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Reports of ingested foreign bodies penetrating the pharynx and migrating through the neck are rare, and mostly involved fish bones. We describe a 44-year-old man who was involved in a motor vehicle accident and accidentally swallowed his tooth. The swallowed tooth penetrated the pharynx and became lodged adjacent to his right thyroid gland. It was successfully removed via neck exploration and the patient recovered well.
Perforations of the gastrointestinal tract by ingested foreign bodies such as chicken or fish bones are rare and may occur at any site from the oesophagus to the rectum; the diagnosis is often very uneasy with conventional radiography. For many years, sonography has been more frequently requested as the first modality for the evaluation of abdominal pathology, and in many cases allowed a correct diagnosis to be reached without further assessment. We report six cases of complicated foreign bodies very successfully and specifically diagnosed by sonography in six different sites of the gastrointestinal tract. Four of these cases were preliminary correctly suspected by CT but the shape, length and the probable nature of the body were always better appreciated by multiaxial real time sonography. The correct sonographic diagnosis and follow-up allowed a conservative treatment in three cases, avoiding surgical exploration. We recommend the systematic sonographic investigation of foreign bodies in close relation with the gastrointestinal tract in all atypical inflammatory processes or to perform sonography as a complement to CT.
Over a 10-year period, a series 96 patients were treated for laryngotracheal and bronchial foreign bodies in the ENT department of the Ouagadougou University Hospital Center (Burkina Faso). The purpose of this study was to analyze the epidemioclinical features and therapeutic pitfalls encountered in that series and to propose measures to improve management. The age of patients ranged from 10 months to 14 years. The male-female ratio was 1.7. Anamnesis documented foreign body aspiration was obtained in 77% of cases. The foreign body was organic in 78 cases (81.2%) including vegetal material in 56 cases. Management was delayed due to late diagnosis since only 59.3% of the patients were admitted to the hospital within the 48 first hours. Endoscopic removal was performed in all cases but such procedures remain challenging in developing countries due to a lack of proper anesthetic facilities, skilled personnel and adequate equipment. Tracheostomy was performed in 10.4% of cases mainly in patients with foreign bodies located in larynx. One patient died during extraction. In addition to providing more information and education on prevention of laryngotracheal and bronchial foreign bodies, better management requires better training of medical personnel and improvement of technical facilities.
A double-blind, controlled study to assess the accuracy of interpretation of lateral soft tissue radiographs of 60 patients with suspected foreign body impaction in the oro/hypopharynx was carried out by 18 respondents from three different specialities. All the patients had endoscopy carried out and foreign bodies were present in 25. Of these, foreign bodies were diagnosed on the radiograph in only 38.3 per cent. False-positive diagnoses were made in a mean of 26.3 per cent of those patients who did not have a foreign body.
PURPOSE: To analyze the utility of helical computed tomography (CT) in the diagnosis of suspected upper esophageal foreign bodies. MATERIAL AND METHODS: A prospective study was performed on 36 patients (26 F, 10 M, mean age 70 years) with a history of foreign body impaction. All had negative findings at indirect laryngoscopy. Radiologic assessment included unenhanced helical CT and a barium contrast study. Patients with positive findings were taken to esophagoscopy. All patients had a posterior clinical surveillance. RESULTS: Twenty patients had both normal CT and barium study and satisfactory clinical outcome. In 12 patients a foreign body was noted in the cervical esophagus by CT, barium study, and endoscopy. In one patient a fish bone was detected by CT (and not by barium) confirmed with esophagoscopy. Another patient had a fish bone esophageal perforation which was observed only by CT and confirmed at surgery. Two patients with normal barium and endoscopy presented a false-positive CT result. CONCLUSION: Barium swallow is currently the first radiologic study, but may involve a risk of aspiration and can impede a subsequent esophagoscopy. Esophagoscopy is an invasive technique with a certain risk of serious complications that can be avoided with a satisfactory radiologic assessment. CT is easy, fast, has 100% sensitivity and is therefore the first choice technique for diagnosing suspected upper esophageal foreign bodies not expected to be visible on plain radiographs.
In the Charnley total hip arthroplasty, periarticular foreign bodies represent potential foci for intraarticular migration at the time of hip dislocation. This complication, although very rare, should be verified radiographically to prevent unsucessful attempts at closed reduction. Although intraarticular radiopaque foreign bodies should be identified on plain radiographs of the hip, intraarticular radiolucent foreign bodies require positive-contrast arthrography for identification. Two illustrative cases are presented.
