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PubMedDate not supplied

[Bronchoscopic removal of foreign body from airway through tracheotomy or tracheostomy].

OBJECTIVE: Most foreign bodies in the airway are removed by respiratory endoscopy. Rarely, the removal of the foreign body has to be performed through endoscopic control by tracheotomy or tracheostomy. This article reports three cases of foreign body removal in children performed by tracheal opening. DESCRIPTION: Retrospective review of records with report of three cases of children who aspirated foreign bodies into the airway. In the first case, there was rupture of the tracheostomy tube, with aspiration of its distal portion. Endoscopic removal was performed by tracheostomy. The second child aspirated a pen cap. It could not be removed by endoscopy because it would not pass through the subglottic region. Cervical tracheotomy was performed and the foreign body was removed with endoscopic control. In the last case, the foreign body was in the left main bronchus. It was removed by bronchoscopy through tracheostomy opening. All children presented good outcome after the endoscopic procedure. The trachea of the patient submitted to tracheotomy was sutured after the foreign body removal. Tracheostomy was not necessary. In the children with previous tracheostomy, the tube was put back after the foreign body removal. COMMENTS: Most foreign bodies in the airway of children can be removed by endoscopy. When the foreign body is too large to pass through the subglottic region, or so sharp that it can injure the airway, the use of tracheotomy or tracheostomy is indicated.

Airway Obstruction↗

PubMed2005

Removal of an unexpected tracheal foreign body after five months.

Foreign body aspiration can produce serious pulmonary diseases. Timely diagnosis and appropriate treatment is important to prevent long-term complications in affected children. We report the case of a 15-month-old child with a 5-month history of regurgitation, vomiting, recurrent tracheobronchitis, and pneumonia. The diagnosis was gastroesophageal reflux. The laryngotracheal endoscopy revealed a rabbit vertebra partially obstructing the airway at the level of the cricoid cartilage. With a rigid bronchoscope and forceps equipped with a telescope, it was possible to disengage and extract the foreign body. Six months later endoscopic control revealed no residual alterations in the larynx and trachea.

Bronchoscopy↗

PubMed2003

Delayed diagnosis of foreign body aspiration in children.

Foreign body aspiration in children is common and usually presents with an initial episode of choking with subsequent respiratory symptoms. There may be cough, wheeze, or stridor, with decreased or abnormal breath sounds on examination. However, it can mimic other illnesses and cause difficulty in diagnosis. Radiological investigations may help to confirm aspiration but should not be used to exclude it. Three cases are presented of foreign body aspiration with a delay in diagnosis ranging from days to weeks. It is believed that delay could have been avoided with a more careful approach to the history and more appropriate use of investigations. These cases demonstrate that children with a history of choking and subsequent symptoms should be referred for bronchoscopy.

Bronchi↗

PubMed1983

[Regression of an inflammatory abdominal tumor after endoscopic removal of a foreign body].

Incarcerations and perforations of foreign bodies in the gastrointestinal tract are relatively rare. In most cases the foreign bodies must be removed by operation, especially after having passed the stomach. A patient is described with an ingested chicken bone which had incarcerated in the sigmoid colon and had brought about an inflammatory stenosis of the gut. After endoscopical removement of the foreign body the symptoms of the patient disappeared and the findings in the gut returned to normal, so that an operation could be avoided.

Aged↗

PubMedDate not supplied

Problems in the management of aspirated foreign bodies.

Observations on nineteen cases of foreign bodies in the air passages have been presented. These mostly got lodged in the right bronchus (42.1%) and larynx (36.8%) while the commonest presenting complaint was respiratory distress. As many as 57.9 percent of our cases were aged two years or less. Large foreign bodies (above 20mm. size) were held up in the oropharynx; irregular and pointed medium sized objects (8-15mm) got stuck in the larynx while small, smooth or linear ones descended to the right bronchus. Absence of positive history, inconsistent clinical features and radiolucency of objects caused difficulty in diagnosis. Slow induction and laryngeal or bronchial spasm during anaesthesia, and fragmentation or impaction of the foreign body posed problems during endoscopic removal. Subglottic, tracheal or laryngeal inlet mucosal oedema were observed after removal of foreign body in six cases. A plea has been made to have a high degree of suspicion of foreign bodies in every child with respiratory symptoms of sudden onset. Endoscopy at the earliest has been recommended for prompt diagnosis and treatment.

