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Wooden foreign body injuries are difficult to diagnose and treat. Three patients who had a common wooden toothpick in the foot are presented. Two patients could recall a puncture injury and one patient could not. Roentgenography and numerous visits to several physicians did not detect the wood, which was only found during careful surgical exploration. Removal of the foreign body is required to treat the inflammatory reaction it produces.
PURPOSE: To present our experience with the removal of intraretinal foreign bodies. MATERIAL AND METHODS: 9 intraretinal foreign bodies were removed by pars plana vitrectomy. Laser photocoagulation of the retina surrounding the foreign body was performed either before surgery or intraoperatively (endolaser). Pars plana vitrectomy with foreign body removal through the sclerotomy site with endomagnet and/or forceps was performed. In some cases fluid-gas exchange was done. RESULTS: The average follow-up period was 6.2 months. Seven of nine foreign bodies were magnetic and two were nonmagnetic. Five of seven magnetic foreign bodies had negative magnetic traction as the first surgical procedure. In these 9 eyes, final visual acuity was below 1/50 in 2 eyes and over 5/50 in 7 eyes. CONCLUSION: Pars plana vitrectomy should be the method of choice in removal of intraretinal foreign bodies.
Tracheobronchial foreign bodies especially in infants and children is fraught with respiratory obstruction and even can lead to death if not intervened in time. The patients can present in variable forms but clinical suspicion and management for such cases is an art itself. We report a case of an unusual foreign body in a child of 1 year showing migratory movements from one main bronchus to other.
The flexible fiberoptic bronchoscope was used to treat bronchial foreign bodies in 33 adults. The length of time that the foreign body was in the lung was less than 1 wk in six (acute group), more than 1 month in 21 (chronic group), and uncertain in two (uncertain group), and the foreign body was an endogenous broncholith in four patients (broncholith group). The foreign bodies were nonfragile, solid matter in most cases and they frequently had sharp projections on them. Granulations around the foreign body were common in the chronic group, but there was no correlation between the length of time the foreign body was in the lung and the amount of granulation or the number of the bronchoscopies needed for diagnosis or management. The granulations did not bleed easily on biopsy or during removal of the foreign body. In fact, they receded if several pieces were removed, making the foreign body much easier to recognize and to retrieve in the next bronchoscopy (about 1 wk later). After removal of the foreign body, the residual granulations regressed, and the bronchial lumen became more patent. The mortality, morbidity, and complication rates were very low, whereas the success rate was high. We conclude that flexible fiberoptic bronchoscopy is practical and safe in retrieving bronchial foreign bodies in adult patients.
Foreign body granulomas of the ear are seldom looked for, but probably common occurrences. They may be due to exogenous or endogenous material which became implanted in the course of trauma or treatment in the external or middle ear. They provoke inflammation which may be subclinical, clinical, or masked by concurrent infection. They can aggravate chronic infection, initiate acute local inflammation, or jeopardize surgical success. Histologically, the foreign material is seen lying freely or partially encapsulated within chronic inflammatory tissue, in close proximity to foreign body giant cells. Medical treatment can only succeed when the offending agent is surgically removed.
Ingestion of a foreign body is a problem seen in nearly all otolaryngologic practices. One of the least common complications of foreign-body ingestion is penetration and migration, which may lead to serious morbidity or even death. We report the findings of a retrospective review of a series of 5 patients who had presented with a complete foreign-body penetration. All of them had radiologic evidence of a foreign body, but findings on rigid endoscopy were negative. Computed tomography is the radiologic study of choice to identify penetrating foreign bodies. The foreign bodies in all 5 patients were extracted via an external approach.
Foreign bodies can present a diagnostic challenge to the maxillofacial surgeon. Three patients, who suffered from a penetrating injury with a wooden foreign body, were examined and treated. Their preoperative CT and MRI scans were evaluated. In an acute case, the penetrating wooden body mimicked air bubbles. In the other two patients, the wood was retained for several months and appeared with a much higher density on CT. In MRI the wooden foreign bodies gave a low signal intensity. In all injuries removal of the foreign body was delayed, because it was initially radiologically missed or misdiagnosed. In the appropriate trauma setting a penetrating wooden body must always be considered. Its attenuation value increases with time as water is absorbed from the surrounding tissues. Although the radiological appearance may show a great variety, CT imaging is the basic diagnostic technique. MRI is the method of second choice.
Three horses examined for complaints of ptyalism and dysphagia were found to have metallic lingual foreign bodies. Metallic foreign bodies were located by oral examination combined with radiography. In 1 horse clinical signs resolved without removal of the foreign body. The foreign body was extracted via an oral approach in the second horse; a mandibular symphysiotomy and radiographic guidance were necessary for removal in the third horse. In all 3 cases, the presenting clinical signs subsided.
