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PubMed2002

Premenarchal vaginal discharge: findings of procedures to rule out foreign bodies.

STUDY OBJECTIVE: Vaginal discharge in children is a common gynecologic complaint and may be resistant to symptomatic and/or antibiotic treatment. In recurrent or unresponsive patients, an evaluation to rule out a foreign body is traditionally recommended. The objective of this study is to review cases of vaginal discharge referred to our institution and assess outcome and diagnosis in those who required irrigation or vaginoscopy to rule out a foreign body.A retrospective chart review was performed on all premenarchal girls identified through the University of Michigan Pediatric and Adolescent Gynecology Clinic database who were seen for evaluation of vaginal discharge between June 1996 and December 2001. The records were reviewed for age, length of time of discharge, aspects of discharge, procedures done to rule out foreign bodies, and findings of such procedures. SETTING: The study was performed in a tertiary care university hospital. PARTICIPANTS: Forty-one premenarchal girls were evaluated for vaginal discharge. The average age was 6.0 yr (range 3 months-11 yr). RESULTS: The average duration of vaginal discharge prior to presentation was 13.7 months (range 1-42 months). Of the 41 girls, 18 girls underwent 1 procedure each, 2 girls underwent 2 procedures each, and 1 girl underwent 5 procedures. Ten vaginal irrigations in clinic were performed in 7 girls, 3 by the referring physician and 7 by us. These irrigations removed a foreign body (tissue paper) in 4 of 10 (40%) cases, 3 at our institution and 1 at an outside institution. In the three irrigation cases with foreign bodies performed at our institution, the foreign body was visible on genital examination prior to the irrigation. Seventeen vaginoscopies under anesthesia were performed in 16 girls, 5 by the referring physician and 12 by us. In the girls who underwent a vaginoscopy under anesthesia a foreign body was found in 3 of 17 (17.6%). The other findings of the vaginoscopies included: biopsy-proven severe dermatitis with no infection in 1 patient, lymphatic duct chylous drainage in 1 patient, nonspecific vulvovaginitis in 11 patients, and normal exam with eventual diagnosis of malingering in 1 patient. In all cases where a foreign body was identified, the patient presented with bloody or brown discharge. CONCLUSIONS: Foreign bodies as a cause of persistent vaginal discharge in a tertiary care referral clinic were identified in 4 of 41 girls (9.8%) and 7 of 27 procedures (25.9%). One child had recurrent foreign bodies removed during 4 of 5 procedures for discharge. In children with persistent vaginal discharge, vaginal irrigation was feasible in older children (average age 7.7 yr). However, no foreign bodies were removed by irrigation that had not already been visually identified prior to the procedure. Exam under anesthesia and vaginoscopy allowed the identification of foreign bodies, and it facilitated the diagnosis of other unusual conditions.

Child↗
PubMed1994

Metallic foreign bodies in the orbits of patients undergoing MR imaging: prevalence and value of radiography and CT before MR.

OBJECTIVE: The purpose of this study was to measure the prevalence of metallic foreign bodies in the orbits of 15,024 patients who were scheduled for MR imaging during a 4-year period and to determine if screening by plain radiography, CT, or both before MR imaging is efficacious. MATERIALS AND METHODS: Records of 15,024 patients scheduled for MR imaging were reviewed. A total of 1593 patients who had identified themselves as being at risk for an intraorbital metallic foreign body had undergone plain radiography or CT of the orbits. Plain radiographs and/or CT scans of patients reported as having orbital metal were reviewed to confirm the presence of a metallic foreign body and to identify its location. RESULTS: Metallic foreign bodies were discovered in 40 patients. Six of these patients had impaired vision in the involved eye. Ten patients had a metallic foreign body in or near the orbit but well away from the globe and were thought to be at low risk for movement of the foreign body as a result of MR imaging. The other 24 patients had metallic foreign bodies adjacent to or within the globe and were thought to be at risk for movement of the metallic foreign body as a result of MR imaging. CONCLUSION: The prevalence of intraorbital metallic foreign bodies in our study population was low (0.27%). Even in those patients identified as being at risk, the prevalence was only 2.5%. Based on the number of MR examinations performed annually in the United States and on data indicating that no radiographic screening is performed at 5% of institutions, we extrapolate that more than 2400 patients with intraorbital metallic foreign bodies have undergone MR imaging since 1986 without report of injury. These data allow us to infer that the risk of eye damage for patients who have intraorbital metal is low and that radiographic screening before MR imaging is not needed as often as it is done.

