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PubMed2000

Aerodigestive foreign bodies.

Accidents with foreign bodies (FBs) are most common within the first two years of life. The airway FBs present a diagnostic dilemma as both the history and the investigations can be misleading. The persistent hypoxia presents a threat to life as does extraction. Moreover, the chemical pneumonitis induced by vegetative FB makes the situation even more worse. The FB of digestive tract are comparatively benign unless long standing. It is neither necessary for the airway FB to present with respiratory symptoms and signs nor for the FB of digestive tract to complain of dysphagia/throat pain. Oesophagoscopy may have to be done if an esophageal FB is causing only recurrent respiratory infections without dysphagia. The situation in dealing with FB varies from site to site in the aerodigestive tract. This article stresses the various dubious factors including the history, examination and investigation which can lead to misdiagnosis and also those problems which are encountered during planned extraction as well as post-operatively.

Airway Obstruction↗

PubMed2001

Spiral CT scanning technique in the detection of aspiration of LEGO foreign bodies.

BACKGROUND: Radiolucent foreign bodies (FBs) such as plastic objects and toys remain difficult to identify on conventional radiographs of the neck and chest. Children may present with a variety of respiratory complaints, which may or may not be due to a FB. OBJECTIVE: To determine whether radiolucent FBs such as plastic LEGOs and peanuts can be seen in the tracheobronchial tree or esophagus using low-dose spiral CT, and, if visible, to determine the optimal CT imaging technique. MATERIALS AND METHODS: Multiple spiral sequences were performed while varying the CT parameters and the presence and location of FBs in either the trachea or the esophagus first on a neck phantom and then a cadaver. Sequences were rated by three radiologists blinded to the presence of a FB using a single scoring system. RESULTS: The LEGO was well visualized in the trachea by all three readers (both lung and soft-tissue windowing: combined sensitivity 89 %, combined specificity 89 %) and to a lesser extent in the esophagus (combined sensitivity 31 %, combined specificity 100 %). The peanut was not well visualized (combined sensitivity < 35 %). The optimal technique for visualizing the LEGO was 120 kV, 90 mA, 3-mm collimation, 0.75 s/revolution, and 2.0 pitch. This allowed for coverage of the cadaver tracheobronchial tree (approximately 11 cm) in about 18 s. Although statistical power was low for detecting significant differences, all three readers noted higher average confidence ratings with lung windowing among 18 LEGO-in-trachea scans. CONCLUSION: Rapid, low-dose spiral CT may be used to visualize LEGO FBs in the airway or esophagus. Peanuts were not well visualized.

Arachis↗

PubMedDate not supplied

[Endoscopic removal of foreign bodies from cats or dogs].

Foreign bodies in the airways or intestines of dogs or cats are a common problem in companion animal practice. Improved endoscopic techniques, together with their greater availability, mean that it is often possible to remove the foreign body endoscopically, making surgery unnecessary. This article describes 53 cats and dogs in which a foreign body was detected and, where possible, removed. Results are compared with those in the literature. Practical guidelines for foreign body removal in specific cases are described, focusing on therapy and prognosis.

Animals↗

PubMed1975

The management of magnetic intraocular foreign bodies.

The management of 34 intracocular foreign bodies is reviewed. When possible the removal of the foreign body was carried out in the quadrant closet to where the foreign body was located and through a site 4-5 mm from the limbus. A circumferential incision was made after tenting had been demonstrated while the magnet was applied to the sclera. Sweet localization and B-scan ultrasound were helfpul in patients with opague media. In particular, ultrasound was used to confirm the magenetic qualities of the foreign body when it could not be visualized ophthalmoscopically. Visual results were surprisingly gratifying, even when the foreign body had damaged the cornea and lens as evidenced by the fact that 26 patients (77%) utimately achieved a vision of 20/50 or better.

Adolescent↗

PubMed2005

[Orbital foreign bodies -- diagnostics, therapy and management].

BACKGROUND: Orbital foreign bodies constitute an interdisciplinary challenge, diagnosis being especially difficult because of inconspicuous entrance orifices. Indication for the removal of an orbital foreign body has always to be decided upon individually taking into account the benefits and risks resulting from an operation. The latter is particularly indicated if there are acute and chronic functional restrictions or inflammatory reactions either present or to be expected. The objective of our study was to produce systematic guidelines concerning the therapeutic procedure of dealing with orbital foreign bodies with a view to a benefit-risk assessment. PATIENTS AND METHODS: Over the last ten years ten patients with an orbital foreign body were treated in our Department, four of them requiring acute attention. CTs were taken of all patients. Only in one case additional MRTs were produced. Eight out of ten patients underwent operation, of which seven resulted in a complete removal of the foreign body. In the case of two patients we decided against an operation after interdisciplinary consultation. RESULTS: In our view the imaging--providing diagnostics by means of computer tomography is the most promising method for determining a foreign body in the orbit. Decision for an operative removal of a foreign body was invariably taken interdisciplinary in cooperation with an ophthalmologist. Surgical approach was chosen in accordance with the localisation of the foreign bodies. None of the patients suffered from a loss of vision or a restriction of functions as a result of the operation. CONCLUSIONS: In the indication the foreign material is of essential importance. Orbital foreign bodies that have been present in the tissue for a longer time can be allowed to stay, unless loss of functions are progressive. Loss of vision always being a consequence of the initial trauma.