INTRODUCTION: In aseptic loosening of cementless hip arthroplasty polyethylene particles are phagocytized by macrophages and foreign-body giant cells. This initiates an osteolytic cascade. In this study, the authors investigated if there are correlations between the size of foreign-body giant cells and the polyethylene loading and number of intracellular particles as determined by light microscopy. MATERIAL AND METHOD: Histological specimens were processed from tissues retrieved during revision surgery of 7 cases of cementless hip arthroplasty which had become aseptically loose. The specimens were analyzed by histolomorphology and histomorphometry. The cell size, polyethylene loading and intracellular particle number of 111 foreign-body giant cells were determined. A regression analysis was performed to investigate if there was a correlation between these variables. RESULTS: The mean cell size was 1417 +/- 487 micron 2, the mean polyethylene loading was 49 +/- 42 micron 2 and the mean intracellular particle number was 10.4 +/- 5.4. The cell size correlated with both the intracellular particle number (r = 0.25) and the polyethylene loading (r = 0.39). CONCLUSIONS: In the cellular reaction to polyethylene particles in aseptic loosening of cementless total hip arthroplasty, the size of foreign-body giant cells correlates with intracellular polyethylene loading and intracellular polyethylene particle number as determined by light microscopy. The presence of large foreign body giant cells might be associated with a high particle load of the tissue and a high osteolytic activity.
The epidemiology and management aspects of 212 consecutive cases of foreign bodies of the ears and nose in children presenting to an urban pediatric walk-in and emergency care facility were retrospectively reviewed. The items most commonly removed from children's external auditory canals were roaches, paper wads, toy parts, earring parts, hair beads, eraser tips, and food. Foreign bodies most often found in the nose included hair beads, toy parts, paper wads, and food. Approximately 90% of all foreign bodies were able to be removed without significant complications by emergency department personnel with simple equipment. Those who required referral for otorhinolaryngologic intervention had more often failed at self or parental home foreign body removal attempts than those who were able to managed successfully by emergency department personnel. Parents should be cautioned against attempting to remove objects not readily visible or not capable of being grasped easily.
This is a retrospective study that describes the historical, physical exam, radiographic, fistulographic, ultrasonographic, and surgical findings associated with non-gastrointestinal and extrathoracic foreign bodies in six dogs. All dogs had a chronic draining tract or abscess. Although radiographs were obtained in five of the six dogs, no foreign bodies were identified with this modality. Fistulography was performed in four of the six dogs, and a filling defect consistent with a foreign body was found in two of four dogs. A foreign body was identified in five of the six dogs with ultrasound. Foreign bodies were removed surgically in five of six dogs. This report clarifies the importance of ultrasound in the evaluation of chronic draining tracts and abscesses in dogs.
PURPOSE: To compare helical CT to conventional CT imaging in the assessment of orbital metallic foreign bodies with regard to image quality, scanning time, and radiation exposure. METHODS: Twenty-four standardized metallic foreign bodies, placed into the orbit (anterior, epibulbar, posterior) of cadaver heads were studied. Helical CT scanning in the axial plane with multiplanar reconstruction of coronal and sagittal images was performed as well as conventional CT imaging with direct scanning in the axial and the coronal planes (Tomoscan SR 7000, Philips, The Netherlands). Two masked observers consensually graded the studies using 5 predetermined criteria. Radiation dose delivered to the lens and scanning time were measured for the helical and the conventional CT imaging workup. RESULTS: Helical CT imaging scored statistically significantly better with regard to overall accuracy of foreign body localization and presence of beam-hardening streak artifacts from dental fillings. Conventional CT scored significantly better with regard to stair-step artifacts. The radiation dose delivered to the lens was 35.4 mGy for helical CT imaging and 73.9 mGy for conventional CT workup (axial and coronal scanning). Total scanning time was 18 seconds for helical CT axial scanning and 104 seconds for conventional CT axial and coronal scanning. CONCLUSION: Helical CT is superior to conventional CT imaging, because it can provide adequate information about orbital metallic foreign bodies with a single acquisition, thus reducing both the number of examinations and the radiation exposure for the patient.
The relative advantages and disadvantages of radiographic and ultrasonic studies in foreign body detection and localization are discussed. The value of ultrasonography in finding radiolucent orbital foreign bodies and its clear superiority in the localization of foreign bodies with respect to the walls of the eye is demonstrated by several examples. The information concerning the state of the lens, vitreous, and retina in such traumatized eyes which is obtained by ultrasonography represents a very important additional benefit of such study.
The aim of this retrospective study was to emphasize the performances of spiral CT (HCT) and multidetector-row CT (MDCT) as very effective imaging modalities for the diagnosis of intestinal perforations caused by calcified alimentary foreign bodies. Eight sites of perforations of the ileum by ingested foreign bodies were found in seven patients--one patient presenting with two separate sites of perforation. The diagnosis was successfully made by HCT in four patients and MDCT in the remaining three. Involuntarily and generally unconsciously ingested chicken and fish bones were the implicated calcified foreign bodies. The acute clinical presentations were nonspecific, mimicking more common acute abdominal conditions. A thickened intestinal segment (7/8 sites) with localized pneumoperitoneum (4/8 sites), surrounded by fatty infiltration (4/8 sites) and associated with already present or developing obstruction or sub-obstruction (5/7 patients) were the most common CT signs, but the definite diagnosis was clearly made by the identification of the calcified foreign bodies (7/7 patients). In each patient, this identification was only possible thanks to the scrupulous analysis of very thin overlapping reconstructions obtained not only in the perforation sites (6/8 sites), but also through the entire abdomen (2/8 sites). Our report emphasizes the high performances of CTA and MDCT in identifying intestinal perforation caused by calcified alimentary foreign bodies. Moreover, the high specificity of the CT diagnosis made it possible to avoid surgerical exploration in three patients.