Blindness↗
PubMed1985

[Extraction of foreign bodies in cases with complications].

Analysis of surgical treatment of 186 patients with intraocular foreign bodies and concomitant complications such as cataract, opacity of the vitreous body, hemophthalmos, and endo-ophthalmitis. The authors employed a variety of surgical procedures to remove foreign bodies, with opticoconstructive operations such as phacoemulsification, lensectomy, and vitrectomy. Reliable data were obtained conforming the efficacy of these operations. A total of 178 foreign bodies were removed; 2 could not be extracted. Six foreign bodies were left in situ, since removal was contraindicated. In the majority of the patients visual acuity improved. The authors have developed a system of interventions for various combinations of intraocular changes and foreign bodies.

Adolescent↗
PubMed1991

[New views on treatment of intraocular foreign bodies].

The authors evaluated the results of surgery in 130 patients operated at the Second Ophthalmological Clinic in 1983-1989 on account of intraocular foreign bodies. Extraction of the body was successful in 126 patients (96%), the function of the eye was preserved in 102 of 126 extracted foreign bodies (81%), a visual acuity of 0.5 to 1.0 was recorded in 78 eyes (60%). The authors investigated the relationship of functional results on the type, size and site of the intraocular foreign body, the way of extraction, interval between the injury and operation and previous attempted extractions. Analysis of results revealed the advantages of extraction of intraocular foreign bodies under visual control in the majority of foreign bodies. Intraocular foreign bodies are not an indication for immediate but for early operation. After careful treatment of the wound where the foreign body penetrated extraction may be delayed for several days before optimal conditions for surgery are created.

Adolescent↗
PubMed1988

Foreign bodies in the tracheobronchial tree: a review of 102 cases in Benghazi, Libya.

A total of 102 children in whom foreign body aspiration was suspected were admitted to hospital and their records reviewed. Bronchoscopy was performed on all except two who coughed out the foreign body. In 76 cases (group A), foreign bodies were identified in the tracheobronchial tree. In the remaining 26 (group B), no foreign body was found. Boys predominated over girls. Most of the foreign bodies were lodged on the right side. The commonest foreign body was the peanut. Clinical and radiological features in group A were not diagnostic; in many instances, therefore, the threshold of suspicion of aspiration should be low. Hence, medical personnel and the public should be made more aware of this problem.

Bronchi↗
PubMed2001

Management of ingested foreign bodies in childhood and review of the literature.

UNLABELLED: The management of ingested foreign bodies in children is not standardised. During a 15-year period, we recorded 325 consecutive paediatric cases of accidental ingestion of foreign bodies or with symptoms suggesting oesophageal obstruction presented at the emergency department or the paediatric gastroenterology unit. The foreign bodies that had to be removed were, in decreasing order of frequency: coins, toy parts, jewels, batteries, sharp materials such as needles and pins, fish and chicken bones, and "large" amounts of food. Only 54% of the patients had transient symptoms at the moment of ingestion, such as retrosternal pain, cyanosis and dysphagia. A minority (28, 9%) of foreign bodies could be removed with a McGill forceps; 65 (20%) were removed with a magnet probe. Endoscopic removal was performed in 82 cases (25%). In the majority of cases (150, 46%) natural elimination occurred. The outcome of all patients was uneventful. CONCLUSION: Recommendations for management of children presenting with a history of suspected accidental ingestion of a foreign body for the community paediatrician are proposed.

Adolescent↗
PubMed1996

[The ultrasonic diagnosis of foreign bodies in the dog and cat].

