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Twelve patients with exogenous foreign bodies (small chicken and fish bones, portion of wire, nail, cherry stone, piece of glass) of appendix (8) or adjacent zone of caecum (4) were treated. Based on experience of treatment of these patients authors analyze pathogenesis of appendicitis associated with foreign bodies, and other aspects of this problem.
Foreign bodies (FBs) of the pharynx are likely to stop at the palatine or lingual tonsils, the cricopharyngeal muscle, or the beginning of the esophagus; they may be removed with direct vision. FBs of the esophagus should be located by esophagram; endoscopy may be diagnostic and therapeutic; sharp objects may cause laceration and vascular injury. In the stomach, the FB may pass through the intestinal tract or stop at the pylorus or duodenum; if after 5-6 days there is no evidence of passage in the duodenum, it should be recovered by gastrotomy or endoscopy. FBs in the small intestine, calculi, or phytobezoar usually stop at the ileocecal valve and should be recovered by enterotomy. They may produce a coloenteric or enteroenteric fistula leading to an inter-intestinal abscess leading to intestinal obstruction. They may pass in the colon and stop at the rectosigmoid junction leading to perforation simulating perforating sigmoid diverticulum. FBs of the rectum may be recovered by sigmoidoscopy. The strategy is exact radiological location and evaluation of whether there is absence or presence of retroperitoneal or perirectal air. Intraperitoneal perforation should be immediately treated by suture of the perforation and temporary sigmoid colostomy. Perforation below the peritoneal reflexion is treated by diverting sigmoid colostomy and extraperitoneal perirectal drainage. Compound lacerations of the rectosigmoid junction may need Hartmann's procedure followed three weeks later by a terminoterminal or terminolateral anastomosis using the EEA stapler.
The study describes 3 children with strange foreign bodies in the esophagus, one aged 14 the other two 8 and 13 months respectively. A metal hanger hook was found in the first one, a lollypop with a plastic stick 10 cm long in the second and a painting brush 21 cm long in the third one. Two of the foreign bodies were removed ambulatory, the third one hospitally. The interventions were not followed by complications.
Three methods complementing each other are available for the preoperative intraocular localisation of foreign bodies. Basing on the results obtained, it is recommended, first of all, to localise the site of the foreign body by means of conventional x-ray film, followed by fine diagnosis via ultrasound and, finally, in problematic or doubtful cases, by means of computed tomography.
UNLABELLED: Funnel-type intraluminal duodenal diverticulum (windsock web) is a rare congenital malformation. A 4-year-old boy with vomiting and abdominal pain for several weeks was referred to the hospital. A plain abdominal X-ray on admission disclosed a double bubble sign. Abdominal echography and CT disclosed a foreign body lodged in the alimentary tract. After the foreign body was removed with a fibrescope, endoscopy showed a stenotic descending portion where the foreign body was located. An upper gastro-intestinal contrast study demonstrated a post-bulbar duodenal stenosis with a barium-filled pear-shaped sac in the descending portion of the duodenum. Surgical exploration was done under the diagnosis of windsock web of the duodenum. A simple excision of the web at its base was carried out. A hole 7 mm in diameter was found at the edge of the web. The microscopic appearance of the resected specimen was characterized by the duodenal mucosa with an extensive chronic inflammation lining both sides of the diverticulum and the lack of muscular layer of mucosa. CONCLUSION: If an ingested material is not excreted in the stool, possible clogging in the intestinal tract should always be considered and a further intensive examination is warranted.
We present a series of 114 cases of children under seven years of age with solid foreign bodies in lower respiratory tract. These cases were analysed under diagnostic and therapeutic aspects. The index of clinical diagnosis is taken into consideration, based on the respiratory symptoms and the aspirative antecedent; the radiologic diagnosis: opacity and indirect signs; endoscopy as diagnostic and therapeutic procedure, and the use of other medical and surgical treatments. From the results obtained we draw the following conclusions: a) Almost all cases of foreign bodies can be diagnosed from a good clinical history, and a radiologic study of the thorax, in inspiration-expiration. b) Endoscopy is the selective diagnostic and therapeutic tool; morbidity and mortality is negligible, and hospitalization period short. Either tracheostomy or bronchotomy are done very rarely. c) The pathologic lesions are dependent upon the shape of the object, its nature, the time it has been in the air tract and the response of the host. d) Foreign bodies appear most frequently in the right principal bronchus.