Adolescent↗

PubMed1990

[Traumatically-induced foreign bodies of the paranasal sinuses].

Foreign bodies of the nose and its related sinuses are a common feature in otorhinolaryngology. Particularly in small children, one will find unilateral rhinorrhea as an initial symptom. In the adult, foreign bodies of the nose or paranasal sinuses are mainly caused by traumatic events. In the present paper the authors report two cases of foreign bodies of the paranasal sinuses. In one case the patient had been suffering from unilateral cephalgia for more than 40 years. The other patient had a short history prior to the extraction of the foreign body from the sphenoid sinuses. Diagnostic and therapeutic procedures are discussed and compared with the relevant literature.

Adult↗

PubMed1993

[Foreign body in the urinary bladder].

Foreign bodies in the urinary bladder are not uncommon, however, only a few cases have been reported in recent literature. This is not a fatal disease, however, it may lead to serious complications such as chronic cystitis, urolithiasis, or rectal abscess formation. These foreign bodies were inserted for autoerotic or unknown reasons by patients. In this paper we report 4 cases of foreign bodies in the urinary bladder. They include a cucumber, glass tube, chewing gum, and filliform catheter. We found that most of the foreign bodies in the urinary bladder can be removed endoscopically, but if the patients also had a lower urinary tract obstructive disease, removal necessitated surgical procedures. All of the four cases had no urological complications for at least one year after treatment.

Adult↗

PubMed1990

Magnetic resonance imaging and computed tomography in a model of wooden foreign bodies in the orbit.

Wooden foreign bodies in the orbit are not detectable by standard roentgenography. Reports in the literature on the ability of computed tomography (CT) to detect orbital wooden foreign bodies have varied. To evaluate whether magnetic resonance imaging (MRI) would offer any advantage over CT in detecting wood in the orbit. MRI and CT were performed on an in vitro model of wooden foreign bodies in the orbit. Woods of different types and sizes were studied in vegetable fat backgrounds chosen to simulate orbital fat. On CT, most types of wood were hypodense to fat. Appropriate window settings were critical in the detection of wood by CT: in this model, a window width of 1000 Hounsfield units was optimal. On MRI, all types of wood were hypointense to fat. Small pieces of wood were surrounded by an MRI truncation artifact consisting of hyperintense spots. T1-weighted images demonstrated wood better than T2-weighted images and required less scanning time than either proton density or T2-weighted images, MRI was superior to CT in detecting the smallest pieces of wood. The role of MRI in the detection of orbital wooden foreign bodies in clinical practice remains to be determined.

Eye Foreign Bodies↗

PubMed2004

Rigid bronchoscopy for foreign body removal: anaesthesia and ventilation.

Foreign body aspiration is a leading cause of death in children 1-3 years old, although mortality is low for children who reach the hospital. Presenting symptoms of an inhaled foreign body depends on time since aspiration. Immediately after inhalation the child starts to cough, wheeze, or have laboured breathing. If the early signs are missed, the child usually presents with fever and other signs and symptoms of chest infection. A plain chest X-ray has relatively low sensitivity and specificity for inhaled foreign body. The gold standard for diagnosis and management of this condition is rigid open tube bronchoscopy under general anaesthesia. For late presentations, time should be taken to fast the child and complete a thorough evaluation before bronchoscopy. The procedure should be performed in a well-equipped room with at least two anaesthesiologists, one with paediatric experience, in attendance. Most experienced anaesthesiologists prefer inhalational rather than intravenous induction of anaesthesia and a ventilating bronchoscope rather than intubation. Equally good results have been reported with spontaneous ventilation or positive pressure ventilation; jet ventilation is not advocated for foreign body removal in children.

Anesthesia↗

PubMed2005

Colorectal foreign bodies.