For the search of foreign bodies by means of ultrasound the 5 resp. 7.5 Mhz transducers are best used depending on the position. The appearance of different materials in the echotomogram such as plant parts, wood, metal or plastic is described. While in the abdominal organs, excluding the intestinal tract, a foreign body can be well detected, it can however only be visible in the abdominal cavity, when the surrounding tissue is inflamed (such as granuloma, abscess, free fluid). The ultrasound was only able to detect foreign bodies in the intestinal tract in approximately half of the cases. In those cases secondary sonographic signs of an ileus are often decisive. Penetrating foreign bodies in the area of the soft tissue of the musculoskeletal system are evaluated in the ultrasound according to their position, size and form. They are best seen when the inflamed reaction-line is well developed. Probes and catheters are definitively detected in the sonographic examination. Their position can be checked.

Animals↗
PubMed2004

Flexible bronchoscopic removal of a distal bronchial foreign body with cinefluoroscopic guidance.

A 15-year-old girl presented to the emergency department with cough and bloody sputum. A chest radiograph demonstrated a radiopaque foreign body (a tongue stud) in the right lower lobe. Rigid and flexible bronchoscopy failed to localize the foreign body. Under fluoroscopic guidance, the foreign body was identified in a right lower lobe distal bronchus; it could be visualized from a distance with a 3.5-mm flexible bronchoscope. An endobronchial biopsy forceps was passed through the suction port of the bronchoscope, but the view of the foreign body was obstructed by the biopsy forceps. The bronchoscope could not be advanced closer to the foreign body, because its diameter was greater than that of the bronchus. Under cinefluoroscopic guidance, the endobronchial biopsy forceps was then used to remove the foreign body. A chest radiograph obtained after removal was normal. The patient was discharged home the following day. Removal of distal bronchial foreign bodies can be challenging, because the bronchial diameter may preclude the advancement of the bronchoscope. Cinefluoroscopy is a relatively safe therapeutic adjunct that may avert the need for thoracotomy.

Adolescent↗
PubMed1998

Management of anorectal foreign bodies: a cause of obscure anal pain.

BACKGROUND: Few patients with anorectal foreign bodies will freely admit to transanal introduction. The results of long-term follow-up in these patients have been sparse. METHODS: Data from April 1989 to April 1997 were extracted from a prospective computerized database. The clinical features and the results of a departmental management protocol for anorectal foreign bodies were analysed. In addition, long-term outcomes were obtained by telephone interview. RESULTS: Thirty patients (25 men, 5 women) with a mean age of 46 (range 16-72) years) were treated for this condition. While 10 patients (33.3%) admitted to transanal insertion, the remaining 20 (66.7%) complained of anal pain. Among the latter, the foreign body was subsequently found on routine digital rectal examination in nine patients (45%), on X-ray in nine (45%) and it was passed out unexpectedly after fleet enema in two (10%). Factors which raised suspicion for X-rays included atypical gender behaviour, lax anal sphincters and bloody or mucoid rectal discharge. Transanal recovery was successful with sedation in 12 (40%), general anaesthesia in 13 (43.3%), and laparotomy was needed in three (10%; which included one perforated bowel at presentation). There were two complications (6.7%; one minor rectal abrasion and one bronchopneumonia). There was no long-term faecal incontinence or re-impaction of foreign bodies at 63 (range 8-96) months of follow-up. CONCLUSIONS: Foreign bodies should be suspected in patients with obscure anal pain. Judicious transanal extraction under sedation or general anaesthesia was usually successful with minimal short- and long-term complications.

Adolescent↗
PubMed1999

[A rare case of foreign body in external auditory meatus].

The authors present a case of a foreign body in external auditory meatus--cement mordant. Particularly++ we have described frequency and kind of the foreign bodies which we have met for 6 years. The foreign bodies were removed in 117 persons, 3 from these were hospitalized and foreign bodies were removed in general anesthesia.

Adult↗
PubMed2006

Tracheobronchial aspiration of foreign bodies: current indications for emergency plain chest radiography.

