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A foreign body in the bronchial tree may mimic many pathological conditions. We present a case of a 62-year-old patient with a foreign body in the tracheal bronchus simulating bronchogenic cancer. After the removal of the foreign body, there has been a gradual regression of the foreign body induced inflammatory changes. To the best of our knowledge, a similar case has not been reported in the English medical literature.
Foreign body ingestion in children is a common presenting complaint to the emergency department. Although the majority of ingested foreign bodies pass through the gastrointestinal tract unaided, some children will require either non-surgical or surgical intervention. Retained oesophageal foreign bodies may cause a multitude of problems, including mucosal ulceration, inflammation or infection, and more seriously paraoesophageal or retropharyngeal abscess formation, mediastinitis, empyema, oesophageal perforation and aorta-oesophageal fistula formation. We present a case of a 12-month-old child in whom delayed diagnosis of glass ingestion resulted in the development of a retropharyngeal abscess, oesophageal perforation and mediastinitis. Such complications following foreign body ingestion in children are rare but potentially fatal. A high index of suspicion must be maintained in young children presenting with a possible history of foreign body ingestion as a delayed diagnosis may lead to significant morbidity and mortality. We review the literature surrounding paediatric retropharyngeal abscesses and mediastinitis.
Foreign bodies and tissue reactions to foreign materials are commonly encountered in the oral cavity. The more common lesions include apical deposition of endodontic materials, mucosal amalgam and graphite tattoos, myospherulosis, oil granulomas, and traumatically introduced dental materials and instruments. Since many foreign materials are unidentifiable histologically, commonly used dental materials were experimentally implanted subcutaneously in rats to assess local host responses and characterize the nature of these materials microscopically. The histologic characteristics of these foreign body reactions are detailed herein. The implanted materials corresponded to reactions seen in human subjects.
Three cases of iatrogenic foreign bodies are described. In case 1 a large stone was removed from the urinary bladder of a 80-year-old man 8 years after suprapubic prostatectomy. The concrement contained a fragment of the gauze tampon left during that operation. In case 2 a surgeon trying to stop a profuse hemorrhage lost a surgical needle in paraurethral tissues above the urinary bladder of an elderly man undergoing prostatectomy. Because of the foreign body the patient developed complications: scarry obliteration of the bladder neck, concrement, a vesical fistula, chronic cystitis and chronic pyelonephritis. In case 3, the Dormia's basket broke with ureteral perforation and the metal fragments penetrated into the paraureteral fat in a 46-year-old woman undergoing ureterolithoextraction. 11 months later, the fragment migrated into the bladder wall and perforated it. The fragment was removed endoscopically.
STUDY OBJECTIVE: To determine the accuracy of detection of wood and plastic foreign bodies in human tissue by relatively inexperienced clinicians using typical ultrasound equipment. METHODS: Uniform wood and plastic foreign bodies were placed through small punctures into recently amputated human legs. Identical control punctures contained no foreign bodies; the sequence of foreign bodies and controls for the puncture sites was randomized. A second blinded investigator scanned each puncture site with a 7.5-MHz ultrasound probe to determine the presence or absence of foreign material. RESULTS: Eighty punctures were scanned. Ultrasound detected 44 of 53 foreign bodies (83% sensitivity). Wood foreign bodies were detected 25 of 27 times (93%) and plastic foreign bodies 19 of 26 times (73%; P = 13). Overall, there were 11 false-positive readings (59% specificity). CONCLUSION: Ultrasound is imperfect but may be useful in screening for superficial foreign bodies in human tissue. Clinical utility in the ED setting remains to be tested.
