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PubMed1998

Laparoscopic removal of a foreign body from the intestine.

Foreign bodies are often introduced into the gastrointestinal tract of both adults and children. At times this is intentional and at others it is accidental. The doctor is usually faced with the problem of deciding whether to apply expectant treatment, endoscopy or surgery to obtain an optimum outcome. The management depends on the type of object, the organ affected, the type of symptoms and the condition of the patient in deciding if, when and how to intervene. A case is reported here where a method not previously described was used to retrieve a sewing needle from the distal ileum.

Adolescent↗

PubMed2005

Foreign body ingestion in children.

Because many patients who have swallowed foreign bodies are asymptomatic, physicians must maintain a high index of suspicion. The majority of ingested foreign bodies pass spontaneously, but serious complications, such as bowel perforation and obstruction, can occur. Foreign bodies lodged in the esophagus should be removed endoscopically, but some small, blunt objects may be pulled out using a Foley catheter or pushed into the stomach using bougienage [corrected] Once they are past the esophagus, large or sharp foreign bodies should be removed if reachable by endoscope. Small, smooth objects and all objects that have passed the duodenal sweep should be managed conservatively by radiographic surveillance and inspection of stool. Endoscopic or surgical intervention is indicated if significant symptoms develop or if the object fails to progress through the gastrointestinal tract.

Algorithms↗

PubMed2001

Foreign body aspiration diagnosed by microscopy.

We report a rare case of foreign body aspiration diagnosed by microscopic analysis of a sample of the foreign body. A 50-year-old man presented with a 5-month history of 40 pound weight loss and a nonresolving right lower lobe pneumonia. Medical history, radiographic studies, direct visualization of the foreign body by flexible fiberoptic bronchoscopy, and gross examination of a sample of the foreign body retrieved by a forceps biopsy catheter failed to yield the diagnosis. Moderate bleeding associated with the bronchoscopic "biopsy" procedure contributed to a preliminary misdiagnosis of endobronchial tumor. Microscopic analysis of the "biopsy" specimen demonstrated vegetable matter. The patient underwent rigid bronchoscopy and a peanut was retrieved from the bronchus intermedius. He was maintained on antibiotics for an additional 8 weeks and had complete clinical and radiographic recovery. The epidemiology, presentation, and management strategies of foreign body aspiration in the adult are briefly reviewed.

Arachis↗

PubMed1989

Tracheobronchial foreign bodies. A persistent problem in pediatric patients.

Extraction of a foreign body from the tracheobronchial tree was accomplished for 83 children. The mean age was 1 year 9 months for the 27 girls and 3 years 1 month for the 56 boys; 46 children (55%) were younger than 2 years of age. Sixteen (19%) of the foreign bodies were radiopaque, and 35 (42%) were either verified or suspected radiologically before endoscopy. Forty-one foreign bodies (49%) were situated in the right bronchial tree. Extraction was successful in 81 children (98%) and was performed on 50 children (60%) during the first 24 hours. Twenty-five (30%) of the foreign bodies were peanuts. Three children experienced a residual foreign body, without serious complications. We believe that an open tube bronchoscopy should be performed whenever abnormal stridor or cough is observed in a healthy child and when appropriate antibiotic therapy is unsuccessful.

Bronchi↗

PubMedDate not supplied

Unsuspected foreign body aspiration.

Aspiration of foreign bodies is a serious complication that may occur during the course of dental treatment. A case report of a 60-year-old man with recurrent pneumonia is presented. One year after the onset of his initial symptoms, a hard substance that made a complete mold of the bronchial tree at the inferior right lobe was extracted with a rigid bronchoscopy. This green material of elastic consistency was dental impression material (polyvinylsiloxane). On careful questioning, the patient indicated that he had dental impressions taken 2 months before the onset of the symptoms. Surgery was indicated and lobectomy of the inferior right lobe was performed without incident. To avoid this complication, some preventive precautions such as identifying high-risk patients; using rubber dam; tethering any small instrument with a ligature; placing a gauze screen to protect the oropharynx in sedated patients; and using custom impression trays to minimize the amount of impression material required have been suggested. In case of a suspected aspiration, the patient must be referred to appropriate medical care.

Bronchi↗

PubMedDate not supplied

Retained foreign body: a fingernail fragment?