PURPOSE: The purpose of this study was to determine the role of plain chest radiography in the evaluation of patients with suspected foreign-body aspiration. MATERIALS AND METHODS: During a 5-year period, 31 patients (18 men and 13 women; age range 6 months to 85 years) were referred to our observation for clinical suspicion of foreign-body aspiration. Clinically, the patients presented with cough in 27/31 cases (87.1%), decreased breath sounds in 22/31 (71%), choking in 18/31 (58.1%), fever in 7/31 (22.6%) and cyanosis in 5/31 (16.1%). Suspected foreign-body aspiration had occurred 2-72 h before hospitalisation. Within 2 h of hospitalisation, all patients underwent plain chest radiography performed in the upright position (two projections) in 10/31 (32.3%) patients and in the supine decubitus position in the remaining 21 (67.7%) patients. Plain chest radiography was subsequently integrated with multislice computed tomography (MSCT) of the chest in 3/31 (9.7%) patients and with bronchoscopy in 27/31 (87.1%) patients. RESULTS: Plain chest radiography showed the presence of a foreign body in the tracheobronchial tree in 7/31 (22.6%) patients, who subsequently underwent successful bronchoscopy in all cases. Foreign bodies included tooth fragment (three cases), nail (two cases), metallic spiral of a ball-point pen (one case) and an earring (one case). In the remaining 24/31 patients, plain chest radiography was positive in 14 cases, showing atelectasis (seven cases), pneumonia (six cases), pulmonary hyperinflation (one case) and pneumomediastinum (one case). Such findings had been caused by an aspirated foreign body, which was subsequently removed by means of bronchoscopy in all 14 patients. Moreover, three of the remaining ten patients with negative plain chest radiograph were submitted to MSCT of the chest, which required in 1 case tracheobronchial aspiration of a foreign body that was subsequently removed by means of bronchoscopy. Overall, plain chest radiography showed the presence of foreign-body aspiration and/or pleuroparenchymal lesions in 21/31 patients (67.7%); bronchoscopy was positive in 23/27 patients (85.2%), localising the foreign body in the right main bronchus in 16/27 patients (59.3%), left main bronchus in 7/27 patients (25.9%), intermediate bronchus in 2/27 patients (7.4%) and right lower lobe bronchus in 2/27 patients (7.4%). No late complications were observed within 6 months of hospital discharge. CONCLUSIONS: Plain chest radiography remains the initial imaging modality for patients with clinically suspected tracheobronchial aspiration of a foreign body. Nevertheless, in the case of negative chest radiography and a clinical suspicion of foreign-body aspiration, MSCT-possibly integrated with virtual bronchoscopy-should be considered in order to avoid unnecessary bronchoscopy.

Adolescent↗
PubMedDate not supplied

[Urethral foreign bodies. Apropos 2 cases].

OBJECTIVE: To report two cases of urethral foreign body. Although this condition is not uncommon, few cases are reported in the literature. METHODS/RESULTS: Two cases of urethral foreign body are described: a 74-year-old male with mental disorder who presented with acute urinary retention arising from a fragment of a metal tube in the bulbous urethra and a 34-year-old female with intense micturition syndrome arising from a calcified electrical cable located in the urethra. Both patients required open surgery for foreign body removal. CONCLUSIONS: A wide variety of urethral foreign body has been described in the literature. In adults this is commonly caused by the insertion of objects used for masturbation and is frequently associated with mental disorder as in the two cases described herein.

Adult↗
PubMed2000

[Foreign bodies of the rectum].

During the 22 years period there were 26 patients (23 men and 3 women) aged from 18 to 71 with foreign bodies in the rectum introduced through the anal canal. The main causes of the appearance of foreign bodies in the rectum were anal masturbation (in 12 patients) and forced introduction of the objects by other people (in 10 patients). Among the foreign bodies prevailing were plastic and glass bottles, cucumbers and carrots, wooden and rubber objects in the from of the phallus. Typical were large sizes of the most objects introduced (the diametrical size more than 6 cm and the length more than 15 cm) which was responsible for the development of complications and made the removal difficult. The symptoms of the presence of foreign bodies in the rectum were determined as well as the optimum methods of diagnosis. A classification of rectal foreign bodies is proposed for the solution of medico-tactical tasks. The transcanal removal of the foreign bodies was fulfilled in 23 patients. The standardized technique of the transcanal removal of the objects is thought by the authors to include 10 principal propositions. Open operative interventions (removal of the foreign body, suturing the rupture, drainage of the abdominal cavity or of the perirectal space, sigmostomy) were performed in 4 patients with penetrating injuries of the rectum wall. The results of the treatment including removal of all foreign bodies were good, without lethal outcomes.