A 27-year-old man sustained a blast injury to the face in April 1996, with a resultant foreign body at the right medial orbital wall. He refused to undergo surgical removal of the foreign body at that time and was discharged on oral antibiotics. Five years later, he presented because of recurrent attacks of swelling, redness, and pain at the right medial canthal area. A repeat computed tomography (CT) scan revealed fragmentation of the original orbital foreign body and an adjacent radiodense lesion that appeared to blend smoothly with the orbital bone from which it arose. This lesion was not present on the initial CT scan done 5 years earlier immediately following the blast. The patient was started on oral antibiotics and surgical exploration was carried out. Three fragments of the foreign body were removed in addition to the adjacent orbital lesion, which proved to be an ivory-type osteoma on histopathology. We briefly review previously suggested factors in the pathogenesis of osteoma and present further evidence in favor of both traumatic and infectious factors.
32 patients, in whom bronchoscopy was performed due to the removal of foreign body from the lower respiratory tract were described. Age of the patients clinical symptoms and a time lapse between aspiration and removal of foreign body from the lover respiratory tract and localization of foreign body in the particular bronchus were analysed. We conclude, that rigid bronchoscopy is still more useful and safe method of foreign body removing from the lower respiratory tract.
The expression of the genes icaA, icaC, aap, and atlE--with a putative role in the pathogenesis of Staphylococcus epidermidis foreign body infections--and of mecA and 3 housekeeping genes (gmk, tpi, and hsp60) was examined in vitro and in vivo. In vitro expression levels of ica, atlE, and gmk were higher in sessile than in planktonic bacteria. Exposure to foreign bodies in vitro and in vivo induced a sharp increase in ica expression that was followed by a progressive decrease. The in vivo expression of aap and mecA was high during early but low during late foreign body infections. The in vivo expression of atlE and gmk remained relatively high and stable. In conclusion, biofilm genes encoding for structural elements are mainly expressed during early foreign body infections. The ica genes are associated with initial colonization but not with persistence. The constant expression of atlE and gmk may indicate a role during the entire course of foreign body infections.
In a review of 19 years' experience with inhalation of foreign bodies by children the 33 patients (mean age 28 months) were found to have presented most frequently with wheezing or coughing, or both, of recent onset, and to have decreased air entry, rhonchi or respiratory stridor, or a combination of these signs. Eighteen children had inhaled a nut, a pea or a bean. The other 15 had inhaled various organic and inorganic objects. All the children underwent bronchoscopy, and the foreign body was completely removed in 19 during the first procedure; the remainder required repeated bronchoscopy or direct surgical removal of the foreign body, or both. Permanent disability or death was not encountered. The findingsof the study indicate that early bronchoscopic removal is the preferred treatment when a child inhales a foreign body.
Many young children and infants wheeze during viral infections of the respiratory tract. The differential diagnosis of those children includes the inhalation of a foreign body. This diagnosis is overlooked in about 20% of cases, which leads to subacute and chronic complications. Two clinical observations are reported, involving young children with clinical asthma exacerbations but where the absence of response to usual treatment and/or the absence of evidence for atopy and/or the acute onset brought us to suspect the inhalation of a foreign body. These cases allow us to remind the usual signs and symptoms associated with the inhalation of a foreign body. Amongst these signs, unilateral hypoventilation on chest auscultation associated with localized emphysema on chest x-ray has a very high positive predictive value. Aggressive management in a specialized surrounding is advocated when an inhaled foreign body is suspected. Algorithms based on the level of suspicion have been designed to allow the pediatric respiratory physician to choose between rigid and fiberoptic bronchoscopy. It is only by systematization of these procedures and development of preventive measures that we will be able to reduce the prevalence of complications secondary to the inhalation of a foreign body.
We describe a case of recurrent tracheoesophageal fistula in a child previously operated for esophageal atresia and tracheoesophageal fistula following impaction of a foreign body. After extracting the foreign body, the diagnosis of recurrence was confirmed by esophagogram and bronchoscopy. The fistula was approached through transpleural thoracotomy and repair effected without significant difficulty. The possibility of unrecognized foreign body impactions as the etiological factor for late recurrence of tracheoesophageal fistula is discussed.