A 19-year-old female presented four and one-half months after an occupational injury from a punch-type machine. Exploration revealed a large fragment of her fingernail embedded in the fingerpad. Foreign bodies are commonly encountered in the practice of emergency medicine and failure to localize and remove them can result in significant morbidity. We present a case of a fingernail as a foreign body. Foreign bodies may be difficult to detect despite sophisticated imaging techniques. Although not visualized often, a radiolucent foreign body may be inferred from boney changes. A thorough history regarding mechanism of injury and resultant wound exploration are required. When an adequate wound examination using digital tourniquet control and proper precautions is performed, the majority of foreign bodies will be detected.

Accidents, Occupational↗

PubMed1999

Foreign body aspiration in children--a persistent problem.

OBJECTIVE: Cough and respiratory distress due to foreign body inhalation in children is a common problem in our society. This study was planned to identify the criteria for early diagnosis and management in suspected cases of foreign body inhalation. SETTING: The study was carried out on indoor patients of Paediatrics Department, Rawalpindi General Hospital (RGH) affiliated with Rawalpindi Medical College (RMC), from January, 1995 to December, 1996. Paediatrics Department has 50-bedded general paediatrics ward, 20-bedded neonatal unit (NNU) and 150-200 daily attendance of outpatient department (OPD). It offers primary to tertiary level care to its patients from whole of Rawalpindi Division. METHODS: This prospective study encompasses profile and immediate outcome of 20 suspected cases of foreign body inhalation. Selection of study subjects and subjection to bronchoscopy was based on symptomatology, clinical and radiological findings and response to treatment. The data with outcome was recorded on a proforma. RESULTS: In 18 cases foreign body was removed successfully by rigid bronchoscope with immediate relief of symptoms and normal chest roentgenograms. Most susceptable age for foreign body inhalation was 1-3 years (n = 14) and male children were at higher risk than females (13 vs 7). Valuable clinical features were sudden onset with respiratory distress, cough, choking, localized poor air entry, crepitations or rhonchi in descending order of frequency. Most common finding in chest roentgenogram was consolidation-collapse and/or emphysema in 50% cases. 30% cases (n = 6) with persistent respiratory tract infection inspite of adequate treatment of recurrent episodes of respiratory distress with wheeze turned out as foreign body inhalation and therefore, such cases need re-evaluation. Betelnut was the most common foreign body removed (n = 7) followed by peanut (n = 6). Most frequent site involved was right main bronchus (n = 7) followed by left main bronchus (n = 5). CONCLUSION: Public awareness through mass media needs attention to prevent foreign body inhalation. High index of clinical suspicion is mandatory for early diagnosis and management to prevent fatal outcome and long term morbidity.

Bronchi↗

PubMed1988

[Percutaneous transfemoral foreign body removal from the heart or great vessels].

Removal of foreign bodies in the heart or great vessels was attempted via percutaneous transfemoral catheter retrieval system in 32 patients, antibiotic treatment--sometimes continued over many months--having failed to eradicate any septicaemia. In 28 patients it was possible to remove the foreign body with a special basket, forceps or sling catheter retrieval system. Most of the foreign bodies were broken-off pacing electrode fragments (n = 18). The most common site was the right ventricle (n = 15). 28 patients had had recurrent high fever; in 21 of them it was possible to identify the causative microorganism. Any fever ceased abruptly after removal of the foreign body. There were no complications ascribable to the procedure. The results indicate that, after foreign-body embolization, immediate removal is both necessary and possible.

Adolescent↗

PubMed2006

Perforation of the gastrointestinal tract secondary to ingestion of foreign bodies.

INTRODUCTION: Ingesting a foreign body (FB) is not an uncommon occurrence. Most pass through the gastrointestinal (GI) tract uneventfully, and perforation is rare. The aim of this study was to report our experience with ingested FB perforations of the GI tract treated surgically at our institution. METHODS: A total of 62 consecutive patients who underwent surgery for an ingested FB perforation of the GI tract between 1990 and 2005 were retrospectively reviewed. Three patients with no definite FB demonstrated intraoperatively were included. RESULTS: The patients had a median age of 58 years, and 37 (60%) were male. Of the 59 FBs recovered, 55 (93%) were toothpicks and dietary FBs such as fish bones or bone fragments. A definitive preoperative history of FB ingestion was obtained for only two patients, and 36 of 52 patients (69%) wore dentures. Altogether, 18 (29%) perforations occurred in the anus or distal rectum, and 44 perforations were intraabdominal, with the most common abdominal site being the distal ileum (39%). Patients with FB perforations in the stomach, duodenum, and large intestine were significantly more likely to be afebrile (P = 0.043), to have chronic symptoms (> 3 days) (P < 0.001), to have a normal total white blood cell count (P < 0.001), and to be asymptomatic or present with an abdominal mass or abscess (P < 0.001) compared to those with FB perforations in the jejunum and ileum. CONCLUSIONS: Ingested FB perforation in the adult population is most commonly secondary to unconscious accidental ingestion and is frequently caused by dietary FBs especially fish bones. A preoperative history of FB ingestion is thus rarely obtained, although wearing dentures is a common risk factor. FB perforations of the stomach, duodenum, and large intestine tend to present with a longer, more innocuous clinical picture than perforations in the jejunum or ileum.