PURPOSE: The authors undertook a 10-year review of bronchoscopies for airway foreign bodies in children to test assertions in previous reports that (1) characteristic abnormalities in chest radiographs are important indicators of the need for bronchoscopy and (2) experienced operators incur negligible complications. METHODS: The medical records of 293 children who underwent bronchoscopies by experienced pediatric surgeons for suspected airway foreign bodies were reviewed for patient age, symptoms, duration of symptoms before bronchoscopy, prebronchoscopy radiographs, type of foreign body, anatomic location of foreign body, success of bronchoscopic removal, length of hospital stay, and complications. RESULTS: Of the 293 bronchoscopies, 265 showed airway foreign bodies. A choking episode was recorded in 228 of the 265 patients with foreign bodies and 5 of the 28 with negative bronchoscopy. The surgeon thought that radiographs were normal at the time of bronchoscopy in 110 patients who had foreign bodies. Nine patients with foreign bodies had atypical radiographs; three had bilateral emphysema and six had upper lobe or bilateral atelectasis or pneumonia. There were three complications: one vocal cord injury requiring temporary tracheostomy, one tracheal laceration from removal of an aspirated tooth, and one severe postoperative subglottic edema requiring a 4-day hospital stay. The age of the patients, symptoms, types of foreign bodies, locations of foreign bodies, management, and outcomes were similar to those of previous reports. CONCLUSIONS: In children with airway foreign bodies, chest radiograph findings are frequently normal and can display abnormalities uncharacteristic for foreign body aspiration. Children witnessed to choke while having small particles in their mouths and noted subsequently to have raspy respiration, wheezing, or coughing should undergo prompt bronchoscopy regardless of radiographic findings. Complications of bronchoscopy for foreign body aspiration are uncommon but occur even in experienced hands.
Bronchofibroscopy was conducted in 9,254 patients, foreign bodies aspired long ago were found in 12 of them. All foreign bodies were radiolucent. During bronchoscopy foreign bodies were detected on the right side in 7 and on the left side in 5 patients. All were surrounded by an inflammatory swelling and covered with granulations. The foreign bodies had remained in the bronchi for 4 months to 27 years. After removal of the foreign bodies all patients were subjected to therapeutic bronchoscopy until full abatement of the inflammatory process in the bronchi.
OBJECTIVE: To determine the effect of soft tissue gas on the accuracy of foreign body detection by realtime sonography. METHODS: This was a prospective randomized study using glass, metal, and bone inserted into turkey breasts to simulate human soft tissue foreign bodies. Air was subsequently injected around a random selection of the foreign bodies to simulate soft tissue gas that can accompany a blast or high-force injury. Using a linear transducer, physicians credentialed in the use of sonography were each asked to scan the breasts, identify the location of any foreign body, and describe whether the object located was bone, metal, or glass. They were also asked to describe the characteristics of the foreign body, including surface echogenicity, visibility, and artifacts, if any. RESULTS: The sensitivity for localization of each foreign body by each sonographer was 100% (48 of 48) and was unaffected by the presence of soft tissue gas. The accuracy of classifying the foreign body was poor except with bone. Glass and metal were often confused with each other. With the addition of soft tissue gas over the foreign bodies, the sensitivity of classifying the foreign body was decreased further from a combined 58% to 28%. The presence of soft tissue gas decreased the amount of reflection of the foreign body and obscured the subtle differences in the brightness of each foreign body, leading to a decrease in the accuracy of identification but not localization of the foreign body. CONCLUSIONS: In an experimental model, soft tissue gas does not affect the localization of soft tissue foreign bodies. However, correct identification of the type of foreign body is limited by soft tissue gas because of loss of the typical sonographic characteristics.
153 patients with swallowed foreign bodies in gastrointestinal tract (GIT) were treated for the last 10 years (1988-1997). In 85 (55.5%) cases foreign bodies (FB) were swallowed by psychopathic persons, in 45 (29.4%)--with the aim of mutilation, in 23 (15.0%)--due to carelessness. In 105 (68.63%) patients the foreign bodies were single, in 48 (31.37%) there were multiple foreign bodies of GIT. In 73 (47.71%) cases FB were found in the stomach. Clinical picture in patients with swallowed FB was variable. Dynamic roentgenological examination together with thorough anamnesis is the most important diagnostic tool in this pathology. The indications for urgent surgical treatment were sticking of the FB, peritonitis, gastro-duodenal bleeding, gastrointestinal obstruction. Elective surgery was used in patients with sticked F.B., with multiple FB, which formed conglomerates, as well as in single FB. with the length over 12-15 cm. Active expectant policy is valid FB of GIT with tendency for passage, due to conservative treatment.