OBJECTIVE: A pictorial review of colorectal foreign bodies and their extraction. METHODS: A prospective data-base and photographic record of patients who presented with retained colorectal foreign bodies at our institution has been maintained since 1995. Information regarding the foreign body, clinical presentation and extraction technique were documented. RESULTS: All 13 patients were male: age range 2-66 years. Seven were Caucasian, 4 African and 1 Asian. The foreign bodies included a penknife, an aerosol deodorant spray can, a blue plastic tumbler, a plastic bag containing two bank-notes and some marijuana, a plastic packet containing fish hooks, a penlight torch, a broomstick, a battery powered vibrator, a primus stove, a cap of an aerosol can, a piece of wire, a piece of hosepipe wrapped with wire and an iron bar. They entered the alimentary tract for a variety of reasons; anal autoeroticism (3), concealment (2), attention seeking behaviour (3), accidental (1), assault (2) and to alleviate constipation (2). Plain radiographs accurately demonstrated the site of the foreign body in 8 patients. Extraction was at laparotomy in 2 patients with peritonitis and in 3 who required extraction by colotomy. In 7 patients who had transanal extraction, four required general anaesthesia to facilitate extraction and extraction was possible under conscious sedation in the emergency room in three. The remaining patient extracted the foreign body himself and presented to hospital with a rectal perforation. CONCLUSION: The emergency room physician must confirm the presence of a rectal foreign body. Extraction in the emergency room is usually not possible and patient's with retained rectal foreign bodies should be referred to a colorectal surgeon.

Adult↗

PubMed2003

Tracheobronchial foreign bodies: a 10 year experience.

BACKGROUND: Our aim is to describe foreign body aspiration in the tracheobronchial tree, a common emergency with serious consequences. METHODS: We reviewed the records of 357 patients who were admitted to our hospital during a 10-year period for the treatment of aspirated foreign body into the tracheobronchial tree. RESULTS: Of these cases, 42.4% were male and 57.6% female. Their ages ranged from 4 months to 70 years (average of 10.8 years). The most common manifestation was coughing, with subsequent dyspnea and wheezing. All underwent rigid bronchoscopy for the removal of the foreign body. Foreign bodies were localized in the right bronchial tree in 188 cases (52.7%), the left in 107 cases (30%) and trachea in 39 cases (10.9%). Foreign bodies were not found during bronchoscopy in 23 cases (6.4%). The foreign bodies were: needles (n=125), peanuts (n=110), plastic objects (n=52), and miscellaneous (n=47). Foreign bodies were removed by bronchoscopy in all but six cases (1.7%), who underwent limited thoracotomy. The present series had a mortality of 0.56 percent (two deaths) following removal of foreign body. CONCLUSIONS: Foreign body aspiration are rapidly recognized from the patient's history and easily treated by bronchoscopy and extraction of the aspirated foreign body. A high index of suspicion is crucial for early diagnosis. However, education is the best preventive measure for decreasing the incidence of this matter.

Adolescent↗

PubMed2002

[Bronchial foreign bodies in children].

BACKGROUND: Tracheobronchial aspiration of foreign bodies in children is a rare event that can be serious. We report a 10-year retrospective study of tracheobronchial foreign body aspiration in children. METHOD: This retrospective analysis involved 87 patients who underwent endoscopy at the ENT unit of the Caen University Hospital. RESULTS: Foreign bodies were found in 34 of the 87 patients. Average age was 3 years, with a male predominance. Peanuts were the most common foreign bodies observed (16/34). Most of the foreign bodies were removed via the right main bronchus (17/34). Clinical and radiological signs depended on delay to admission and were found to be normal in 15% and 37.5% of the cases respectively. Twenty-four children out of 34 had a positive history of foreign body inhalation. All foreign bodies were removed during the endoscopy procedure. CONCLUSION: This work underlines the much-debated function of chest x-ray, the need for a rigorous technically correct endoscopy procedure and the importance of close cooperation between the anesthesiologist and the endoscopist.

Bronchi↗

PubMed2000

[Nasal foreign bodies in 299 cases].

Although nasal foreign bodies very commonplace in daily clinical practice, their simplicity in pathology and diagnosis is so unique that case reports based upon a large number have been rather scarce. We report 299 verified cases of nasal foreign bodies seen during the past 13 years from January 1986 to December 1998, at our institute, together with clinical and statistical analysis. The total number of first visits during the surveyed period was 55,312 and nasal foreign bodies comprised 0.54%. Of these 217 subjects (72.6%) appeared in emergencies. Man comprised 172 (58%) and woman 127 (42%), with the right side comprising 166 cases (57%), the left side 123 (42%) and bilateral 3 cases (1%). In monthly distribution, cases are more often seen in November and December and less often seen in January, with the monthly average being 25. In age distribution, the majority were seen in those under 10 years old, excluding 6 cases. The average age was 4.0 and the range 1 month to 81 years. In the majority of cases, foreign bodies remained only a short time (with in 24 hour) but in 15 cases stayed rather a long time (over 24 hour). In specificity, the majority of foreign bodies were toys, with plastic bullets used with air guns most frequent, in 46 cases (15.3%), followed by beads in 36 cases (12.0%). Other foreign bodies seen comparatively often were pieces of tissue paper, buttons, and plastic toys components.

