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PubMed1996

Perforation of the gastro-intestinal tract by a foreign body. A case report.

Most ingested foreign bodies pass through the gastro-intestinal tract without giving rise to complications. If they become lodged in a narrow segment of the gastro-intestinal tract, perforation may occur. The resulting morbidity depends on the further route of the penetrating object and whether septic sequelae ensue. This article describes an unusual case of foreign body perforation with a protracted clinical course. It emphasises that there are no insurmountable barriers in the pathway of foreign bodies.

Adult↗
PubMed1996

Fogarty catheter extraction of unusual urethral foreign bodies.

PURPOSE: The removal of multiple obstructing foreign bodies from the urethra of an acutely ill, elderly man is describe. MATERIALS AND METHODS: A 4F Fogarty catheter under fluoroscopic guidance was used to manipulate, with slow traction, several clarified foreign bodies from the bulbar urethra to the meatus for extraction. RESULTS: The urethra was cleared rapidly, allowing drainage of retained, infected urine via a Foley catheter. Inspection of the objects revealed incrusted, friable masses consistent with nut shells. CONCLUSIONS: Some obstructive urethral foreign bodies can be expediently removed in the emergency setting with a fluoroscope and a Fogarty catheter in a well lubricated urethra. Self-insertion of foreign bodies into the urethra usually accompanies a psychiatric co-diagnosis, which should also be evaluated.

Aged↗
PubMed1998

Subclavian-oesophageal fistula as a complication of foreign body ingestion: a case report.

Foreign bodies in the upper aerodigestive tract are very common. In the local community, the commonest foreign body encountered in the oesophagus is the fish bone. Impaction in the thoracic oesophagus can lead to perforation and the subsequent formation of an arterial-oesophageal fistula. Such fistulae are inevitably aorto-oesophageal in nature. A subclavian-oesophageal fistula is described in this patient.

Animals↗
PubMedDate not supplied

Endoscopic protector hood for safe removal of sharp-pointed gastroesophageal foreign bodies.

Endoscopic removal of sharp and pointed foreign bodies in the upper gastrointestinal tract still poses technical difficulties. Overtubes may be uncomfortable to the patients and only objects fitting within a lumen of about 11-15 mm can be removed. We present here our preliminary experience with a commercially available new endoscopic end protector hood having the unique characteristic of maintaining its bell portion inverted during the progression of the scope through the gut and flipping back to its original shape during withdrawal through the lower esophageal sphincter. This prevents exposure of the esophageal and pharyngeal wall to injuries from the edges of the foreign body. We used this device to remove nine large sharp or pointed gastroesophageal foreign bodies in six consecutive patients in whom conventional techniques were considered unsafe or not technically feasible owing to the size and shape of the objects. In all cases, removal was successful and easily performed without bowel damage. We believe that this device enhances the safe removal of a wide variety of potentially dangerous gastroesophageal foreign bodies.

Adult↗
PubMed2006

Use of an inferior orbitotomy for safe removal of a wooden foreign body penetrating the orbit.

Penetrating orbital foreign bodies must be removed in a safe and controlled manner. Adequate access is necessary so that there is no further damage to the orbital structures and to allow haemostasis. We describe a case of a wooden foreign body that penetrated the left orbit and its subsequent removal using an inferior orbitotomy. To our knowledge, this technique has not been previously described for removal of a foreign body.

Adult↗
PubMed1992

Foreign body in the sphenoid sinus.

Foreign bodies in the paranasal sinuses, especially in the sphenoid sinus are uncommon. We report a rare case of a foreign body in the sphenoid sinus after an occupational accident.

Accidents, Occupational↗
PubMed1995

Intraorbital wood foreign body.

It is frequently difficult to identify and localize organic intraorbital foreign bodies despite modern day high-resolution imaging studies. Although there can be grave complications associated with retention of organic intraorbital foreign bodies, many believe that removal of such bodies in most cases is unwarranted. A high clinical suspicion, proper choice of imaging studies, and removal by a skilled orbital surgeon probably make the risk of surgical exploration and foreign body removal less than the risk of foreign body retention. We present a case of an intraorbital wood foreign body that required two separate explorations for retrieval. An initial intraconal exploration failed to locate the foreign body. Although the clinical suspicion was high, the imaging studies were equivocal, complicating the management. A second exploration yielded a large intraorbital wooden foreign body in the inferior extraconal space. The patient fully recovered and regained visual acuity of 20/20. The evaluation of such patients and details of management strategy are discussed.