Adult↗

PubMedDate not supplied

Multiple foreign bodies in the anterior and posterior urethra.

Foreign bodies of the urethra and bladder are seen with iatrogenic injury, self-insertion, and rarely migration from adjacent sites. Treatment is focused on foreign body extraction, diagnosing complications, and avoiding compromise of erectile function. With advances in endourology, the majority of cases can now be managed endoscopically. We present a case of a man with multiple foreign bodies located both above and below the urogenital diaphragm. Advancing the posterior objects intravesically and extracting with a stone basket accomplished successful removal.

Foreign Bodies↗

PubMed2002

Management of sharp esophageal foreign bodies in young children: a cause for worry.

The most common foreign bodies in children are coins, particularly in the age group of 2-5 years. Sharp esophageal foreign bodies in children are not commonly encountered. We present a report of two sharp foreign bodies in young children. Both of them required cervical esophagotomy for removal of the foreign body after an unsuccessful endoscopic attempt. The principles of evaluation and management of sharp and penetrating foreign bodies of the esophagus are described.

Esophagus↗

PubMedDate not supplied

[Foreign bodies in the esophagus].

OBJECTIVE: To study the management (diagnostic and therapeutic) of esophageal foreign bodies. MATERIAL AND METHODS: A retrospective study was made of all rigid esophagoscopies performed for suspected foreign bodies in the esophagus by the otolaryngology department of Marqués de Valdecilla Hospital (Santander, Spain) from 1992 to 1996. RESULTS: Rigid esophagoscopy was performed for suspected foreign bodies in 195 patients (121 females, 74 males; age range 2 to 97 years). In 183 cases an impacted foreign body was found. The most frequent location was the upper third of the esophagus (165/85.2%). The most common type of foreign body was fish bones in adults (75/171) and coins in children (7/12). In 145 cases a barium esophagogram was obtained before surgery, which yielded 1 false negative and 8 false positives. In 16 patients flexible endoscopy had failed previously to remove the foreign body. Twelve patients (all adults) had serious complications. CONCLUSIONS: The barium esophagogram and rigid esophagoscopy are still appropriate techniques for managing esophageal foreign bodies.

Adolescent↗

PubMed1989

Foreign bodies in tendons.

At the National Institute of Traumatology in Budapest, a search has been made for foreign bodies in tendons over the last 15 years. 53 foreign bodies have been found in 931 tendons removed at operation and 45 foreign bodies in 950 tendon samples at autopsy. The foreign material was found to be organic in 29 cases, metal in 20 cases and plastic in six cases. In the others, glass, sand, mineral grease and textiles could be detected. In 33 cases the material could not be identified. The foreign bodies were found in the tendons of the upper extremities in 51 cases and the lower extremities in 47 cases. Foreign bodies in the tendons were more likely to cause problems in the upper limbs than in the lower limbs: these problems were purulent tendonitis, necrosis, foreign body granuloma, fibrosis and peritendonitis and calcification.

Foreign Bodies↗

PubMed1976

Removal of endobronchial foreign body by fiberoptic bronchoscopy.

A relatively large foreign body (ham bone) was seen in the left upper lobe bronchus of a 25-year-old woman and was successfully extracted with the use of a standard fiberoptic bronchoscope. Although the removal of foreign bodies by the fiberoptic bronchoscope has serious technical limitations, the use of this instrument should be considered when the foreign body is not within range of the rigid bronchoscope.

Adult↗

PubMed1998

[Foreign bodies in the ear; report of 40 cases].