Adolescent↗

PubMed1985

Extracapsular extraction and lens implantation for cataracts with foreign bodies.

Two cases of intralenticular foreign bodies are reported. In the first, a foreign body composed of copper had been embedded in the lens for about 40 years, but had produced only a localized cataract. In the second, the foreign body, presumably composed of stone, remained undiagnosed for one and a half years. In both cases extracapsular cataract extraction with intraocular lens implantation was performed, which restored good visual acuity.

Aged↗

PubMed1993

[Prognosis of intralenticular lead foreign bodies].

BACKGROUND: The prognosis of intraocular foreign bodies consisting of lead remains controversial. While experiments have shown that infected lead becomes sterile when fired from rifles, both the total absence as well as presence of severe inflammation have been observed following perforating injuries with lead. Furthermore, alterations of the ERG have been described in experimental settings. This case report is presented in order to clarify the long term prognosis of intralenticular lead particles. PATIENT AND METHOD: The 69-year-old patient suffered from a bilateral perforating injury caused by a bullet during World War II (1942). The right lens was extracted due to a secondary cataract several weeks following the injury. The left lens remained clear despite a paracentrally located metallic foreign body. The patient underwent extracapsular cataract extraction in 1992 because of an opacity of the posterior capsule which was well separated from the foreign body. Preoperatively the ERG was normal. An energy dispersive X-ray microanalysis in a scanning electron microscope was performed in order to determine the chemical composition of the foreign body, and X-ray diffraction with a Gandolphi camera was used for its structural characterisation. The foreign body consists of lead. However, its surface is probably altered to lead oxide, hydroxide or carbonate, which hindered further reaction of the lead. Calcium phosphate was deposited on the walls of the foreign body. CONCLUSION: Our report shows that lead in the lens remains inert for several decades and does not cause alterations in the ERG. Therefore, intralenticular lead outside of the optical axis may be left in situ unless a secondary cataract develops.

Aged↗

PubMed1998

Ear and nose foreign body removal in children.

The removal of foreign bodies in children is very common in the otolaryngologist's daily routine. We present a prospective series of 187 cases of ear and nose foreign bodies removed from children aged 0-12 years old in a 6-month period--95 females (50.8%) and 92 males (49.2%); 78 children (41.71%) aged from 1 to 2 years, 66 (35.29%) from 3 to 5 years. There were 93 cases (49.73%) of ear foreign bodies, in which a bean was the most common (24.73%), and 94 cases (50.27%) of nose foreign bodies, in which sponge fragments predominated (36.17%). In 82 cases (45.85%), the removal was performed within the first 24 h after the foreign body insertion, and 86 (45.98%) of the patients had previous attempts to remove it. Thirteen cases with complications (external ear canal lacerations, tympanic membrane perforation) were observed in patients in whom these previous attempts had been made, but there were no sequelae. This corresponds to one of the largest reports of ear and nose foreign body removal in children in the literature; we conclude that younger children are more prone to insert foreign bodies, which are objects usually found at home. Complications may occur as a result of attempts to remove the foreign body without the help of specialised personnel or proper conditions.

Child↗

PubMed2004

Use of ultrasonography to facilitate surgical removal of non-enteric foreign bodies in 17 dogs.

Plant material foreign bodies may cause vague clinical signs at the time of initial presentation but can progress to cause persistent or recurrent abscessation, sinus tract formation and debilitating disease, due to migration of the foreign body, severe tissue reaction and secondary infection. Ultrasonography is a non-invasive technique that can be used to identify precisely the presence, location and size of radiolucent foreign bodies. Early identification of foreign bodies using ultrasonography facilitates surgical retrieval before further migration and tissue injury occur. This paper reviews the ultrasonographic findings and outcome in 17 dogs with non-enteric, radiolucent, plant material foreign bodies.

Animals↗

PubMed1997

A wooden foreign body in the neck.

Foreign bodies in the throat and/or neck are uncommon and transpharyngeal impaction of a wooden foreign body in the neck without vascular injury is very rare. The patient presented in this communication, reported to our center five days after severe physical assault with a pharyngocutaneous fistula in the left side of the neck. Clinical examination and X-rays were unremarkable. Conservative treatment led to healing of the fistula and he was discharged. Two weeks later he was readmitted with an abscess in the right supraclavicular region. Exploration under general anaesthesia revealed a 7 cm long wooden fragment of a spear in the abscess cavity. The fragment was removed. After several days' antibiotic treatment, he recovered fully and was discharged.

Abscess↗