Airway Obstruction↗

PubMed2006

Anesthesia and periinterventional morbidity of rigid bronchoscopy for tracheobronchial foreign body diagnosis and removal.

BACKGROUND: Undiagnosed tracheobronchial foreign body aspiration (FBA) or delayed extraction can lead to serious morbidity. The aim of this study was to evaluate anesthetic and periinterventional morbidity of a straightforward regime using rigid bronchoscopy to rule out or remove a tracheobronchial foreign body in children with suspicion of FBA. METHODS: We retrospectively analyzed rigid bronchoscopy charts of children with suspicion of acute (< or = 24 h) and subacute (>24 h-2 weeks) tracheobronchial FBA (1990-2003). Patient characteristics, duration of fasting, technique/course of anesthesia induction, and duration/course of rigid bronchoscopy were taken. Anesthetic, periinterventional complications and length of hospital stay were noted. Data are given in median (range [interquartile range]). RESULTS: A total of 287 children were included in this study. Median age was 1.7 years (0.2-14.2 [1.2-2.5]); in 72.1% a tracheobronchial foreign body was found and removed. Fasting time before induction of anesthesia was 5 h (1-14 [4.0-7.0]). Anesthesia adverse events were seen in 0.7%, whereas periinterventional complication from rigid bronchoscopy was observed in 7.6%. Hospital discharge within 4 h after bronchoscopy was possible in 65.2%. Complications of delayed diagnosis (>24 h) were prolonged duration of rigid bronchoscopy because of severe mucosal changes or difficulties in foreign body extraction. CONCLUSIONS: General anesthesia for rigid bronchoscopy to rule out a tracheobronchial foreign body in children carries low morbidity. Most of the complications originated from the foreign body itself especially in patients with late diagnosis. The risk for serious complications caused by retained foreign bodies outweighs the low morbidity of explorative rigid bronchoscopy in children with suspected FBA or children with prolonged cough or pulmonary infection unresponsive to medical treatment.

Anesthesia, General↗

PubMed1999

[Foreign bodies in the esophagus].

1496 patients with foreign bodies of esophagus, reported between 1945-1997 to ENT Department of K. Marcinkowski University of Medical Sciences, were analysed. The age ranged from 0.5 to 95 years, but the most numerous group was under 5 years of age. Men outnumber women. Very detailed anamnesis, oropharynx and hypopharynx examination, neck palpation, chest X-ray were crucial for diagnosis. More than 50% of patients reported within first 10 hours after foreign body wedged. The most often met foreign bodies were: bones, coins, denture, fish bones, fruit-stones, buttons. The most dangerous were supposed to be: needles, pieces of glass, springing anchores, safety razors. Foreign bodies were removed by means of rigid esophagoscopes. In 75.3% foreign bodies occupied the first isthmus. Serious complications met in the analysed material, included: esophageal wall perforation [27], mediastinitis [21], aortal hemorrhage [3], esophagus-tracheal fistula [1]. Intramural abscesses, posteriol pharyngeal wall abscesses were found more often. 98% of esophageal foreign bodies were removed by the same route they had been introduced.

Adolescent↗

PubMed1983

[Indications for vitrectomy in the extraction of intraocular foreign bodies].

Vitrectomy represents an important advance for the extraction of intra-ocular foreign bodies, a study of 20 cases emphasizing the advantages of the method. Pars plana vitrectomy was performed using Klöti's vitreous stripper; intra-ocular foreign bodies were extracted through the pars plana incision by a magnet or with forceps. The main indications of the technique are: posterior pole foreign bodies; old embedded metallic foreign bodies; foreign bodies with complications (traumatic cataract, vitreous hemorrhage, retinal detachment); non-magnetic oxidizable foreign bodies: these must be extracted under visual control with vitrectomy techniques, but complications and failure remain common. This technique also has its limits: extraction of non-oxidizable non-magnetic foreign bodies; foreign bodies attached to the ocular globe wall. These are preferably left in place. Vitreoretinal complications were the main reasons for failure in this study. Nevertheless, vitrectomy allows clearing of cloudy media, visualization, localization and extraction of foreign bodies under visual control through the pars plana, and reduction of complications.

Adult↗

PubMed1987

[Three cases of an intracranial wooden foreign body].

