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Extraction of endobronchial foreign bodies using the Fogarty catheter has been widely accepted. An unsuccessful application of this technique complicated by pneumothorax and catheter tip separation is presented. Avoidance of complications resulting from forceful instrumentation is emphasized.
We experienced three cases of bronchial foreign bodies which required thoracotomy for the removal. In case 1 (51-year-old male), as the foreign body (a nail) was present at extremely peripheral bronchus (left B10b), the removal using bronchoscope was unsuccessfully tried and thoracotomy was performed. In case 2 (12-year-old male), as the foreign body (a lead) was lodged firmly in the bronchus (left B8) surrounded by a granulation tissue, the removal using bronchoscope failed and thoracotomy was performed. In case 3 (6-year-old female), during the removal of the foreign body (a pen-cap) tightly wedged in the left main bronchus using bronchoscope, the general condition was getting worse and emergency thoracotomy was performed. In each case, the foreign body was removed by bronchotomy without sacrifice of significant lung tissue.
PURPOSE: To report five cases of insect wing case foreign body. METHODS: Clinical presentation, investigations, management, and outcome of these cases are discussed. RESULTS: Five patients, four males and one female, in the age group from 4 to 55 years presented with an insect wing case embedded in the cornea or peripheral limbus. All patients were relatively asymptomatic, and the foreign body was associated with vascularization and infiltration. Culture of the foreign body after removal showed Staphylococcus epidermidis in two cases and Corynebacterium species and Mycobacterium fortuitum in one case each. All patients responded to removal of the wing case foreign body and treatment with topical ciprofloxacin (0.3%). CONCLUSION: Insect wing case is an unusual foreign body and produces minimal symptoms and may be associated with infective agents in some patients.
The host foreign body response ensues immediately following implantation of medical devices and prostheses. We have previously identified the role of macrophages in adhering to biomaterial surfaces and guiding the foreign body response while fusing into foreign body giant cells (FBGCs) and concentrating degradative and phagocytic activities. Despite their early and transient presence around implanted biomaterials, few studies have focused on the role of lymphocytes in the foreign body response and biocompatibility. To address this, an in vitro human lymphocyte/macrophage coculture system has been developed. Using this system, it has been shown that when lymphocytes are present during the initial adhesion of monocytes, the rate of monocyte adhesion and fusion is significantly increased (1,500 cells/mm2 and 60%, respectively) when compared to either no lymphocytes present (500 cells/mm2 adhesion and 0% fusion). Although lymphocytes adhered to the tissue culture polystyrene surface, 90% of the lymphocytes were associated with adherent macrophages. However, these cell-cell direct interactions were not necessary to influence macrophage adhesion or fusion as separating the two cell types by a Transwell insert still resulted in significantly increased levels of macrophage adhesion (p < 0.05 when compared to macrophage only cultures). Conversely, the presence of macrophages in Transwell experiments increased lymphocyte proliferation rates at all time points tested. These studies begin to detail the interactions between lymphocytes and macrophages in the absence of known antigen that appropriately relates to the scenarios experienced upon implantation of biomedical devices and the initiation of the foreign body response.
In the last 7 yrs, we have removed 51 foreign bodies inhaled by children. In five cases involving long-standing foreign bodies, retrieval of the inhaled objects was complicated by their peripheral location in the bronchial tree and by the presence of abundant granulation tissue. In two of these children, the inhaled foreign bodies had been pushed further down the bronchial tree during a previous unsuccessful bronchoscopy. The use of a rigid bronchoscope with optical peanut forceps and 2-4 doses of an aqueous solution of epinephrine 1:100,000, at the dosage of 0.1 mL.kg-1.body weight (during removal of granulation tissue and after removal of the foreign bodies) permitted the complete removal of the foreign bodies in one session and a good control of bleeding.
Foreign bodies in the urinary bladder are frequently the objects of jokes among doctors, but they may sometimes cause serious implications to the patients. Here we present our experiences in 3 such cases where long segments of wire were introduced into the urinary bladder through the urethra.
An unusual intraocular foreign body--the silicone sleeve of a soft-tipped extrusion cannula left behind accidentally in the vitreous cavity following a vitreoretinal surgical procedure for complex retinal detachment--is reported. The silicone sleeve remained within the eye for a year without causing any problem.
BACKGROUND: Reports on endoscopic management of ingested foreign bodies of the upper-GI tract in China are scarce. OBJECTIVE: To report our experience and outcome in the management of ingestion of foreign bodies in Chinese patients. SETTING AND PATIENTS: Between January 1980 and January 2005, a total of 1088 patients (685 men and 403 women; age range, 1 day to 96 years old) with suspected foreign bodies were admitted to our endoscopy center. INTERVENTIONS: All patients underwent endoscopic procedure after admission. MAIN OUTCOME MEASUREMENTS: Demographic and endoscopic data, including age, sex, and referral sources of patients, types, number and location of foreign bodies, associated upper-GI diseases, endoscopic methods, and accessory devices for removal of foreign bodies were collected and analyzed. RESULTS: A total of 1090 foreign bodies were found in 988 (90.8%) patients. The types of foreign bodies varied greatly: mainly food boluses, coins, fish bones, dental prostheses, or chicken bones. The foreign bodies were located in the pharynx (n = 12), the esophagus (n = 577), the stomach (n = 441), the duodenum (n = 50), and the surgical anastomosis (n = 10). The associated GI diseases (n = 88) included esophageal carcinoma (33.0%), stricture (23.9%), diverticulum (15.9%), postgastrectomy (11.4%), hiatal hernia (10.2%), and achalasia (5.7%). A rat-tooth forceps and a snare were the most frequently used accessory devices. The success rate for foreign-body removal was 94.1% (930/988). CONCLUSIONS: Ingestion of foreign bodies is a common clinic problem in China. Endoscopy procedures are frequently performed, and a high proportion of patients with foreign bodies require endoscopic intervention.
