, including those found in the synovial lining. This finding was confirmed by avidin-biotin-peroxidase complex-alkaline phosphatase-anti-alkaline phosphatase double staining and the specificity of the staining by antigen preabsorption using recombinant human collagenase-3. Collagenase-3 was released into the extracellular space and thus found in the synovial fluid in all patient samples as shown by Western blotting. The similar extent of collagenase-3 expression in aseptic loosening and OA compared with the low expression in control synovial membrane suggests involvement of a similar, foreign-body-based pathogenetic component in both. Comparative analysis of collagenase-3 and of foreign particles indicates that paracrine factors rather than phagocytosis per se are responsible for the induction of collagenase-3. We suggest that due to its localisation and substrate specificity, collagenase-3 may play a significant pathogenetic role in accelerating tissue destruction in OA and in aseptic loosening of a THR.

Adult↗
PubMed1996

Magnetic resonance imaging characteristics of a lead pencil foreign body in the hand.

Foreign body detection and removal from the hand can present a challenging problem for the hand surgeon. Imaging studies often are of little help and may even be misleading regarding the size and location of the object. This article reports imaging techniques used in the detection of foreign bodies and presents a case in which magnetic resonance imaging was used to localize a lead-pencil foreign body in the hand prior to surgical removal. We also present the results of magnetic resonance imaging analysis of several lead pencils, showing a similar signal that indicates that iron and magnesium were responsible for the artifact seen on the magnetic resonance image.

Adult↗
PubMed2000

Migrating oesophageal foreign body--an unusual case.

Ingested foreign bodies which migrate extraluminally are rare occurrences. If untreated, they may result in life threatening complications. Exploration of the neck via an external approach to remove the foreign body is the recommended treatment. The CT Scan utilising fine cuts is invaluable in localising the foreign body for exploration. The case of a patient with a metallic foreign body in the oesophagus which migrated extraluminally is presented. Hemithyroidectomy was required to gain access for removal of the foreign body. A discussion on the management of such a case follows.

Aged↗
PubMed2002

Foreign body aspiration in children.

Foreign body aspiration is a common accident in children and represents an important cause of morbidity and mortality. Diagnosis of this condition demands a high degree of suspicion since physical examination and basic radiology exams have low sensitivity. It is more frequent in children younger than 3 years of age, predominantly boys. Food materials are most commonly involved, particularly peanuts, although this could change according to regional feeding habits. The right main bronchus is the site where foreign bodies are most commonly found. Radiographical findings are not diagnostic, but the presence of unilateral obstructive emphysema or atelectasis are important clues. A rigid endoscopy is indicated whenever there is a suggestive history, since delays in removing foreign bodies can lead to severe bronchial sequelae. In developing countries this type of accident may be more relevant due to the lack of resources and awareness, which can lead to late diagnosis and treatment. Routine preventive measures must be taught to caregivers in order to reduce the incidence. Health care professionals should also be made more aware of the prevalence of this condition.

Age Factors↗
PubMed2000

Ultrasound-guided Kopans' needle location and removal of a retained foreign body.

Penetrating injury with retained foreign body is a common problem. Location of the foreign body and surgical excision may be difficult. Ultrasound can be a sensitive and cost-effective tool in both the detection and surgical removal of retained foreign bodies in soft tissue. We report a case in which ultrasound-guided needle localization was used for removal of a wooden foreign body

Dermatologic Surgical Procedures↗
PubMed2001

Use of digital subtraction fluoroscopy to diagnose radiolucent aspirated foreign bodies in infants and children.

OBJECTIVES: Most tracheobronchial foreign bodies in children are radiolucent, and accurate diagnosis of such foreign bodies is not always easy. This can result in delay of diagnosis or misdiagnosis of foreign body aspiration. We report the usefulness and pitfalls of use of digital subtraction fluoroscopy (DSF) to diagnose radiolucent aspirated foreign bodies in infants. METHODS: From 1991 through 1999, DSF was conducted for a total of 19 patients (ranged from 11 months to 4 years and 7 months in age (mean 1.8+/-0.9 years)) who were suspected to have radiolucent aspirated foreign bodies. Since DSF revealed abnormal findings in a trachea or main bronchus in 18 cases, inspection was performed for foreign body bronchofiberscopically. In the one remaining case, no abnormality was recognized on DSF, but since the symptoms at the time of onset strongly suggested aspirated foreign body, bronchofiberscopy was also performed. RESULTS: Foreign body was verified bronchoscopically in 13 of 19 cases, and all 13 (100%) had abnormal findings on DSF, including obstruction of the trachea in two, obstruction of the bronchial lumen in nine, and indistinct visualization of the bronchial lumen in two. Bronchial stenosis was verified bronchoscopically in five of the remaining six cases, including mucus plug in three, granuloma in one and mucosal edema in one case. All five patients (100%) had abnormal findings on DSF, including obstruction of the bronchial lumen in four and indistinct visualization of the bronchial lumen in one. In the one remaining patient with normal findings of DSF, no foreign body or pathological bronchial changes were noted. CONCLUSIONS: DSF was very sensitive in the diagnosis of foreign body aspiration and stenotic changes in the bronchial lumen. However, its diagnostic specificity for aspirated foreign body itself was not high (17%). Therefore, when abnormalities are found on DSF, we recommend to perform flexible bronchofiberscopy initially under general anesthesia via a tracheal tube. When a foreign body is verified, rigid ventilation bronchoscopy is successively performed to retrieve the foreign body.

