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PubMed1996

Airway foreign bodies.

The removal of airway foreign bodies can be challenging even for the most experienced endoscopist. A familiarity with and working knowledge of older time-tested techniques and instrumentation as well as of the newer rigid and flexible fiberoptic equipment is essential for all who desire to accept these challenging situations. Each instrument has inherent advantages, disadvantages, and limitations in certain situations. Occasionally, a foreign body may be removed more safely through open surgical procedures. A knowledge of the lessons learned and techniques developed by pioneering endoscopists coupled with continuing practice of different endoscopy techniques with a variety of instrumentation will prepare the endoscopist to handle unusual foreign body dilemmas with greater skill and safety.

Adolescent↗
PubMed1986

Normal radiographic findings after foreign body aspiration. When the history counts.

Foreign body aspiration in children is frequently associated with unilateral emphysema or atelectasis on chest x-ray. Two cases are reported of tracheal or bilateral foreign bodies in which the original chest x-rays were read as normal, but the history was suggestive of the foreign body aspiration. Early bronchoscopy can prevent the long-term morbidity that results from unrecognized tracheobronchial foreign bodies.

Bronchoscopy↗
PubMed2003

Foreign bodies in the aerodigestive tract in pediatric patients.

OBJECTIVE: To investigate pediatric foreign body cases in the aerodigestive tract, and to elucidate the characteristic problems in Japan. METHODS: A total of 310 pediatric patients (age 15 or below), gathered from two medical university hospitals (University of Tokyo and Jichi Medical School), were included in this study. Data were collected by retrospective chart review and were statistically analyzed. RESULTS: Two-year-olds were the most common patients, and the range from age 1 to age 4 included 67.7% of all the patients. The most involved sites were the nose (39.4%) and the pharynx (38.4%), followed by the esophagus (12.9%) and the trachea-bronchi (6.5%). Fish bones and toys were the representative foreign bodies (30.7 and 13.6%, respectively). Other foreign bodies often encountered included coins, food, candy, peanuts and nuts, and batteries. The type of foreign body was closely related to the site in which foreign bodies were lodged: 77.3% of foreign bodies in the pharynx were fish bones, and toys were the most common impacted foreign body in the nose. In the esophagus, representative impacted foreign bodies were coins (35.7%), but disk-type battery ingestion has been increasing in recent years. Although most foreign bodies in the esophagus were safely removed, one case of a disk-type battery had a serious sequela. In the trachea-bronchi, peanuts, food, cotton, and coins were impacted. A rigid bronchoscope was basically used to remove foreign bodies, but in some cases, a fine flexible endoscope, with a channel for fiber forceps, was useful, because it could be inserted into narrow bronchi. Advance of a flexible endoscope will make it an excellent tool for diagnosis and management of the trachea-bronchial foreign body. CONCLUSIONS: Fish bones in the pharynx, which were closely related to Japanese eating habits, and toys in the nose, were the typical foreign bodies encountered in this study. In the esophagus, an increased incidence of disk-type battery ingestion has become a serious problem in recent years. Since prevention is the most essential way to manage foreign body cases, feedback from studies to public education should be encouraged.

Adolescent↗
PubMed1990

Magnetic resonance imaging and computed tomographic scanning of fresh (green) wood foreign bodies in dog orbits.

Wooden foreign bodies in the orbit can extend into the intracranial cavity without diagnostic clues from the small eyelid entrance wound, from neurologic examination, and from imaging studies such as ultrasound, plain x-rays, or computed tomography (CT) scans. In cadaver magnetic resonance imaging (MRI) studies, dry wood in the orbit can be seen as a negative or hypointense image in contrast to orbital fat. We studied fresh, green wood in dogs to determine the reliability of CT and MRI scans to image hydrated wood. Wood was placed into each orbit of two dogs. After 24 h the wood was removed from one orbit, but not the other. The dogs were then scanned with CT and MRI. Radiologists were asked to determine if any wood had been left in either or both orbits. The fresh wooden foreign bodies could not be detected despite an intensive effort. MRI does not appear to reliably demonstrate fresh wood in the orbit. MRI can show dry wooden foreign bodies that have not become hydrated, but has not yet been reliable in the clinical situation to rule out the presence of wood in the orbit.