Adolescent↗
PubMed1980

Retention of wooden foreign bodies in the orbit.

Two cases of retention of wooden foreign bodies in the orbit are presented. Both patients had a draining fistula. A brain abscess developed in one and a foreign body granuloma in the other. In both cases computerized tomography was very helpful in localizing the foreign bodies and the sequelae. In such cases a subperiosteal surgical approach provides good exposure and minimizes the damage to the orbital contents. A high degree of suspicion of penetration of the orbit is essential in tree branch injuries of the eyelids.

Adult↗
PubMed2001

Unique presentation of a bronchial foreign body in an asymptomatic child.

A child who aspirates a foreign body may present in many ways. We present the case of an 8-year-old boy whose initial presentation consisted only of his preoccupation with his lost toy and his gesturing toward his oral cavity. There was no witnessed coughing or choking episode, and there were no initial physical examination findings of note, and no abnormalities on appropriate radiographic studies. The patient was transferred to our institution for further evaluation and management. Our careful examination revealed a slight wheeze at the left upper lobe. Endoscopy was immediately performed, and bronchoscopy revealed a yellow, tubular, plastic foreign body in the left main bronchus through which the patient was breathing freely. This was removed without incident by means of optical graspers. The physical characteristics of this foreign body, including its small size, relatively inert material, and large lumen, allowed this patient to present relatively asymptomatically. This case demonstrates the need for a high index of suspicion in the evaluation and management of foreign bodies in the aerodigestive tract.

Bronchi↗
PubMed2006

Foreign body in the bladder mimicking nephritis.

Cases of foreign bodies in the bladder self-inserted via urethra are not rare in childhood. Urinary tract infection, dysuria, lower abdominal pain, or haematuria with and without pain are common symptoms. We report on a 11-year-old boy with accidentally detected microscopic haematuria, proteinuria and leukocyturia. Because of increasing proteinuria up to 2330 mg/g creatinine and elevated antistreptolysin titre glomerulonephritis was suspected. However, some echogenic material was detected in the bladder by ultrasound. X-ray of the pelvis showed a 30 cm long tube projecting onto the bladder. The boy then admitted having had inserted a plastic tube into the urethra two years ago. The foreign body was removed cystoscopically. Four weeks after cystoscopy erythrocyturia, leucoyturia and proteinuria had disappeared. We state that symptoms of a local inflammation caused by a foreign body in the bladder can imitate the symptoms of nephritis.

Child↗
PubMed2000

Retropharyngeal abscess secondary to penetrating foreign bodies.

A retrospective study was conducted on patients with upper aerodigestive tract foreign bodies requiring operative intervention over a 12-year period to aid in the recognition and management of foreign body associated complications. Oesophagoscopies were performed for the removal of foreign bodies in 37 patients, age one to 82 years with a male to female ratio of 1.2:1. Retropharyngeal abscesses accounted for eight of 11 foreign body-associated complications. Fish bones were the cause in six cases, chicken bone and a pen refill in one case each. An abscess was already present at the time of initial procedure in six cases and developed in two cases after successful removal of the foreign body. A high level of suspicion for a retropharyngeal abscess should be maintained in cases with perforation, and in patients with immunodeficiency.

Adolescent↗
PubMed2000

Hyphema caused by a metallic intraocular foreign body during magnetic resonance imaging.

PURPOSE: To report a 63-year-old man with a retained intraocular foreign body who developed a hyphema during magnetic resonance imaging (MRI) of the brain. METHODS: Case report and review of the current literature on ocular injury caused by intraocular foreign bodies when subjected to an electromagnetic field. RESULTS: Our patient underwent a brain MRI, and the intraocular foreign body caused a hyphema and increased intraocular pressure. The presence and location of the intraocular foreign body were determined by computed tomography (CT). CONCLUSION: Magnetic resonance imaging can cause serious ocular injury in patients with ferromagnetic intraocular foreign bodies. This case demonstrates the importance of obtaining an occupational history, and, when indicated, a skull x-ray or CT to rule out intraocular foreign body before an MRI study.

Anterior Chamber↗