Accidental ingestion of foreign bodies is common enough, especially in children, but is of relatively small importance as such objects readily pas through the body and no particular treatment is required. A more interesting and less frequent occurrence is the ingestion of objects such as bone fragments, fish bones, etc. that form part of ordinary food. Cases of intestinal perforation caused in this way are described, together with their clinical and surgical management.
A metallic mediastinal foreign body, which eroded into the esophagus and resulted in a mediastinal abscess, was removed through the mediastinoscope. Tubes for drainage and irrigation were easily inserted after the pus had been entirely drained. Satisfactory low-risk treatment was accomplished without the need for major surgical intervention.
Aero-digestive foreign bodies are a common occurrence in infants and children. The manifestations, hazards and consequences depend upon the location, nature of the foreign body and the time lapse. This communication reports a series of four cases with unusual course and consequences of aero-digestive foreign bodies. These were generalized tetanus, hypernatremia and metabolic acidosis with intra-cranial hemorrhage and severe pneumonia and empyema. Awareness of these consequences would help treating doctors to take appropriate steps in devising preventive and therapeutic strategies.
A microcatheter foreign body retrieval device is described and its first two clinical applications are presented. The device functions identically to larger loop snare retrievers. It permits access to small vessels and was successful in its first clinical applications.
Foreign bodies within the tongue are a rare finding. The history is often not helpful as it is usually remote. Presented is a case of an unusual foreign body in the tongue which masqueraded as a malignancy. The differential diagnosis of an asymptomatic tongue swelling or tongue pain should include foreign body.
Late diagnoses of foreign body aspiration were defined as occurring beyond 3 days between the aspiration of the foreign body, or onset of symptoms, and correct diagnosis. We reviewed a total of 210 children with late diagnosis of foreign body aspiration. The causes creating late diagnosis of foreign body aspiration in children were as follows: (1) parental negligence (106/210, 50%); (2) misdiagnosis by the fellow professionals and pediatricians (39/210, 19%); (3) the normal chest roentgenographic findings (29/210, 14%); (4) lack of typical symptoms and signs (26/210, 12%); (5) mismanagement (8/210, 4%); and (6) a negative bronchoscopic finding (2/210, 1%). The most common complications encountered were obstructive emphysema (77/186, 41%), mediastinal shift (63/186, 34%), pneumonia (43/186, 24%), and atelectasis (33/186, 18%) in 186 patients who underwent a chest roentgenographic examination. The incidence of major complications was 64% (48/75) in the children who were diagnosed within 4 to 7 days; however, the complication rate was 70% (39/56) in those with a delay in diagnosis of 15 to 30 days, and 95% (20/21) in the cases with a delay in diagnosis of over 30 days after aspirating the foreign bodies.
BACKGROUND AND STUDY AIMS: Ingested foreign bodies may be managed by endoscopy, observation, or surgery. The aim of the study was to investigate the methods of removal of foreign bodies according to type and location, success rates, and complications. PATIENTS AND METHODS: The charts of 104 children who had ingested foreign bodies were retrospectively reviewed. RESULTS: Of the patients, 80 (76.9%) were managed endoscopically. The overall success rate for endoscopic management was 98.8%. There were no complications during endoscopic interventions. In 23 cases the foreign bodies spontaneously passed through the gastrointestinal tract (22.1%). Surgical removal of a foreign body was done in only one case (0.96%). The majority of the foreign bodies which were located in the upper gastrointestinal tract could be removed endoscopically regardless of the nature of the material. Foreign bodies in the small and large intestine tended to pass through spontaneously without complications. CONCLUSIONS: It appears that the endoscopic approach is the preferable method for the extraction of upper gastrointestinal foreign bodies in child patients because of its high success rate, and that foreign bodies in the small and large intestine tend to be passed spontaneously without complications.
Intralenticular foreign bodies are not uncommon after penetrating eye injuries. This is an observational case report where a patient was found to have an embedded lenticular foreign body for more than 60 years. Following such a long period of time the patient has not experienced any significant cataract formation or compromised ocular function due to the foreign body.
PURPOSE: To present the evaluation of computed tomography (CT) application for detecting the intraocular foreign bodies. MATERIAL AND METHODS: Sixteen computed tomographies of orbit to localise a foreign body were performed in the 2nd Radiology Department at Lublin University School of Medicine from May 1995 to October 1998. During examination 2 mm computed tomography cuts were taken. In almost all cases fundus examination was not possible because of hazy media (cataract, vitreous haemorrhage, endophthalmitis). Pars plana vitrectomy was applied to remove foreign body in all cases. RESULTS: In 14 cases a foreign body was localised inside the eye (3 of them were embedded in the wall of the eye) and in 2 cases a double perforation was noticed. With pars plana vitrectomy 12 of 14 intraocular foreign bodies were removed. Two foreign bodies deeply embedded in the wall of the eye were left. One of the two foreign bodies after double perforation was removed from the orbit and the second, which was localized deeply in the orbit, was left. CONCLUSION: The localisation of the foreign bodies using the computed tomography is a very accurate and sensitive method, facilitating further surgery.
Intraocular foreign bodies (IOFB) are a public health challenge because they are a major cause of poor vision in the young population. Initial management must be adapted to each case. The history analyzes the trauma circumstances and tries to determine the nature of the IOFB. The ocular examination must be complete. After a systemic antibiotic treatment has been prescribed, the patient is evaluated with plain radiography and a CT scan. The wound will be sutured as soon as possible. The IOFB will usually be removed later using vitrectomy. However, a pars plana magnet extraction can still be considered in some selected cases.