Child↗
PubMed1994

Effect of treatment with methicillin and gentamicin in a new experimental mouse model of foreign body infection.

A new mouse model of foreign body infection has been developed. Intraperitoneal placement of a silicone catheter followed by injection of 10(8) Staphylococcus aureus organisms resulted in a reproducible, localized foreign body infection. The infection persisted as an intra-abdominal abscess surrounding the catheter for at least 30 days. Treatment with up to nine doses of methicillin or gentamicin or both was started 3 days after infection. The treatment showed a significant effect (P < 0.05), measured as reduction of bacteria on the foreign body, for all three regimens with a reduction of up to 2 log units, but no synergism was observed. The result of the treatment was poor, despite the facts that the local concentrations of methicillin were greater than the MIC for at least 72 h and that nine peak concentrations of gentamicin of > 13 micrograms/ml were obtained. The poor result of the treatment was not caused by development of antibiotic resistance or influenced by protein concentration, pH, or local presence in the pus of inhibitors of antibiotics. Both antibiotics showed good effects in time-kill studies in vitro on bacteria on catheters taken out of infected mice and catheters infected in vitro. During treatment, the proportion of intracellular bacteria increased in all treated mice to 60 to 75% compared with 20 to 30% in nontreated mice (P < 0.05). This indicates that intracellular survival of staphylococci may influence the outcome of the treatment in foreign body infections.

Animals↗
PubMed2005

Suture foreign body granuloma masquerading as renal neoplasm.

Foreign body granulomas and pseudotumors due to retained surgical linen are well known in surgical practice. These lesions usually correspond to the actual size of residual foreign body and have characteristic presentation according to the anatomy involved. Renal suture granuloma is a rare postoperative complication of renal surgery due to persistence of sutures used to close the pelvicalyceal system/nephrotomy incisions and usually present as incidentally detected small mass lesions. This case of a suture foreign body granuloma presenting with hematuria, large peripheral mass lesion and characteristic computed tomography picture of renal cell carcinoma confounded the diagnosis and underwent laparoscopic radical nephrectomy. In retrospect, such lesions warrant the use of selective needle biopsy and intraoperative frozen section confirmation to clinch diagnosis. Mass lesions occurring in a previously operated kidney should have granuloma as a differential diagnosis.

Adult↗
PubMed1985

Self-inflicted foreign bodies involving lower urinary tract and male genitals.

A great variety of self-inflicted foreign bodies have been removed from the lower urinary tract and male external genitalia. These foreign bodies were inserted or applied for autoerotic, psychiatric, therapeutic, or no definite reasons by the patient. Most patients were too ashamed to admit they had inserted or applied any object and usually presented when a complication had occurred from the foreign body such as difficulty voiding, hematuria, pain or swelling, extravasation, or abscess formation. Inspection and palpation diagnosed foreign bodies involving the male external genitalia in 3 patients and anterior urethra in 6. Radiographic studies with and without contrast medium and endoscopy were required to diagnose foreign bodies in the posterior urethra and bladder in 9 patients, and the exact location, shape, and orientation of the foreign bodies in all sites, radiolucent objects, and the complications of mucosal laceration and extravasation. All 16 foreign bodies in the anterior urethra (below urogenital diaphragm) were removed by endoscopic manipulation in the 6 patients. Nine foreign bodies in the posterior urethra or bladder (above the urogenital diaphragm) were removed by endoscopic manipulation in 2 females and 2 males, while suprapubic cystostomy was required in 1 female and 4 males. The 3 foreign bodies applied to the external genitalia of 3 males were removed carefully to avoid injury to the underlying skin. Foreign bodies lying below the urogenital diaphragm were palpable and readily removed endoscopically while foreign bodies above the urogenital diaphragm required greater endoscopic manipulation or open surgical procedures.

Adolescent↗
PubMed2004

Retained intraorbital metallic foreign bodies.