This case documents the course and treatment of a severe reaction to an unusual foreign body. A tooth brush bristle was lodged in the lower anterior areas between the cuspid and lateral incisor teeth. Although the patient noted some original discomfort, severe pain and bone destruction did not occur until 6 weeks after the original symptoms began. Treatment involved full thickness flap reflection of the involved area. The histologic examination showed a typical foreign body reaction to the bristle. All teeth remained vital throughout the disease process and healing phase. Healing was uneventful and the lost bone completely regenerated.
A broken end of the spear presenting as a foreign body in the nasopharynx and right maxillary sinus in a 19-year-old Papua New Guinean is described. The types of foreign bodies and their mechanisms of introduction into this site are summarized.
The fluoroscopically controlled Foley catheter technique can be used to remove nonopaque esophageal foreign bodies that are smooth or soft and foreign bodies in patients with esophageal strictures or after esophageal atresia repair. These situations have previously been felt to be contraindications for this procedure. Successful treatment was accomplished in 21 of 25 patients.
Real-time ultrasound was used to identify a foreign-body abscess causing an extraluminal esophageal obstruction in the neck of a horse. Surgical exploration to remove the foreign body and drain the abscess was performed after 2 months of medical management that had failed to resolve the problem. The abscess could not be visualized because there was no draining tract or other localizing sign of inflammation. Ultrasound was used aseptically to guide surgical dissection to the walled off abscess with minimal damage to adjacent vital structures in the surgical field. The signs of esophageal obstruction abated and have not recurred in 15 months.
The present paper reports some organizational hypotheses and presents personal experience in the endoscopic management of tracheobronchial foreign bodies in children. Many changes have taken place in endoscopy and anesthetic techniques over the last twenty years and these are reviewed. The present experience is based on data for 42 pediatric patients who had undergone tracheobronchial endoscopy from 1974 to 1994. Within this time lapse 3 separate periods have been identified-1974-1978, 1979-1990 and 1991-1994-for which there was a progressive improvement in endoscopic techniques. During the first period endoscopy was performed with the patient in apnea. During the second period endoscopy was able to last longer as the patient was periodically ventilated by means of the bronchoscope set in the trachea and by intermittently closing the proximal hole in the bronchoscope with a finger. During the third period endoscopy was made easier by the use of rod-lens telescopes attached to the forceps: this provided a better view when grasping the foreign body. Extractive tracheobronchial endoscopy requires close cooperation between anesthesiologist and endoscopist. As there is the risk of complications, the patient must be closely followed, not only during diagnosis and treatment but also post-operatively. For this reason parenteral administration of corticosteroids and antibiotics is advisable during the post-operative stage. Since extractive tracheobronchoscopy in pediatrics is still high risk surgery, the authors suggest three different solutions for the medical organization: a) The Pneumology-Bronchoscopy wards could be totally responsible for extracting the above-mentioned foreign bodies in children. b) An E.N.T.-Pneumological department could be set up aimed at improving rigid and flexible bronchoscope methods in both fields; this is suggested in view of the shortage of operating rooms in pneumology wards and the availability of E.N.T. specialists. c) The most important, most qualified E.N.T. wards (at least one for reach region) could be equipped with all the necessary tools. In this case the medical and paramedical staff would be kept up to date, also by attending bronchoscopy centers for adults. Hence the number of patients treated by each center would increase and the tracheobronchoscopic expertise of the E.N.T. specialists would improve. This would translate into a lowering of the risks and a better prognosis for these young patients.
Intravesical foreign bodies should be considered in cases of unexplainable lower urinary tract symptoms or recurrent urinary tract infections with therapy-resistant microbes like Proteus mirabilis and Pseudomonas. Usually these conditions are due to accidents in genitourinary surgery or instrumentation, but in our case occurred as a complication to an erotic procedure. This paper describes a case with a so-called "dimme-lenke", i.e. a chain used to count down days until demobilization from compulsory military service for Norwegian recruits, found in the bladder of a 13-year-old boy. A knot at the end of the chain made endoscopic removal impossible and it had to be removed by cystotomy.