Three cases of intracranial wooden foreign body are reported discussing the diagnostic and therapeutic problems. First case is a 50-year-old man. After drinking, he drove a bike and fell to the ground. On admission the wooden foreign body could not been detected in appearance. CT scan showed low density area similar to air in bilateral anterior horn of lateral ventricle. The patient was treated for traumatic pneumocephalus at first. Later, it proved that he was stabbed with a foreign body penetrating into the contralateral frontal lobe through the left nasal cavity. It was extracted by endonasal approach by otolaryngologist, fortunately without trouble. The foreign body was a branch of tree. The second case is an 18-year-old man. He was driving a car, and suffered injury. He was stabbed with a wooden stake penetrating into his left eye. Immediately, bifrontal craniotomy was performed and the stake was withdrawn carefully. Moreover bone fragments were removed. The third case is a 61-year-old man. When he cut the timber by chain saw, a piece of wood hit and stabbed his right eye directly. Immediately right front temporal craniotomy was performed. The piece of wood was withdrawn from the right eye, and pieces of glass, wood and bone fragments were evacuated. It is difficult to confirm intracranial foreign body accurately by means of only plain skull film and usual CT scans. It is necessary to utilize various function of CT scanner. For example, it is useful to know CT values or select measure mode with window width and level or make reconstruction image to sagittal or coronal section, and so on.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2005

Plastic laryngeal foreign bodies in children: a diagnostic challenge.

OBJECTIVE: To review Children's Hospital and Regional Medical Center experience with pediatric airway foreign bodies, and examine the incidence and treatment of laryngeal foreign bodies. To determine if plastic laryngeal foreign bodies present differently than other laryngeal foreign bodies. METHODS: A retrospective review of all cases of children (1874 patients) undergoing direct laryngoscopy and/or bronchoscopy from 1st January 1997 to 9th September 2003 at a tertiary care children's hospital. Patients with endoscopically documented laryngeal foreign bodies were identified and the medical record reviewed in more detail. Patient age, gender, foreign body location, foreign body type, duration of foreign body presence, radiographic findings, endoscopic findings and treatment complications were recorded. RESULTS: One hundred and five aspirated foreign bodies were identified. The nine laryngeal foreign bodies included five clear plastic radiolucent items, two radiolucent food items, and two sharp radioopaque pins. Time to diagnosis and treatment was on average 11.6 days with 17.6 days for thin/plastic foreign bodies and 1.6 days for metal/food foreign bodies. CONCLUSION: Laryngeal foreign bodies represent a small portion of all pediatric airway foreign bodies. Difficulty in identifying laryngeal foreign bodies, especially thin, plastic radiolucent foreign bodies can delay treatment. Thin plastic foreign bodies can present without radiographic findings, can be difficult to image during endoscopy and can be particularly difficult to diagnose. A history of choking and vocal changes is associated with laryngeal foreign bodies. Laryngeal foreign bodies should be in the differential diagnosis of all children presenting with atypical upper respiratory complaints especially if a history suggestive of witnessed aspiration and dysphonia can be obtained.

Airway Obstruction↗

PubMed2005

Detection of foreign bodies of the head with digital volume tomography.

OBJECTIVES: Foreign bodies occur as a sequela of trauma or therapeutic interventions. If the risks are not too high, therapy of choice is the removal of the foreign body. This is only possible if the existence of a foreign body is detected and it is localized accurately. METHODS: The suitability of digital volume tomography (DVT) for the detection and localization of foreign bodies was investigated. Samples of various materials that are typically found as foreign bodies in the head and neck region were used. RESULTS: All materials investigated are principally detectable with DVT. Highly radiopaque material was detectable down to small sizes. The detectability of less radiopaque substances like wood and resins was poor when located in soft tissue. CONCLUSION: DVT is an appropriate tool for the detection of radiopaque foreign bodies. However, foreign bodies made of wood and resin, although detectable by DVT, can be missed when located in muscular tissue. The detectability decreases further when the foreign body is located adjacent to a highly radiopaque tissue like bone. This has to be taken into consideration when using DVT for foreign body detection.

Contrast Media↗

PubMedDate not supplied

Proptosis as presenting symptom of orbital foreign body.

An unusual case of orbital foreign body is presented. The foreign body had penetrated through a small wound of the upper lid and was asymtomatic for two years. Proptosis due to hyperostosis of the orbital roof was a presenting symptom of the foreign body.

Abscess↗

PubMedDate not supplied

Foreign bodies in the nose.