Management of 242 foreign bodies of the upper gastrointestinal tract are reported. Thirty-nine were in the pharynx, 181 in the esophagus, 19 in the stomach, and 3 in the small bowel. The flexible panendoscope was used 211 times (87.2%) to manage these foreign bodies, while the rigid esophagoscope was used 12 times (5.0%). Two hundred thirty-nine foreign bodies (98.8%) were successfully managed endoscopically. The surgery rate was 0.4%. There was no morbidity or mortality. Twenty-five percent of the cases were done under general endotracheal anesthesia. Coins in the esophagus are removed promptly if in the cervical or mid esophagus, and within 12 hours if in the distal esophagus. Once in the stomach, they will usually pass without difficulty. Meat impaction resulting in an obstructed esophagus is an urgent problem and the bolus should be removed within hours. Sharp and pointed foreign bodies can be very difficult to manage. Dry runs with a reproduction of the foreign body are essential to successful removal. Button batteries lodged in the esophagus represent an emergency and should be removed without delay. Once in the stomach, they will usually pass through the gastrointestinal tract without difficulty. The forward-viewing flexible panendoscope has become the instrument of choice in managing foreign bodies in most tertiary medical centers as well as in the community hospitals.
In 39 patients was removed an intraocular foreign body in the years 1989-1991. 12 of them in the anterior segment of the eye, 14 in the vitreous body, 11 in the retina and 2 in the posterior part of the sclera. From the anterior segment were all bodies removed with forceps. From the vitreous body and the retina were foreign bodies removed mostly by forceps after previous vitrectomy. Functionally the worst results were achieved in foreign bodies where pre-, or peroperatively retinal detachment was present. Visual acuity under hand movement was present in 12 eyes.
From 1974 to 1980, 57 consecutive cases of children with tracheobronchial foreign bodies were treated by a new protocol in which peripherally located foreign bodies were treated nonoperatively and centrally located foreign bodies were removed bronchoscopically. Bronchoscopic removal was ultimately successful in all of the 29 children in whom the foreign body was located in the trachea or mainstem bronchus. There were eight minor complications, and in three instances it was necessary to repeat the bronchoscopy for retained fragments. In the other 28 children the foreign body was located in the segmental or lobar bronchi, and initial treatment consisted of a program employing inhalation bronchodilators, pulmonary drainage, and thoracic percussion. Treatment was successful (foreign body coughed out) in 18 patients (64%). Of the other 10 children subsequent bronchoscopy was successful in eight and failed in two patients. Of the latter patients, one required bronchotomy, and the other coughed out the foreign body. There were no deaths, major complications, or permanent pulmonary damage in either treatment series.
OBJECTIVES: This study was undertaken to document the aerodigestive tract foreign body accidents among children, and to investigate the circumstances surrounding these events. METHODS: A review of the charts of pediatric patients admitted with the definitive or suspicious diagnosis of aerodigestive tract foreign bodies was carried out in the period between January 1, 1998 to December 31, 2002. RESULTS: There were 53 eligible children; 39 boys and 14 girls, with an age range of 7 months to 14 years. Food items were the most common airway foreign bodies and coins were the most common esophageal foreign bodies. Among the 32 patients who underwent bronchoscopy, no foreign body was identified in 9 patients. Among the 21 patients who underwent esophagoscopy, foreign body was removed in 19 patients. In 2 cases, large foreign bodies which we could not extract with forceps were pushed into the stomach. CONCLUSIONS: Foreign bodies in the airway and esophagus constitute a constant hazard in all age groups, which demands immediate approach and management. Although the rigid endoscopic removal of aerodigestive foreign bodies was successful in this series, the most effective treatment of foreign body accidents is their prevention.
Accidental aspiration of a foreign body (FB) is an event which is reasonably frequent and dramatic in children and is still today one of the main causes of death due to accidents at home in children up to three-four years of age. The severity of the clinical picture varies according to the size, shape, type and site of arrest of the material aspirated and can be associated with both severe asphyxial forms and forms with insidious and vague symptoms which are difficult to diagnose correctly. A late diagnosis is however a fairly common event in literature. An anamnesis suggesting probable aspiration in a child under the age of 3 should direct doctors towards diagnostic and operative endoscope examinations of the patient, even where there is a negative clinical and radiological picture. Organic material, mainly peanuts, represented 60-75% of the findings, particularly in the 0-3 year age-band. In the other of cases inorganic material was extracted from school-age children. Aspiration of a FB exposes the patient to risk of serious complications and sequelae. Antibiotic, dexamethasone therapy and the ventilation support in the CPAP helped to avoid post-extractive sequelae. Prevention should in any case be the primary aim as regards to aspiration of foreign bodies in children. This should be stimulated by appropriate educational campaigns to raise awareness. The study included 62 child patients observed in the Department of Anesthesia and Intensive Care of the S.Orsola-Malpighi Hospital of Bologna over the last 11 years who were admitted for suspected FB aspiration.