OBJECTIVES: Foreign body aspiration into the lower airway in adults is uncommon. We designed this study to investigate the clinical presentations, precipitating factors, management choice, and complications of foreign body aspiration in Chinese adults. PATIENTS AND METHODS: We analyzed 43 consecutive adult patients with foreign body aspiration between February 1980 and December 1995 from the medical record registry and cross index system of a tertiary medical center. RESULTS: The most common symptoms are chronic cough, hemoptsis, fever, and dyspnea. Only three patients (7%) presented with choking. Chest radiograph demonstrated the foreign body in nine cases (21%). The most common foreign body was bone fragments (21/43, 49%). Lodgment is more common in the right, especially the right intermediate bronchus and basal bronchus. Three patients were also diagnosed as having lung cancers. Precipitating factors include CNS dysfunction, facial trauma, intubation, dental procedure, and underlying pulmonary diseases. Flexible fiberoptic bronchoscopy removed the foreign body in 25 cases (58%) during the first attempt and 32 cases (74%) in total. Complications include obstructive pneumonitis (including one case of actinomycosis infection), atelectasis, bronchiectasis, lung abscess, and lung torsion (two cases). CONCLUSION: The nature of foreign body in Chinese adults was different from the Western adults. The initial clues to foreign body aspiration in adults are usually obscure or indirect. We suggest flexible fiberoptic bronchoscopy as the first-line approach. Follow-up bronchoscopy and chest radiograph are recommended to detect chronic complications or coexisting lung cancer.
Foreign body ingestions are common in children. They can pose a diagnostic problem if the foreign body is embedded in the soft tissues of pharynx. A 4 year old girl presented with halitosis for two years. A pharyngeal foreign body, a metallic ring, was seen on lateral radiographs of the neck. The foreign body was removed under general anaesthesia. A completely embedded pharyngeal foreign body should be considered in cases presenting with halitosis.
Sonography was used to detect, localize, and guide removal of foreign bodies in the soft tissues of the extremities and neck. Twenty localization procedures were performed in 19 patients (12 children and seven adults) with 21 foreign bodies including wood, glass, stone, metal, and lead pencil. Localization was accomplished by using anatomic landmarks, ink marks on the skin, and needle and hemostat markers. Localization was facilitated by the use of small standoff pads that were cut for use on small surfaces. The foreign bodies were visualized as hyperechoic foci with acoustic shadows that were partial or complete depending on the angle of insonation and foreign body composition. Hyperechoic comet-tail artifacts (reverberation artifacts) were seen with six metallic foreign bodies and one glass fragment. Nine foreign bodies were surrounded by hypoechoic halos caused by edema, abscess, or granulation tissue. A slow meticulous scanning technique and high-frequency transducer helped in detection of small foreign bodies. Sonographically guided removal of the foreign body was successful in all four patients in whom it was attempted. Scanning with the ultrasound beam parallel to the long axis of the hemostat and the foreign body was the fastest way to guide the hemostat to the tip of a foreign body. The procedure was accomplished most easily and quickly when one physician performed sonography and hemostat removal of the foreign body simultaneously. Our experience with these cases indicates that sonography is a useful tool in the localization and removal of soft-tissue foreign bodies.
OBJECTIVE: To evaluate management of foreign bodies in the upper gastrointestinal tract. DESIGN: Cross-sectional analytical study. PLACE AND DURATION OF STUDY: Ear, Nose, Throat Department of Mayo Hospital, Lahore, from February 1999 to December 1999. PATIENTS AND METHODS: A total of 103 patients with history of foreign body ingestion were included in this study. X-ray neck and rigid oesophagoscopy was carried out in all patients for diagnosis and removal of foreign bodies. A structured questionnaire was designed to record all information. RESULTS: Dysphagia (92%) and tenderness in neck (60%) were the most common clinical features. Majority (89%) patients had come to the hospital within 24 hours. X-ray of the neck (lateral view) was the most useful investigation with presence of air in the esophagus being a significant finding. Post-cricoid region was the site of impaction of foreign bodies in 84% of the subjects. The procedure of esophagoscopy was successful in 90 patients (97%) and failed in 3 patients (3%). Coins were the most common foreign bodies (60%), followed by meat related foreign bodies (22.5%) and dentures in 5% cases. Complications occurred in 18% patients and were more common in adults (37.1%) compared to children (8.8%). The most serious complication was pneumomediastinum. Maximum complications occurred with dentures (80%) and bone chips (42%). CONCLUSION: Foreign body in the esophagus is a serious condition and early removal by rigid esophagoscopy is recommended which is a safe and effective procedure.
A new intraocular foreign body retriever especially suited for removal of small nonmagnetic foreign bodies was devised. Initial clinical trials have proved satisfactory, especially with vitreous surgery.
A retrospective study of 310 patients with foreign bodies in the esophagus was analyzed. The most common age of the esophageal foreign body patients was between 0 to 9 years old (32.6%), and a coin was the most common foreign object in children. Bone, fish bone and bolus of meat were found commonly in adults, while dentures were encountered in the old age group. History of foreign body ingestion, dysphagia and odynophagia were usually presented by the patients. Roentgenographic study was useful in diagnosis and plan of management. Rigid esophagoscopy under general anesthesia is recommended in all patients with suspected history of foreign body, even though plain films of the chest and neck failed to demonstrate any significant findings. Complications can be reduced if the treatment is conducted within 24 hours of foreign body impaction.