BACKGROUND: Nasal foreign bodies occur most frequently in children and most times first present to the emergency physicians. It poses a challenge to the Otorhinolaryngologist when tampered with. The objective of this paper is to determine the pattern of foreign bodies lodged in the nasal passages in Port Harcourt with a view to documenting the types and highlighting the results of management. METHODS: A retrospective study was done using 134 patients who presented with foreign bodies in the nose to the Ear, Nose and Throat clinic of the University of Port Harcourt Teaching Hospital (UPTH) and Benok Consultants Clinic both in Port Harcourt over an eight-year period from January 1993 to December 2000. RESULTS: One hundred and thirty four patients were seen with a male female ratio of approximately 1:1. Age range was 1-21 years with a mean of 3.23 years +/- 2.48 [SD] and mode of 2-years. The children within the age group 2-4 years had the highest incidence. The right side of the nose was more involved than the left with only one bilateral case noted. The foam was the commonest foreign body found. Most patients presented within the 1st day with only 15 presenting late. Most were removed in the clinic under good illumination, only 6 had to undergo examination under anaesthesia (EUA) in the theatre and these were the uncooperative patients. CONCLUSION: Foreign body in the nose is an emergency only as far as it concerns anxiety to the relations. It presents no problems in management to the Otorhinolaryngologist

Adolescent↗

PubMed2000

Dislodgement of bronchial foreign body during retrieval in children.

Foreign body aspiration is a leading cause of death in children aged less than 1 year. The removal of a foreign body poses a great challenge to the skill of the anaesthetist. Four cases are presented, analysing the part played by modes of respiration in the dislodgement of a bronchial foreign body during its retrieval.

Airway Obstruction↗

PubMed1999

A novel approach to ring-type foreign body removal: the "U-wire".

BACKGROUND: Foreign body ingestions are common, especially in pediatric, edentulous, psychiatric, and incarcerated populations. For the 20% of foreign bodies that do not pass spontaneously through the gastrointestinal tract, removal using modern, flexible endoscopes has become routine. METHODS: We describe the successful endoscopic removal of a ring-type or "closed loop" foreign body by means of a novel technique. Utilizing a nasogastric tube inserted alongside the endoscope, a guidewire inserted through the tube is directed through the ring with a "rat-tooth" grasping forceps passed through the accessory channel of the endoscope. The wire is snared and pulled up through the endoscope creating a "U," with both ends of the wire outside of the patient. The nasogastric tube, endoscope, and foreign body may then be removed safely. RESULTS: The technique was easy to perform and the foreign body was removed without complication. CONCLUSIONS: Using the U-wire technique, ring-type foreign bodies may be readily and safely removed.

Adult↗

PubMedDate not supplied

Two unusual cases of foreign body larynx.

Two adult patients of foreign body larynx who presented to us with a short history of foreign body inhalation with severe respiratory distress are being reported. They underwent elective tracheostomy preoperatively for maintenance of airway and the foreign body was removed successfully. We conclude that preoperative tracheostomy can be attempted to secure a patient's airway before resorting to removal of foreign body lodged in the larynx.

Adult↗

PubMed1998

Triple procedure in posterior segment intraocular foreign body.

Three patients with intraocular foreign bodies and traumatic cataracts underwent single stage pars plana lensectomy with anterior capsule preservation, vitrectomy, removal of the foreign body, and intraocular lens implantation. The preserved anterior capsule permitted support for the placement of an intraocular lens in the posterior chamber in the ciliary sulcus. The procedure enabled early visual rehabilitation. This procedure seems useful in the management of posterior segment intraocular foreign body associated with cataract.

Adolescent↗

PubMedDate not supplied

[A morbidity study of intraocular foreign bodies].

190 patients presenting intraocular foreign bodies, hospitalized between 1981-1991, are examined. The study of accidents: cases showed a clear prevalence of work accidents--127 cases (66.84%); 86 of these cases occurred in industry (45.26%), the rest of 41 occurred in agriculture (21.58%). The professions most exposed to such accidents are those of locksmith, mechanic in agriculture or automobile industry. The postsurgical evolution and the incidence of complications show that intraocular foreign bodies are wosse-making factors of ocular plagues, because of anatomical structures disorganization, transparency modifications and infectious complications implied, which determined the diminishing of visual acuity in 88.08% of cases. The big percentage of work accidents in the etiology of intraocular foreign bodies emphasize the great importance of foreign the work-protection rules (regarding a especially the wearing of protection glasses) and of introducing of automation in technological processes involving great risks.

Accidents, Occupational↗