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A new foreign-body forceps with diamond-coated jaws can grasp and hold intraocular foreign bodies of any shape and composition. A self-closing mechanism holds the material once grasped.
OBJECTIVE: Occurrence of foreign bodies (FBs) in ear, nose and throat (ENT) in children are not uncommon in clinical practice. We described our experience with ENT foreign bodies in Melanesian children. METHOD: The study was carried out at the tertiary referral center which is also a University teaching hospital. The 15-year period from 1990 to 2004, 1037 cases of ENT foreign bodies were managed. The clinical, operative and follow up data of these patients were collected from available clinic cards and admission charts. A retrospective analysis was made with these data. RESULTS: Foreign bodies in the external auditory canal constituted 711 (68.6%) cases. It was followed by nose in 258 (24.9%), pharynx in 26 (2.5%), esophagus in 21 (2.0%) and laryngotracheobronchial (LTB) tree in 21 (2.0%) cases. Innumerable varieties of foreign bodies were removed from the ear. The common ones were stones in 277 (39.0%), seeds in 142 (20.0%), plastic ornament beads in 70 (9.8%) and cotton in 48 (6.8%) cases. Six hundred and thirteen (86.2%) of them were removed under microscope at the clinic without any complications. The difficult ones in uncooperative children were removed in the operation theatre. They numbered 98 (13.8%). The nasal foreign bodies were exclusively limited up to the age of 12 years. Common nasal foreign bodies were foam in 54 (20.9%), seeds in 51 (19.8%), stone in 28 (10.9%) and ornament beads in 24 (9.3%) cases. Two hundred and forty-six (95.3%) of them were removed in the clinic. Only 12 (4.7%) were removed in the operation theatre. Fishbone was the commonest (23, 90.2%) foreign body encountered in the pharynx of the children. Coins were the exclusive esophageal foreign bodies in children and all were removed in the operation theatre under general anesthesia. In the LTB tree the FBs were mostly localized to the right main bronchus which occurred in 11 (52.4%) cases. This was followed by the trachea in four (19.1%) cases. The different types of FBs encountered were coffee beans in eight (38.0%), peanuts in five (23.8%), plant seeds in three (14.2%) cases. We encountered two mortalities in these LTB FB patients. CONCLUSIONS: Otolaryngological foreign bodies in children are common. For early diagnosis a high index of suspicion has to be maintained by pediatric otolaryngologist.
The most frequent cause of intraocular foreign bodies involves a small piece of metal penetrating the eye following a metal-on-metal impact occurring at work. Other metallic foreign bodies resulting from aggression with firearms have become less frequent due to changes in the law. More rarely, intra-ocular foreign bodies may come from explosives have a telluric origin, or else be made of glass. Treatment is primarily preventive. Eye accidents caused by foreign bodies at work are common. European-level standards therefore impose individual protective equipment adapted to user needs. These measures should be adopted not only in companies but also for handiwork at home.
A non-magnetic vitreal foreign body was aspirated from over the macula through the pars plana. The surgeon guided a blunt needle towards the foreign body while watching both with the binicular indirect ophthalmoscope. His assistant's tentative suction movements with an attached syringe drew the foreign body up into the needle without risking a retinal perforation. Visual recovery was complete. It is suggested that aspiration might be the procedure of choice for such small visible intraocular fragments.
Eight cases of non-metallic foreign body synovitis are presented. In all cases, an apparently innocuous penetrating injury led to synovitis, and early articular cartilage destruction. Delay in appropriate diagnosis frequently occurred because of confusion regarding the management of these injuries. Pitfalls identified were: 1) failure to appreciate the seriousness of the initial injury and to debride the wound appropriately; 2) failure to obtain satisfactory initial radiographs; 3) failure to explore the wounds surgically; 4) failure to appreciate that a symptom-free interval may follow foreign body penetration. Synovectomy was necessary in six cases to ensure removal of either microscopic or hidden gross particulate matter. Pathologically, these specimens showed chronic synovitis and foreign body granuloma. The implications of such foreign bodies to longterm joint degeneration are discussed.
Inhaled foreign body (FB) is a rare clinical entity for the ENT surgeon. We present a case of an inhaled foreign body in the right main bronchus shown to move to the left main bronchus by repeat chest X-ray during a delay prior to removal. The role of repeat chest X-ray if there is a significant delay before removal of an inhaled foreign body and the optimal management are discussed.