PURPOSE: To document the biological tolerance of retained metallic orbital foreign bodies managed with conservative treatment. METHODS: A retrospective chart review of 43 patients treated between 1987 and 1993 with retained intraorbital metallic foreign bodies was performed. Age, sex, injury, imaging studies obtained, location of the foreign body, initial and final visual acuity, length of follow-up, treatment, and related adverse reactions and/or complications were recorded. RESULTS: Fifty cases involving 34 male and 9 female patients ranging in age from 2 through 63 years (median, 25 years) were included. Seventeen cases were the result of gunshot wounds, 17 were from BB gun injuries, and 16 cases were from shotgun injuries. Forty-two patients had CT scans to assess the injury and one patient had plain radiographs. In 37 cases, the metallic foreign bodies were located posterior to the globe. There were 19 ocular penetrating injuries, 11 ocular contusion injuries (sclopetaria, commotio retinae, vitreous hemorrhages), and 20 injuries with no ocular involvement. Initial visual acuity ranged from 20/20 to no light perception, as did final visual acuity. The metallic foreign bodies were retained from 6 months to 68 years (median, 2 years). There were 19 ocular penetrating injuries, including 12 enucleations and 7 primary repairs. When contusion injuries were sustained, treatment consisted of vitrectomy for the removal of persistent hemorrhages (3 cases), exploration of the globe (1 case), and nonsurgical treatment (7 cases). Among the 20 cases with no ocular involvement, only 2 patients had secondary complications that required surgical intervention: One had mechanical strabismus, the other a sterile abscess. Visual acuity remained stable or improved in all cases. There were no late complications from the retained foreign bodies in 36 (95%) of 38 cases when the eye remained intact. CONCLUSIONS: Retained intraorbital metallic foreign bodies are well-tolerated and typically have minimal adverse visual prognosis. They should be managed conservatively in the absence of specific indications for removal.

Adaptation, Physiological↗
PubMed1983

[Retinal detachment following extraction of an intraocular foreign body. Effects of vitrectomy].

Intra-ocular foreign bodies have an extremely poor prognosis, retinal detachment with vitreo-retinal retraction being the main factor of treatment failure. Vitrectomy appears to be an effective method for preventing this complication. 77 patients with intra-ocular foreign bodies were studied in two separate groups: 45 patients in group I did not have preventive vitrectomy and 23 developed retinal detachments; 32 patients in group II did have preventive vitrectomy within 3 weeks following foreign body extraction, and only 6 patients developed retinal detachment. Vitreous hemorrhage and cataract were present in all cases with retinal detachment. The retinal detachment rate was significatively different between group I and II. Early vitrectomy seems to be effective in preventing retinal detachment after an intra-ocular foreign body. However, others factors still have to be studied: cataract, hemorrhage, contusion.

Adolescent↗
PubMed1998

Tracheobronchial foreign bodies in children: reaching a diagnosis.

Tracheobronchial foreign body aspiration constitutes a significant cause of morbidity and mortality in the paediatric age group. Diagnosis is often delayed with symptoms and signs being attributed to other causes of respiratory distress. In this study we evaluate the importance of three criteria on which the diagnosis of foreign body aspiration may be based--a history of aspiration, physical examination and a plain chest radiograph. These parameters are correlated with findings on bronchoscopy. It is seen that a history of foreign body aspiration is notoriously unreliable in children of all age groups (p > 0.1). Similarly, presence or absence of findings on physical examination suggestive of foreign body aspiration or its sequalae are not always indicative (p > 0.1). Chest radiograph may be normal or misleading. It is therefore concluded that this is a diagnosis based on the cumulative evidence provided by all three parameters in the clinical context. The hazards of betel nut intake, the object most commonly incriminated, are emphasized.

Age Distribution↗
PubMedDate not supplied

Foreign body in ear, nose and oropharynx: experience from a tertiary hospital.

UNLABELLED: The occurrence of foreign bodies in otorhinolaryngology is reason of constant searches for emergency services. OBJECTIVE: To value the incidence of patients with foreign body, to analyze the clinical situation and the treatment in these cases. METHOD: The prospective study was realized in 81 patients with diagnosis of foreign body of nose, ear or oropharynx in the otorhinolaryngology service of the Hospital do Servidor Público Municipal de São Paulo between april/2003 and march/2005. RESULTS: 57 cases of foreign body of ear, 13 cases of nose and 11 of oropharynx. These patients, 51.85% were men and 48.15% were women. The age average was 23 years old. The average of the evolution time was 18.36 days, being that 38.27% these cases were taken care in less 24 hours of evolution. Inside the total of patients, 83.95% received initial attendance in the otorhinolaryngology clinic, and 16.05% came of another service after some previous removal attempt. The most common symptom of the foreign bodies cases of oropharynx it was odinofagia present in 90.91% of the cases; in the foreign bodies of nose, the unilateral rhinorrhea and cacosmia were present in 46.15 of the cases; in the foreign bodies of ear, 38.60% evolved without symptoms and 28.07 with hipoacusia. The most frequent foreign body of oropharynx it was the fish spine (54.55%); in the nose it was the paper (30.77%); and in the ear it was the cotton (31.58%). The complications resulting of the presence of foreign body or about the manipulation of these had been found in 13 cases (16.05%). CONCLUSION: Most cases of foreign body conditions, in which a non-specialist professional or a non-professional person previously handles its removal, have a bad evolution with emerging complications. Such outcomes strengthen the fact that an otorhinolaryngologist using the proper equipment must treat patients with foreign body.

