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Five cases of aspirated foreign bodies in bronchial tree were described. The clinical symptoms did not suggest the real cause of the illness and most of patients did not remember the fact of foreign body aspiration. The foreign bodies were removed during bronchofiberoscopy performed in local anaesthesia.
Accidental incorporation of foreign bodies may cause bizarre and varied complications. The patient may remain asymptomatic for months or years, or an abscess or sinus may develop. Foreign bodies which cannot be seen on radiographs are usually difficult to detect. A detailed and careful history of the patient is of the utmost importance.
Echocardiography is ideal for localizing cardiac foreign bodies and for characterizing associated cardiac and vascular injury before and during extraction. We report 5 cases of traumatic and iatrogenic cardiac foreign bodies that illustrate the central role of transthoracic and transesophageal ultrasonography in the management of these patients.
Traumatic cataracts resulting from penetrating injuries occur most frequently from projectile metallic foreign bodies. The majority of intraocular foreign bodies cause sight-threatening damage including traumatic cataract in up to 25% of the cases. A case of traumatic cataract and retained intralenticular foreign body that was removed successfully with phacoemulsification and foldable intraocular lens implantation in the capsular bag is described. This case report highlights the benefit in planning surgical management as a two-staged procedure after appropriate investigations.
Seventy-nine children with foreign body aspiration (FBA) were treated at the Ethio-Swedish Children's Hospital in Addis Ababa, Ethiopia, over a seven year period, from September 1987 to August 1994. There were 55 boys and 24 girls with a mean age of 3.4 years. Only 15 (19%) children presented within 24 hours of aspiration. A definite or suggestive history of FBA was obtained in 68 (86%) children. Abnormal radiologic findings were present in 60 (76%) cases. Correct diagnosis was delayed or missed in 16 (20%) cases. Bronchoscopic extraction of foreign bodies was made in 62 out of 69 bronchoscoped cases. Three children coughed up the foreign bodies spontaneously. Nine (11%) children died, six before, two during and one after bronchoscopy. Late presentation, delay in diagnosis and intervention as well as missed diagnosis were major causes of prolonged morbidity and high mortality. Considering FBA early in the differential diagnosis of unexplained pulmonary problems, early bronchoscopy for such cases and prompt bronchoscopic extraction of aspirated foreign bodies are stressed to reduce and eventually avoid the high morbidity and mortality associated with FBA in children.
Closed posterior intraocular microsurgery with vitreous instruments and bimanual surgical techniques have markedly altered the management of intraocular foreign bodies (IOFB). This paper presents an approach to 14 metallic intraretinal foreign bodies (IRFB) that could not be removed by conventional methods. In all cases, posterior vitrectomy was required to visualize the foreign body or to facilitate its removal through a pars plana incision with intraocular forceps under microscopic visualization. Although successful removal of the intraretinal foreign body was possible in all 14 patients, central visual acuity of 20/400 or better was obtainable in only 40% of this series. An important observation in these patients was a tendency to macular pucker from subsequent epiretinal membrane formation and retinal detachment with massive periretinal proliferation (MPP), which occurred in 90% of these eyes. Despite an obviously enhanced ability to remove foreign bodies from the retina, made possible by vitreous instruments and surgical techniques, the magnitude of the secondary complications in this variety of ocular trauma suggests a poor visual prognosis for such injuries.
This case demonstrates the unpredictability of foreign bodies in the face. The retained knife blade eluded detection on two separate examinations. The essential components to making a correct diagnosis of a foreign body following a stabbing to the face include a thorough review of the mechanism of injury, a complete head and neck examination, a high index of suspicion, and plain radiographs of the face.
OBJECTIVE: To evaluate the clinical features and outcome in girls with a vaginal foreign body. METHODS: Retrospective review of medical records of 35 girls with a vaginal foreign body seen in an outpatient clinic for paediatric and adolescent gynaecology between 1980 and 2000. RESULTS: The ages ranged from 2.6 to 9.2 years. The most common symptom was blood-stained vaginal discharge/vaginal bleeding (49%). Duration of symptoms varied from 1 day to 2 years. Fifty-four percent of the patients recalled insertion of the foreign object, usually by the girl herself. All but three patients (91%) either recalled insertion of the foreign object and/or had vaginal bleeding or blood-stained or foul-smelling vaginal discharge, and/or visualization or palpation of the foreign body in physical examination. Symptoms resolved after removal of the foreign body followed by a single irrigation with Providon-Iod (Betadine). CONCLUSION: In the majority of patients a carefully obtained history and physical examination suggest the diagnosis of a vaginal foreign object. The leading symptoms are vaginal bleeding and blood-stained or foul smelling vaginal discharge. Removal of the foreign object followed by a single irrigation with Providon-Iod is the definitive treatment and does not require additional measures.
Three large wooden foreign bodies were undetected in the orbit despite extensive evaluation and orbital exploration. In two cases there was motility disturbance from orbital inflammation that resolved after late spontaneous extrusion of the foreign material. Recurrent fistula unresponsive to antibiotics persisted in two cases until the wood extruded. Computerized tomography and ultrasonography failed to identify the foreign material. Orbital exploration without preoperative localization of the foreign body is usually contraindicated because proptosis, motility limitation, and fistula usually resolve after late spontaneous extrusion. In our cases and in the literature early exploration did not lead to complete extirpation of foreign material. We inform the patient of our diagnostic limitations and the prudence of conservative management.