Animals↗
PubMed2002

Feline gastrointestinal foreign bodies.

The common presentations of gastrointestinal foreign bodies in cats are discussed in this article. The options for diagnostic imaging modalities and other diagnostic tests are detailed. The management of foreign body obstructions at different levels of the gastrointestinal tract is discussed. Particular attention is paid to the management of linear gastrointestinal foreign bodies, morbidity associated with this condition, and treatment. There is also a brief discussion on the types of gastrointestinal foreign bodies presenting to a veterinary teaching hospital at which both referral and primary cases are seen.

Animals↗
PubMed1998

Retained wooden foreign body in a child's parotid gland: a case report.

Foreign bodies can present a diagnostic challenge to even the experienced surgeon. In one review of 200 surgical cases involving retained foreign bodies, one-third of the cases had been initially missed. Wooden foreign bodies in particular pose a challenge to the physician. In the review cited above, only 15% of wooden foreign bodies were well visualized on plain radiographs. Acutely, on computed tomography (CT) scans, wooden foreign bodies will usually mimic air. However, with time, the attenuation value of a wooden foreign body may increase as moisture is absorbed from the surrounding tissues. Once this occurs, the wooden foreign body may mimic fat, water or muscle. We present an interesting case of a wooden foreign body in the parotid gland in order to illustrate a common presentation of such a foreign body, to review current guidelines for their clinical and radiologic diagnosis, and to suggest strategies for the management of their unique complications.

Accidental Falls↗
PubMed2001

[Tension pneumothorax during removal of a foreign body from the esophagus].

Extracting foreign bodies from the esophagus is a common procedure in emergency rooms. We report the case of an 82-year-old man who came to the emergency room after swallowing a clam shell. After three successive examinations by fiberoptic endoscopy, the last of which was performed with general anesthesia, the patient suffered pneumomediastinum and pneumothorax first on the right side and then, within a few hours, on the left. After extraction of the foreign body, bilateral pleural drainage and emergency repair of esophageal perforation were required. Episodes of pneumothorax have been described after endoscopic procedures on the digestive tract such as esophagoscopy. The cause of esophageal perforation described may be iatrogenic, produced during esophageal manipulations or it may be caused by the foreign body itself, by an awake patient's performance of Valsalva maneuvers during esophagoscopy, or the entrance of air in the pleural cavity through esophageal perforation; any of these would explain the presentation of pneumothorax in this case. In the presence of sudden cardiorespiratory deterioration in a patient undergoing an endoscopic procedure, a diagnosis of tension pneumothorax must be considered.

Aged↗
PubMed1984

Diagnosis and management of ingested foreign bodies: a ten-year experience.

Ingested gastrointestinal foreign bodies may be managed by observation, endoscopy, and/or surgical intervention. We retrospectively reviewed 87 consecutive cases of foreign body ingestion. In 49 patients the ingested foreign body had passed beyond the gastroesophageal junction, and these cases form the basis of this study. Of the 49 patients, 19 (38.7%) required surgical intervention for removal of the swallowed object. Nearly 75% of these patients had swallowed objects that were more than 6.5 cm in length. Of 30 adults, more than 50% required surgery for removal of the foreign body. However, fewer than 16% of children who had swallowed and retained foreign bodies required surgery for ultimate cure. Based on these findings, guidelines are presented for the management of foreign body ingestion.

Adolescent↗
PubMed1986

Tracheobronchial and esophageal foreign bodies in the pediatric population.