Two cases of chronically retained foreign bodies are presented, demonstrating that a long delay may exist between a penetrating injury and the manifestation of a severe symptom, such as haemoptysis or recurrent infection, referable to a retained foreign body. In only one of these cases was the diagnosis of retained foreign body considered the most likely pre-operatively. Some diagnostic and management problems arising in such situations are discussed.
A foreign body impacted in the esophagus is an emergency case that requires immediate treatment. Often the foreign body can be removed easily using forceps or loops. Sometimes, however, safe grasping and extraction may become very difficult. A patient swallowed a chestnut which then stuck in the upper esophagus. The chestnut was removed with a gynecological instrument with a spiral tip used for myoma fixation. Thereafter this technique was applied to in vitro tests with various kinds of meat and wood. In the clinical case, the chestnut could be removed with the spiral tip of the instrument for myoma fixation, whereas in the in vitro tests it was impossible to grasp meat or cut it into pieces. The removal of foreign bodies, such as wood, with the spiral tip of the instrument for myoma fixation during rigid esophagoscopy is an alternative to extraction with forceps or loops. This method is ineffective for the removal of pieces of meat.
The present report describes how minor foreign bodies in the pharynx can be detected and extracted with a videoendoscope. A videoendoscope and biopsy forceps were used for the extraction of minute pharyngeal foreign bodies. The patients were examined and treated in a sitting position. The endoscope was inserted through the nasal passage. Ten minute pharyngeal foreign bodies (all fish bones) were extracted by this method. The advantages of this intervention were that 1) the videoendoscope showed clear dynamic color images of the minute foreign body on a color video monitor and provided excellent resolution and recording, and thus, its diagnostic accuracy was high; 2) minute fish bones located in the pharynx, which are hard to examine, could be well documented; 3) accurate and fine interventions could be performed, and all of the foreign bodies could be extracted quickly; 4) foreign bodies as thin as 0.15 mm could be extracted; 5) the diameter of this videoendoscope was relatively small, resulting in less discomfort for patients, even children; and 6) pernasal endoscopy allowed the physician to examine patients who had a strong gag reflex. Extraction of minute pharyngeal foreign bodies with a videoendoscope is a reliable procedure of office-based endoscopy of the pharynx.
Difficult airway foreign bodies can create perplexing problems for the bronchoesophagologist. Sometimes, creative skills are necessary to allow removal of foreign bodies without the need for an external procedure. This article presents the first reported case of the removal of a severely impacted air valve cap in the left main bronchus and discusses the creative and innovative techniques and instrumentation that are required for successful removal when standard foreign body instrumentation is ineffective for the task. The case demonstrates that sometimes, against all odds, the most difficult airway problem can have a solution, avoiding increased patient morbidity.
Although infrequent, rectal foreign bodies present a challenge in management. The authors report on their experience with 29 patients who had rectal foreign bodies. Emergency-department procedures included rectal examination, proctoscopy and abdominal radiography. Soft or low-lying objects having an edge could be grasped and removed safely in the emergency department, but grasping hard objects was potentially traumatic and occasionally resulted in upward migration toward the sigmoid. Operating-room procedures included anal dilatation under general anesthesia, transrectal manipulation, bimanual palpation if necessary and withdrawal of the foreign body. In two cases, rectal mucosa was trapped--in an open deodorant bottle in one patient and in a curtain rod in the second patient; operative release of the mucosa enabled safe removal. Two patients presented with peritonitis; both had "broomstick" injuries and required proximal colostomy. Five patients had perianal sepsis due to inadvertently ingested pieces of wood (three) and chicken bones (two). The mean hospital stay was 3 days (range from 6 hours to 6 days). There were no deaths. Because of the potential complications, rectal foreign bodies should be regarded seriously and treated expeditiously.
AIM: Foreign body aspiration is one of the accidents with highest incidence, morbidity and mortality in childhood. It is favoured by curiosity and the immature swallowing mechanisms of this age group. To determine the most common signs and symptoms leading to the diagnosis of foreign body aspiration and to demonstrate the diagnostic value of a detailed anamnesis, we analyzed the cases of foreign body aspiration treated in our hospital between 1975 and 1997. MATERIALS AND METHODS: Retrospective study of 210 patients with suspected foreign body aspiration. In 208 patients rigid bronchoscopy was performed. Evidence of a foreign body was found in 90%. RESULTS AND CONCLUSIONS: We emphasize the clinical value of thorough anamnesis which showed high sensitivity (80%) in choking crises and persistent cough. Physical examination and respiratory auscultation showed high sensitivity (90%) but low specificity (16%). Chest X-ray showed the lowest sensitivity with 16% of false negatives. Most foreign bodies were vegetable fragments (82%), with a complication rate of 5.7%. Mortality was 0.9%, with no deaths occurring in the last 8 years.