A patient with chronic unilateral maxillary sinusitis caused by a foreign body (dental amalgam) and mistaken diagnosis of extensive ethmoid neoplasm is presented. The imitation of tumour symptoms was due to a long presence of foreign body in the maxillary sinus and chronic inflammation of maxillary, ethmoid and sphenoid sinuses.
A new type of foreign body retrieval forceps recently has become available. It consists of single- or multiple-tooth forceps mounted on a flexible stainless steel 0.038-inch shaft. The authors have successfully used this device in the vascular system (three cases), in the urinary tract (seven cases), and in the biliary system (two cases) without complications. Foreign bodies removed include a catheter fragment, angiographic guide wire, detachable balloon, stone retrieval basket, and various stents. All the procedures were performed quickly and without difficulty. For the authors, these forceps have become the first choice in many retrieval situations.
PURPOSE: To report a case of large bilateral intraocular foreign bodies mistaken for crystalline lens on computed tomography (CT). DESIGN: Case report. METHODS: A 24-year-old man was referred after bilateral open globe repair following a motor vehicle accident. Preoperatively, the CT scan had been read as "Right eye posteriorly dislocated lens. No evidence of foreign bodies." RESULTS: The patient underwent left eye cataract extraction with removal of a 7 x 5 x 5 mm piece of glass buried in the crystalline lens. The patient subsequently underwent right eye pars plana vitrectomy, removal of another piece of glass measuring 6 x 5 x 5 mm, retinal detachment surgery, and corneal grafting. CONCLUSIONS: Current safety standards require auto glass to fracture into pieces of a specific size to minimize laceration and missile injury. These pieces of glass may have a shape and size similar to the crystalline lens but have higher radiodensity on CT scan.
Current recommendations for the management of pediatric foreign body ingestions are based on studies of patients cared for at tertiary care hospitals; they call for aggressive evaluation because of a high incidence of complications. Two hundred forty-four children with suspected foreign body ingestions were prospectively followed to analyze adverse outcomes, ie, procedures, complications, and hospitalizations. Patient enrollment into the study was from three sources: (1) patients who referred themselves to a tertiary pediatric emergency department, (2) patients referred to the same tertiary pediatric emergency department after an initial evaluation by another hospital or physician, and (3) patients who reported their foreign body ingestions to a private pediatric practitioner participating in the study. Most children were well toddlers in normal circumstances, under parent supervision at the time of ingestion. Coins were the most common item ingested (46%). Procedures were done in 53 (24%) of 221 patients and complications occurred in 48 (22%) of 221. Complications were higher in patients referred to the emergency department (63%) than in emergency department self-referred patients (13%) or private practice patients (7%) (chi 2, P < .01). These findings demonstrate the risk of drawing conclusions regarding a universal standard of care from studies involving only hospital-based patients.
Chronic maxillary sinusitis is a common condition. The disease is most often caused by blockage of the sinus ostia or presence of an oroantral fistula. We report two cases of unilateral chronic maxillary sinusitis associated with foreign bodies in the maxillary sinus. In the first case the foreign body consisted of dental amalgam, in the second case of two silastic sponges left behind from a former operation because of "blowout" fracture. In the case of benign chronic maxillary sinusitis and foreign bodies, functional endoscopic sinus surgery (FESS) preceded by a CT-scan is an excellent approach, by which diagnosis as well as treatment can be achieved with minimal surgical trauma.
The virulence of two previously described Staphylococcus epidermidis strains was examined in an experimental model of foreign body infection in mice. Animals challenged with the slime-producing strain developed three times as many infections as animals challenged with the strain that did not produce slime (P less than 0.001). Bacterial isolates recovered from the infected sites retained the characteristics of the inoculated strain. Animals without foreign bodies but challenged in a similar manner with either staphylococcal strain did not become infected. Thus, the presence of a foreign body predisposed the animals to S. epidermidis infection. These results indicate that the production of slime by S. epidermidis is a stable characteristic retained after animal passage and may be important in the pathogenesis of these infections.