Among 91 children with airway foreign bodies there were 10 with radiopaque foreign bodies. Seventy-four of the cases of non-opaque foreign bodies were unilateral. Seventeen had pulmonary consolidation or loss of volume and 33 had a unilateral hyperlucent lung. In 18 of the latter there was unilateral overinflation, but in 15 the hyperlucency was the result of pulmonary vasoconstriction. Twenty-three patients had normal routine inspiration radiographs; in 14 of these fluoroscopy or expiration films were obtained and air-trapping was demonstrated in 13. In twenty-three of the children the diagnosis was delayed. Fifteen of these had normal chest radiographs or unilateral hyperlucency alone. Since normal inspiration chest radiographs are frequently seen in cases of airway foreign bodies even when the diagnosis is delayed, it is strongly recommended that fluoroscopy or expiration films be obtained in any patient where the diagnosis is in doubt.
Twenty-two cases of probable esophageal or pharyngeal foreign body seen at an emergency service were studied retrospectively, using 15 predetermined factors chosen to detect or anticipate the acute consequences of foreign body ingestion. Three findings were particularly predictive: 1) foreign body visualized directly or on plain x-ray films; 2) hypersalivation; 3) obstruction or foreign body image in the esophagus on barium swallow. No patient with none of these three abnormal findings, even in the presence of localized pain increased by swallowing, received further treatment, and no complications developed. All patients with any one of these three findings underwent direct foreign body removal (four cases) or esophagoscopy (11 cases). Five esophageal foreign bodies passed spontaneously into the stomach before esophagoscopy; four foreign bodies were removed, and two esophagi were abnormal (stricture, myasthenia gravis). In two cases no foreign body was found. Hypersalivation was the only finding always associated with an abnormal esophagoscopy. Particular attention must be paid to the interpretation of plain x-ray films, with regard to probable foreign body location at the cricopharyngeal constriction and to indirect signs such as fluid levels, soft tissue swelling, free air, if small foreign bodies are not to be missed.
We reviewed the clinical benefits of hospitalization, esophagogastroduodenoscopy, and surgical intervention for ingested foreign bodies in adults. Patients with esophageal foreign bodies were not included in the study group. A 10-year experience is reported. Each patient's physical examination findings at presentation, white blood cell count, length of hospital stay, number and types of foreign bodies ingested, endoscopic interventions, surgical interventions, and complications were reviewed. There were 75 separate hospitalizations, all occurring in 22 male prison inmates. A total of 256 foreign bodies were ingested. Patients incurred 281 hospitalization days (average 3.7 days per admission). One patient had signs of peritonitis. White blood cell count was less than 10 K/microL in 85%. Sixty-four endoscopies were performed with removal of 79 of 163 foreign bodies (48% success rate). Five patients required general anesthesia because of a lack of cooperation. Complications occurred in four of them, one requiring laparotomy. Eight additional laparotomies were performed. One was performed for an acute abdomen on admission and one for the development of an acute abdomen after conservative management. Two were performed to remove metal bezoars. Four additional laparotomies were performed because of surgeon preference. Among the 23 patients admitted and managed conservatively, 77 (97%) of 79 foreign bodies passed spontaneously. One patient required laparotomy. Of the 256 ingested foreign bodies, 79 were removed endoscopically, 71 were removed surgically, and 106 passed spontaneously. The size, shape, and number were not predictive of the ability to transit the gastrointestinal tract. Foreign body ingestion is problematic in prison inmates. With conservative management, most foreign bodies will pass spontaneously. Endoscopy has a high failure rate and is associated with significant complications. Surgical intervention should be reserved for those who have acute conditions in the abdomen or large bezoars.
OBJECTIVE: Timely and experienced intervention for esophageal foreign bodies generally allows for removal with minimal morbidity. However, esophageal foreign bodies present a risk for esophageal perforation and subsequent mediastinitis, especially if the diagnosis of the foreign body is delayed. Although much has been written about the management of esophageal foreign bodies and their complications, little has been mentioned in recent literature about the specific complication of mediastinitis. This review was performed to examine our experience with this uncommon complication of esophageal foreign bodies. METHODS: A retrospective review of the esophageal foreign body database at Children's Hospital of Wisconsin from 1987 to 1997 was performed to identify patients with esophageal foreign bodies and subsequent mediastinitis. RESULTS: Four patients with esophageal perforation with associated mediastinitis secondary to retained esophageal foreign bodies were identified. Three of the four patients were treated with conservative measures consisting of foreign body removal, intravenous antibiotics and discontinuing of oral nutrition. These patients all achieved resolution of their mediastinitis and esophageal perforation with subsequent return to normal diets and no significant morbidity. One patient, with vascular erosion, required aggressive, invasive therapy. CONCLUSION: From review of this limited number of patients, in the absence of major vascular erosion, conservative methods of treating children with foreign body esophageal perforation and subsequent mediastinitis appears to be effective.