BACKGROUND: Foreign bodies in the external ear canal present a frequent situation in pediatric practice. It is generally benign, but infectious complications may occur. POPULATION: Between January 1996 and March 1997, 35 children with a foreign body in the ear canal were treated in the ENT department of Robert-Debré hospital. RESULTS: Age ranged from 15 months to 14 years, with a mean of 6.5 years. The sex ratio was 1.2 (19 boys/16 girls). Five children had bilateral foreign bodies. The most frequent foreign bodies were pearls (8/40) and cockroaches (7/40). Eleven children had complications: ear canal laceration in five cases, otitis externa in five cases, cervical adenitis in three cases, general septic syndrome with fever in one case, and drum perforation in one case. CONCLUSION: The methods of extraction and the management of the complications are discussed.

Adolescent↗

PubMed1998

Nasal foreign bodies in children.

Between 1994 and 1997, a total of 72 nasal foreign bodies were removed from 68 children (28 girls and 40 boys, including 2 repeats) in the ENT Department at Robert Debré Hospital, Paris. Ages ranged from 1 to 12.5 years (median, 3 years). Two children had bilateral foreign bodies. The unilateral foreign bodies were on the right side in 67.6% of cases. The most frequent objects were plastic objects, beads, paper, cotton and foam. Insertion was witnessed by an adult or reported by the child himself in the majority of cases. The other cases were diagnosed when complications occurred (as seen by persistent rhinorrhea and a foul body odor). All foreign bodies were removed in the consultation room using a hook or nasal forceps.

Child↗

PubMed1995

Retrieval of intravascular foreign bodies: experience in 32 cases.

OBJECTIVE: Recent reports suggest that both the nature of intravascular foreign bodies and the tools available to retrieve them have changed substantially in the past decade. We reviewed our recent experience with percutaneous retrieval of intravascular foreign bodies to determine the efficacy and safety of the procedure using currently available devices. MATERIALS AND METHODS: Between 1990 and 1994, we attempted retrieval of 35 intravascular foreign bodies in 32 patients. Twelve patients (38%), including all five with intraarterial foreign bodies, were treated for complications of transcatheter interventional procedures that resulted in embolization of seven coils, four intravascular stents, an inferior vena cava filter, and a valvuloplasty balloon fragment. From procedure records, we reviewed the types of retrieval devices and methods used; the medical record was studied to determine the occurrence and treatment of any procedure-related complications. RESULTS: Retrieval was successful in 31 (97%) of 32 patients. All five intraarterial and 29 of 30 IV objects were removed. Nitinol goose-neck snares were used in 28 of 32 cases, but more than one retrieval system was required in eight cases (25%), often using grasping forceps, tip-deflecting wires, or stone baskets to move the foreign body into a more favorable position for snaring. In the single failure, the tip of a largely extravascular catheter fragment lay in a venous valve and could not be snared in a patient who refused surgery. Two of five patients with arterial foreign bodies suffered occlusive arterial spasm, reversible with local administration of nitroglycerine. Two large objects were repositioned to the femoral vein and removed by surgical cutdown. No other procedural complications occurred, and none of the patients required additional compression, transfusion, or surgical intervention. CONCLUSION: We conclude that use of preformed nitinol goose-neck snares facilitates retrieval of intravascular foreign bodies in most cases, although interventional radiologists must be familiar with a variety of techniques to deal with the expanding spectrum of foreign bodies currently encountered.

Adolescent↗

PubMed2005

Small intestinal foreign body in an adult Eclectus parrot (Eclectus roratus).

A 14-month-old female Eclectus parrot (Eclectus roratus) was presented with a 4-week history of bloody diarrhea and depression. No additional information could be gained from physical examination. Only selected diagnostic tests (faecal examination, haematocrit, aspartate aminotransferase, and uric acid) could be performed due to financial constraints, but all where within reference range. Unspecific antibiotic treatment was started and the bird responded well initially, but had to be readmitted 2.5 weeks after initial presentation. Four weeks after initial presentation the owner finally consented to taking whole body radiographs and a diagnosis of an intestinal foreign body could be made. The foreign body was surgically removed 2 days later. The bird recovered uneventfully after surgery and was still in good health 1 year after surgery. This article emphasises the importance of diagnostic imaging in the avian patient. A brief review of avian gastrointestinal foreign bodies is given (concentrating on the psittacine patient) and the importance of distinguishing metallic from non-metallic gastrointestinal foreign bodies are discussed.

Animals↗