Bronchi↗
PubMed2004

Ultrasound for the detection of vegetative foreign body in hand--a case report.

Foreign bodies in soft tissues are commonly encountered in daily orthopaedic practice. While most of the metals and glass foreign bodies can be detected by plain radiograph, organic substances such as wood and vegetative materials are radiolucent. Unfortunately, these radiolucent foreign bodies are usually more prone to cause an inflammatory reaction and infection. The detection can be even more difficult in cases of multiple foreign bodies and in penetrating injuries with small innocuous skin wounds. Ultrasonography is a sensitive and reliable investigation for detection of foreign bodies in soft tissue. We present a case of penetration injury to thumb with residual radiolucent foreign bodies and demonstrate the proper role of ultrasonography in the management of foreign bodies in soft tissues.

Adult↗
PubMed1984

Management of foreign body ingestion.

Management of ingested foreign bodies (FB) is a common clinical problem. A 10-year experience of 101 foreign body ingestions is reported. The experience suggests that endoscopic removal of foreign bodies is curative for objects located in the cricopharynx or upper esophagus. Foreign bodies which pass into the stomach can be observed for development of symptoms, as 80% of FB which reach the stomach spontaneously pass. Only 12% of patients required operation, which was done without mortality.

Adolescent↗
PubMed2001

Ultrasonography as a diagnostic modality and therapeutic adjuvant in the management of soft tissue foreign bodies in the lower extremities.

BACKGROUND: Foreign bodies are sometimes overlooked in the initial evaluation of soft tissue wounds in the emergency room setting. The physical examination identifies foreign bodies that are superficial enough to be seen or palpated, while radiographs reveal those that are radio-opaque. If these two criteria are not met, however, the foreign body may remain undetected. These patients present later with long-standing pain in the area of penetration sometimes associated with localized tenderness. OBJECTIVES: To assess the role of ultrasonography in the diagnosis and management of patients with a suspected retained foreign body. METHODS: Ultrasound was used in 21 patients with suspected retained foreign bodies and the diagnosis was positive in 19. Fifteen underwent a surgical exploration in which the ultrasound was used as an adjunctive modality either pre- or intraoperatively to assist in the localization of the foreign body. RESULTS: All procedures were successful. No postoperative complications were recorded at an average follow-up of 2 years. Three patients gradually became asymptomatic and were left untreated. One patient was lost to follow-up. CONCLUSION: Sonography is an extremely effective tool for the late diagnosis of retained foreign bodies in the soft tissues. We suggest that its availability in the emergency room may decrease the rate of misdiagnosis and avoid these unfortunate cases, although this remains to be proven.

Adolescent↗
PubMed1999

Nonradiopaque penetrating foreign body: "a sticky situation".

Foreign bodies within soft tissues are common in children. They may cause a chronic inflammatory reaction that can result in abnormal findings on radiographs, including lytic or blastic osseous changes. These radiographic findings can mimic both benign and malignant processes. In cases where the history is uncertain and the foreign body is not recognized, magnetic resonance (MR) imaging can make a specific diagnosis and direct appropriate therapy.

Child↗
PubMedDate not supplied

Negative findings of esophagoscopy for suspected foreign bodies.

PURPOSE: Suspected impaction of esophageal foreign bodies may at times pose a diagnostic problem as to the decision to perform esophagoscopy. It is not unusual to perform a rigid esophagoscopy following a diagnostic work-up for an impacted foreign body and not to find one. This study attempts to delineate the clinical situations where negative esophagoscopies are more likely to occur. MATERIALS AND METHODS: In a retrospective analysis of 98 rigid esophagoscopies performed for suspected foreign bodies in our department, an attempt was made to delineate the clinical and radiologic findings characteristic of the patients who had no foreign body at esophagoscopy compared with the patients in whom a foreign body was found. RESULTS: Negative esophagoscopies were associated with suspected bone (mostly fish) impaction in 20 of the 22 negative esophagoscopies. Other parameters associated with negative findings were prolonged duration of symptoms and a positive finding at the physical examination. In suspected bone impaction, barium studies and neck x-rays were not helpful in determining the presence of a foreign body. CONCLUSION: Clinical history is the main indicator in the decision to perform esophagoscopy for suspected foreign bodies.

Bone and Bones↗