Wooden skewer foreign bodies were found in eight dogs. Five presented for evaluation of draining sinuses and two for inflammatory disease referrable to the thorax, abdomen or pelvic region. In an additional case, pneumothorax resulted from perforation of the stomach and diaphragm. Ingestion was considered the most likely mode of access of the foreign body in all cases. Although the wooden foreign bodies were seen radiographically in only two dogs, identification of soft tissue or bony changes, or the results of contrast sinography assisted diagnosis. Surgical retrieval led to resolution of signs in all cases.
Despite the recent advances in instrumentation and anesthesia, removal of esophageal foreign bodies remains a challenge. Endoscopic removal of foreign bodies has yielded a success rate of 80%. Surgical removal of these foreign bodies is necessary when the endoscopic manipulations fail. Localization and size of the bodies play a critical role in the method of treatment. Here we present a patient with a large stone with sharp edges located in the cervico-thoracic region which was removed after being pushed into the hypopharynx through the esophagus rather than being pushed into the stomach. The technique used proved to be effective and safe; this may be the first use of the procedure in the literature.
Nasal foreign bodies are common in young children and are typically the result of intranasal placement by the child. The authors report a case of an extranasal foreign body in an adult, which presented as a nasal fracture following trauma to the nose. This uncommon presentation, previously unreported in the literature, highlights the importance of careful history taking in cases of nasal trauma and of thorough wound exploration if any penetrative injury is found.
OBJECTIVES: To study the pattern of ingestion of radio-opaque foreign bodies in children and to ascertain the average transit time to passage per rectum in order to rationalise future management. METHODS: This prospective study consisted of 100 children under the age of 14 years, presenting to the accident and emergency department of the Royal Aberdeen Children's Hospital having ingested a radio-opaque foreign body. All children had initial radiography and were subsequently followed up in an attempt to ascertain the transit time of the foreign body. RESULTS: The majority of ingestions (73%) were in younger children (5 years and under). The time taken to pass the foreign bodies per rectum varied greatly. Almost half were never recovered. Transit time appears to increase with age. Three children were given oral cisapride to increase gastric motility after prolonged retention in the stomach. CONCLUSIONS: Transit time is very variable and cannot be predicted. Sifting of the stools is unpleasant and unhelpful. Repeat radiography should not be encouraged as this results in unnecessary radiation. Cisapride may be useful in cases where there is prolonged retention of a foreign body in the stomach. There may be an indication for routine use of cisapride in all cases of ingested foreign bodies, however further audit would be required.
OBJECTIVE: The objective of this study was to compare 3 imaging techniques-plain radiography, soft-tissue radiography, and ultrasonography-in detecting nonradiopaque foreign bodies in soft tissue. METHODS: In this randomized, blinded, and descriptive in vitro study, 40 chicken thighs with 2 types of nonradiopaque foreign bodies (wood and rubber) and 40 chicken thighs as part of a control group were evaluated to detect soft-tissue foreign bodies with plain radiography, soft-tissue radiography, and high-frequency ultrasonography. RESULTS: The overall sensitivity, specificity, as well as positive predictive and negative predictive values of plain radiography for both nonradiopaque foreign bodies were 5%, 90%, 33%, and 48%, respectively; those of soft-tissue radiography for both nonradiopaque foreign bodies were 5%, 90%, 33%, and 48%, respectively; and those of ultrasonography for both nonradiopaque foreign bodies were 90%, 80%, 81%, and 89%, respectively. CONCLUSIONS: In this experimental model, the results show that high-frequency ultrasonography is superior to plain and soft-tissue radiographies and that the latter 2 techniques are similarly poor at detecting nonradiopaque foreign bodies.
To determine whether aluminum foreign bodies located in the soft tissues of small body parts are radiopaque, six pieces of aluminum (0.5 mm x 0.5 mm x 1 mm; 0.5 mm x 0.5 mm x 2 mm; 0.5 mm x 0.5 mm x 4 mm; 1 mm x 1 mm x 1 mm; 1 mm x 1 mm x 2 mm; and 1 mm x 1 mm x 4 mm in size) were placed in a chicken wing model and anteroposterior and lateral radiographs of the preparation were obtained. Aluminum fragments (of all sizes used) were easily discernible when projected away from bone. The authors conclude that aluminum foreign bodies located in the soft tissues of small body parts are radiopaque.
Tracheobronchial foreign bodies, which are common in children, are a leading cause of accidental deaths in children under four years of age. Three cases of tracheobronchial foreign bodies in children less than two years old are described. One of the foreign bodies was unsuspected; the other two were probably related to food habits. All three cases improved without sequelae following prompt bronchoscopic intervention. Young children should not be given food containing bones or hard chitinous shells.
Percutaneous removal of centrally located, embolized, intravascular foreign bodies is essential. A technique was developed to shift fixed foreign bodies into a position where they may be grasped and eventually removed with a snare or Dormia basket. It involves insertion by bilateral femoral vein puncture of a curved-end catheter and a second catheter attached to a Dormia basket set. A wire passed through the first catheter is grasped with the Dormia basket, and the foreign body is mobilized by means of traction on both catheter systems.
The right eye of a 17-year-old patient had been injured by a metallic, nonmagnetic foreign body which had perforated the eye at the limbus at 6 o'clock and become lodged in the posterior part of the ciliary body near the ora serrata. The operation to remove the foreign body was unsuccessful. After three months without any inflammatory reaction the patient noticed it in the conjunctiva. The splinter had been spontaneously rejected via the same route by which it had entered the eye; it was removed from the point of entry under local anesthesia. The special circumstances which, in the authors' opinion, led to spontaneous rejection of this foreign body are discussed.