A foreign body lodged in the aerodigestive tract of a child often poses a difficult medical problem. Experience with the diagnosis and removal of these foreign bodies is presented in this retrospective review. The description by a witness of the actual ingestion frequently provided the key to diagnosis. Rigid endoscopy remains a safe technique for foreign body extraction with a low resultant morbidity and mortality. Organic matter comprises the majority of bronchial foreign bodies (70%) while coins are the predominant finding (80%) in the esophagus.

Adolescent↗
PubMed1989

Mediastinal mass and radiolucent esophageal foreign body.

The diagnosis of radiolucent esophageal foreign bodies can be difficult, particularly in patients with predominant respiratory symptoms. The consequences of the impaction of a foreign body in the esophagus are serious, and esophageal stenosis, perforation, acquired tracheoesophageal fistulas are among the complications already reported. An unusual complication of a nondiagnosed radiolucent plastic coin that remained impacted for 11 months on the posterior esophageal wall of a 20-month-old child, who presented only with respiratory symptoms, is reported. The foreign body eroded through the esophageal wall, causing an intramural abscess that was initially interpreted as a mediastinal mass, and the patient was operated on with the diagnosis of a foregut duplication. Literature on this situation was reviewed, and the problems associated with the diagnosis and treatment of children with radiolucent esophageal foreign bodies are discussed.

Abscess↗
PubMed1982

Management of posterior-segment foreign bodies.

Of 28 patients with a foreign body in the posterior segment, 24 were managed primarily and 4 had been referred for treatment of associated injuries or complications after extraction. There were 19 magnetic and 9 nonmagnetic (including 6 copper-containing) foreign bodies. Preoperative localization was achieved mainly by visual and radiologic (Sweet's) methods, supplemented by computer-assisted tomography and ultrasonography. The magnetic foreign bodies were extracted through the pars plana or sclera. The nonmagnetic foreign bodies were extracted mainly by a two-instrument vitrectomy technique through the pars plana. Secondary procedures included vitrectomy, lentectomy, scleral buckling and dissection of preretinal membranes. In a follow-up period ranging from 1 to 53 (average 14) months the overall salvage rate (final visual acuity 6/60 [20/200] or better) was 46%. Four eyes were enucleated.

Eye Foreign Bodies↗
PubMedDate not supplied

New insights in the pathogenesis of foreign body infections with coagulase negative staphylococci.

Foreign body infections by coagulase negative Staphylococci are an important and growing problem in our hospitals. Only recently have we started to get some data on the specific virulence factors that permit the otherwise non-pathogenic Coagulase Negative Staphylococci (CNS) to be so successful in causing foreign body infections. Adherence of the Coagulase Negative Staphylococci to the foreign body is a first and crucial step. Several genes and gene-products have been identified that enhance staphylococcal adherence to biomaterials. Adherence is followed by accumulation; in this phase the Coagulase negative Staphylococci organise themselves into a complex multilayer of cells covered with polysaccharide. This we call the biofilm. Finally coagulase negative Staphylococci undergo complex and as yet non-defined metabolic changes that in combination with biofilm formation allow them to persist on the foreign body and become less susceptible to antibiotics. Few data are available on the factors involved in the accumulation and persistence phase.

Bacterial Adhesion↗
PubMed2005

[Hematemesis in an 11-month-old child: an unusual symptom revealing a foreign body in the stomach].

Ingestion of foreign body has often no consequence. We report on a case in an 11-month-old girl who was referred for mild hematemesis and anorexia. Upper digestive tract endoscopy found a small metallic foreign body in the gastric antrum. After its removal, all symptoms disappeared. It is usually recommended to remove foreign bodies by endoscopy when they are in esophageal position, or are more than 3 to 5 cm long, or have a shape that may hurt the gut mucosa. Although rare, a gastric foreign body should be searched for in face of an upper gastrointestinal bleeding in an infant.

Female↗
PubMed2006

An unusual foreign body migrating through time and tissues.