Adolescent↗
PubMed1999

[Indications of bronchial endoscopy in suspected tracheo-bronchial foreign body in children].

The diagnosis and early extraction of a respiratory foreign body (FB) in a child requires a rapid bronchoscopy. Thus, the possibility of a foreign body requires an endoscopy even in the absence of clinical or radiological signs. While the sensitivity of "the foreign body syndrome" is important (79-85%) its specificity is low (21-46%) which results in numerous endoscopies which do not show FB. This justifies the promotion of flexible fibroscopy, under a simple local anaesthesia of the upper airways and some sedation, each time that the foreign body is not obvious. That is when there is an absence of a radio-opaque foreign body (2-20% of cases) or an absence of associated unilateral diminution in breath sounds or ipsilateral obstructive emphysema (a positive predicted value of 94%, 95% confidence interval: 71-100%). The complications of flexible fibroscopy are rare but still justify its performance in an environment where there is resuscitation equipment and the possibility of rapidly performing a rigid bronchoscopy. Rigid bronchoscopy, which requires a general anaesthesia, remains the best technique to remove a foreign body in a child. It is also indicated initially in cases of respiratory distress where there is a fear of a foreign body in the trachea. The extraction of the CE by flexible fibroscopy under general anaesthesia has been reported in children but it is more difficult and more risky.

Algorithms↗
PubMed2006

Rigid tracheobronchoscopy in the management of airway foreign bodies: 10 years experience in Kosovo.

OBJECTIVES: To review the incidence of tracheobronchial foreign body aspiration in the population of Kosovo and to evaluate the clinical features and management of tracheobronchial foreign body aspiration during a 10-year period. SETTING: Tertiary medical institution, ENT/Head and Neck Surgery Clinic, University Clinical Center, Prishtina, Kosovo. METHODS: We retrospectively reviewed the medical records of patients with tracheobronchial foreign body aspiration who underwent rigid tracheobronchoscopy between January 1994 and December 2003. RESULTS: During a 10-year period, 244 rigid tracheobronchoscopy procedures were performed when foreign body aspiration was suspected. In 182 patients (75%), a foreign body was found and extirpated. Of these, 107 (59%) were male and 75 (41%) were female; 124 patients (68%) were aged 0-3 years and 36 (20%) were aged 4-7 years. The most commonly extirpated foreign bodies were peanuts (30% of cases) followed by beans (22.5%) and corn kernels (9%). Of 176 plain chest radiographs, 65% showed no signs of foreign bodies. Two patients (1.1%) died as result of complications related to foreign body aspiration. CONCLUSION: Rigid bronchoscopy represents a safe and effective tool in the management of foreign body aspiration. However, the high percentage of false-negative results on chest radiography in our series warrants further investigation.

Adolescent↗
PubMed2001

Chest pain: overlooked manifestation of unsuspected esophageal foreign body.

Two cases of unsuspected esophageal foreign body ingestion with chest pain as the main symptom are reported. Both patients had extensive cardiac evaluation to rule out myocardial ischemia. They were discharged home with continuing chest pain and odynophagia. Both patients were denture wearers, and further questioning revealed the coincidence of chest pain with taking meals. Further evaluation revealed an impacted esophageal foreign body in one patient and an esophageal perforation with a mediastinal abscess in the other. These cases illustrate the importance of considering esophageal foreign bodies as factors in chest pain.

Abscess↗
PubMed1988

Laryngo-tracheo-bronchial foreign bodies in children.

Inhalation of a foreign body into the respiratory passage can be a serious and sometimes fatal childhood accident. In this paper we analyse the management of 223 children with laryngo-tracheo-bronchial foreign bodies. Children below three years of age were found to be the most vulnerable. The majority of the patients were boys. Over a quarter of the patients did not present with a history of inhalation. Only 52 per cent reported within 24 hours of inhalation. Endoscopic removal was possible in all but nine cases. One hundred and forty eight (66.4 per cent) of the recovered foreign bodies were organic in origin, the majority of them being peanuts. In one hundred and five (47.1 per cent) the objects found their way into the right bronchial tree. There were two deaths. The modalities of diagnosis and management are discussed.

Bronchi↗