OBJECTIVES: We report a case of urethral foreign bodies in a patient with posttraumatic psychiatric disorders. METHODS: The patient presents with clinical signs of scrotal abscess. Many foreign bodies were removed from the bulbar urethra; one urinary stone formed around one of them required lithotripsy. RESULTS: Treatment included removal of the foreign bodies, abscess drainage, and administration of wide spectrum antibiotics. CONCLUSIONS: Urethral foreign bodies are exceptional, and may present with many symptoms making diagnosis difficult. We noted symptoms and diagnosis in our case, and additionally the therapeutic options proposed in the literature.
Two hundred children aged 6 months to 12 years were admitted to the hospital with a foreign body in the airway. Food materials constituted 93% of all foreign bodies. A positive history of foreign body aspiration was obtained in 88% of the cases. The most common symptoms of laryngotracheal foreign bodies were dyspnea, cough, and stridor, whereas those of bronchial foreign bodies were cough, decreased air entry, wheezing, and dyspnea. Chest fluoroscopy contributed to the diagnosis in 90% of the cases of bronchial foreign bodies, but only 32% of those in the laryngotracheal area. Of the foreign bodies removed, 98 1/2% were done by laryngoscopy, tracheoscopy, and/or bronchoscopy. Complications were involved in 6% of the cases, including one death. History of recurrent intractable pneumonia should make one consider a foreign body in the airway. Removal of one foreign body does not exclude the existence of another. The condition may be fatal; thus immediate removal of the foreign body is mandatory.
To evaluate the possibility that sonography might be effective in the clinical detection of foreign bodies in the soft tissues, we used high-resolution sonography to study 10 patients with suspected foreign bodies in the hand and foot. Using ultrasound, we detected foreign bodies (glass, metal wire) in the sole of the foot of two patients and glass in the hand of another. Seven patients were proved to be free of foreign bodies. In an experimental model to ascertain which types of foreign bodies could be detected by ultrasound, wood, glass, and metallic foreign bodies 2.5 cm in length that had been inserted into the flesh of a chicken breast were immediately identified by high-resolution sonography. Ultrasound also pinpointed the surface beneath which the foreign bodies lay and localized all precisely as to depth from the surface. While detection of a foreign body is important, precise localization is crucial to avoid miscalculation of surgery leading to increased tissue damage, blood loss, and an increased risk of complications. This initial study suggests that high-resolution sonography has applicability in both the detection and the precise localization of foreign bodies in the soft tissues, but the sensitivity and specificity of the procedure remains to be determined.
INTRODUCTION: The removal of foreign bodies in the head and neck area is often a surgical challenge due to a combination of difficult access and a close anatomical relationship of the foreign body to vital structures. Recent developments in computer-assisted surgery (CAS) have brought major improvements to the operating rooms for maxillofacial surgeons. The purpose of this paper is to report our experience in computer assisted removal of foreign bodies from the head and neck area, based on various clinical cases. PATIENTS: Computer assisted removal of foreign bodies from the head and neck area was performed in 11 patients. Three patients sustained gun shot wounds with remaining projectiles or fragments in the soft tissue. In six cases, objects related to a preceding surgical intervention were removed. Two patients presented with dislocated teeth in the facial or cervical soft tissues after 3rd molar surgery. METHOD: For surgical planning and intra-operative navigation, a computer based image guided surgery system (VectorVision(2), BrainLab) was used. RESULTS: In 10 of 11 cases the foreign bodies could be removed without major complications by a minimal invasive manner. More than 40 % of surgery time could be saved compared to similar interventions operated upon using conventional methods. CONCLUSION: In our opinion, the use of a computer based image guided surgical system is of great benefit when removing foreign bodies from the head and neck area. The minimally invasive access helps to prevent major complications such as injury to vital structures and allows a quicker operation.