BACKGROUND: Beside infections, foreign body incidences are amongst the most frequently encountered pathologies in pediatric otolaryngology. While inhaled foreign bodies represent an acute emergency, symptoms of ingested foreign bodies sometimes appear with some delay. Typically fishbones tend to go unnoticed in a first examination and become symptomatic by fever, odynodysphagia and torticollis. Exceptionally, foreign bodies migrate and become manifest with a considerable delay. CASE REPORT: We present a case of a young girl who presented with an unusual foreign body which migrated through the cervical tissues causing repeated cervical tumescence's before being diagnosed. CONCLUSION: Repeated cervical abscesses or tumescence's in children or young patients should alert the treating physician to seek for an underlying pathology such as unnoticed foreign bodies or malformations (e.g. cysts). Further the scarce literature on these migrating foreign bodies is discussed.

Abscess↗
PubMed2005

Laparoscopic-assisted rectal foreign body removal: report of a case.

PURPOSE: Rectal foreign bodies are not an uncommon presentation to the emergency department. Frequently they can be removed in the department through the transanal approach. However, this often is not well tolerated by the patient or can force the foreign body more proximal. We present a case of a difficult rectal foreign body in an obese patient that was successfully removed transanally in the operating room with laparoscopic assistance. METHODS: Under general anesthesia, with the patient in Trendelenburg position, laparoscopy was used to push the rectal foreign body from above while it was removed transanally from below. This was performed with one 10-mm and two 5-mm incisions. RESULTS: The foreign body was successfully removed transanally with laparoscopic assistance, and the patient was discharged within 12 hours from the operation. CONCLUSIONS: The laparoscopic approach to assist in rectal foreign body removal is a good treatment choice for difficult cases. It allows for easy removal, detection of rectal injury, and early discharge.

Foreign Bodies↗
PubMed2005

[Ingestion of foreign bodies containing lead].

Ingestion of a foreign body containing lead in children carries the additional risk of acute lead poisoning secondary to dissolution and absorption of the ingested lead in the acid environment of the stomach. We report the case of a 3-year-old girl who ingested a lead sinker. The patient was asymptomatic but therapy with a proton pump inhibitor (omeprazole) was empirically started on admission and the foreign body was removed from the stomach by emergency endoscopy within 6 hours of ingestion. Despite the quick removal, blood lead levels (drawn 3 hours after ingestion) exceeded 40 .g/dl. The patient completely recovered and continues to do well after 1 year of follow-up. This case reveals that acute elevations of blood lead concentrations may occur rapidly after ingestion of lead foreign bodies. Even in the absence of symptoms, lead foreign body ingestion in children should prompt lead screening and initiation of appropriate treatment.

Acute Disease↗
PubMed1978

Explosive intraocular foreign bodies.

We examined two patients, each with a foreign body composed of smokeless gunpowder in the vitreous body of one eye and multiple similar foreign bodies in the eyelids, conjunctiva, and cornea. No damage to the eye was caused by the retention of these foreign bodies for over three years in one case and two years in the other. The composition of these foreign bodies appeared to be nontoxic to the eye and thus, extraction of the foreign bodies did not seem to be necessary.

Adult↗
PubMed1977

Foreign body removal with the flexible fiberoptic bronchoscope.

Intrabronchial foreign bodies are occasionally encountered in adults but most available information in humans consists only of reports evaluating one or two cases. We surveyed our experience and found seven patients with intrabronchial foreign bodies who had been examined with the flexible fiberoptic bronchoscope, six of whom were managed successfully. Nine cases have been identified in the literature. Although there were no major complications in either our cases or those in the literature, several problems were identified which under other circumstances could have caused significant complications. We assessed all of these cases for situations which presented potential risk to the patient. These risks were grouped into the following problem categories: 1. selection of appropriate bronchoscope, 2. availability of appropriate instruments, 3. control of the foreign body, and 4. unexpected foreign bodies. Endoscopists planning to use the FFB in foreign body removal should be aware of the problems and hazards which may ensue if improperly managed, and should attempt to gain experience either in the animal laboratory or in models prior to approaching patients with foreign bodies with the flexible fiberoptic bronchoscope.

Adolescent↗