Diagnosing aspiration of foreign bodies in children still causes a great deal of difficulties, especially as the anamnesis is not always dependable and the aspiration has often not been noticed. This is why it sometimes takes months before the foreign bodies are discovered and removed. Quite often a child is treated over a long period for bronchitis which is actually caused by a foreign body. This report is based on experience with 33 children between 8 months and 15 years, who aspirated foreign bodies and were treated by bronchoscopy. The diagnostic difficulties are described with special emphasis on radiodiagnosis.
PURPOSE: To evaluate the ultrasound biomicroscopic appearance of anterior segment foreign bodies under clinical and experimental conditions. METHODS: Ultrasound biomicroscopy was performed on 4 eyes of 4 patients referred for evaluation of anterior segment trauma and known or suspected intraocular foreign body. Imaging of wood, aluminum, concrete, and glass foreign bodies was performed in the anterior chamber of a human cadaver eye. RESULTS: Ultrasound biomicroscopy verified the location of a foreign body in two patients and identified occult foreign bodies in two others. Under clinical and experimental conditions, intraocular aluminum and glass produced comet tail artifacts. Under experimental conditions intraocular wood and concrete produced shadowing artifacts. CONCLUSION: Ultrasound biomicroscopy provides useful information in the evaluation of known and occult anterior segment foreign bodies. Ultrasound patterns of shadowing and comet tail may help differentiate foreign body materials.
A preputial foreign body caused severe preputial swelling and depression in a 4-year-old Shorthorn bull. Disruption of the preputial epithelium by the foreign body resulted in abscess formation lateral to the prepuce. A patent urethral fistula, probably a complication of prior fibropapilloma excisional surgery, was also detected on the distal portion of the glans penis. Foreign body removal, antimicrobial administration, and warm hydrotherapy resolved the swelling and abscess. Electroejaculation was used to extend the penis and to minimize preputial adhesions. Breeding soundness examinations were used to evaluate breeding potential.
OBJECTIVE: Tracheobronchial foreign body aspirations comprise the majority of accidental deaths in childhood. Diagnostic delay may cause an increase in mortality and morbidity in cases without acute respiratory failure. We report our diagnostic and therapeutic modalities. METHODS: In our department, bronchoscopy was performed on 548 patients with the diagnosis of tracheobronchial foreign body aspirations (from 1987 to 1997). Of these cases, 55.6% were male and 44.4% female. Their ages ranged from 2 months to 16 years (average 5.5 years). Diagnosis was made on history, physical examination, radiological methods and bronchoscopy. RESULTS: Foreign bodies were localized in the right bronchial tree in 312 cases (56.9%), the left in 126 cases (23.0%) and in the trachea in 62 cases ( 1.3%). Foreign body was not found during bronchoscopy in 48 cases (8.7%). The majority of the foreign bodies were vegetable matters. Foreign bodies were removed with bronchoscopy in all but two cases which underwent limited thoracotomy. In the late period, pulmonary resection was performed in five cases because of irreversible complications. After bronchoscopy, hypoxia developed in four patients, requiring mechanical ventilation. Pneumothorax developed in two cases and mediastinal emphysema in two. Four patients (0.7%) died because of respiratory failure. CONCLUSION: Proper use of diagnostic techniques provides a high degree of success, and the treatment modality to be used depending on the type of the foreign body is mostly satisfactory.
Endobronchial foreign bodies are often difficult to diagnose as the cause of obstructive pneumonias and atelectasis, but once discovered, they can generally be removed, leading to immediate and dramatic resolution of symptoms. The use of flexible fiberoptic and rigid bronchoscopy to extract foreign bodies is well-known. Thoracotomy is generally reserved as a last resort due to the inherent risks of the procedure. We describe a new technique for foreign body removal utilizing steerable hydrophilic guidewires, standard sheaths, and a snare device commonly utilized in intravascular foreign body retrieval.
Large foreign bodies of the esophagus are uncommon. We report two unusual cases of eating utensil, esophageal, foreign bodies that occurred unintentionally following self-instrumentation of the oropharynx. The histories, radiographs, and clinical management of these cases are presented and discussed.