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PubMed1995

[Non-surgical extraction of intravascular foreign bodies in children. Experience with 8 cases].

BACKGROUND AND OBJECTIVES: Foreign body retrieval in the catheter room is a useful procedure at any age, but, although its interest, few reports of such technique have been reported in children. METHODS: We review and present our experience in 8 children, aged 5 days to 11 years, five of them having congenital hearts defects. RESULTS: We retrieved 4 catheter fragments, 2 endocardial electrode catheter tips, 1 Rashkind 12 mm. PDA umbrella, and 1 detachable Jackson coil. All of them were placed in systemic veins, right heart chambers or pulmonary arteries. We used biplane fluoroscopy and percutaneous right femoral vein puncture in all cases. Goose-Neck (Microvena Corporation) snares were used in 5 patients, hand made snares in 2 and a Swan-Ganz catheter in one. In 4 cases, the snare was introduced trough a Mullins long sheath and the foreign body pulled into its distal end, in order to bring it out of the femoral vein. Six foreign bodies came off the femoral vein: 4 trough the puncture site and 2 needing a venous cut-down. The two remaining foreign bodies, stopped while pulling at the common iliac vein and a minor surgical procedure was needed for final extraction. CONCLUSIONS: Therapeutic catheterization is the technique of choice for intravascular foreign body retrieval in children.

Catheterization↗

PubMed1999

Removal of a foreign body from the bronchial tree--a new method.

Tracheo-bronchial foreign bodies can be very difficult to remove. This may be related to the location and type of foreign body, the experience of the bronchoscopist and the availability of appropriate instruments. We report a case of an uncommon foreign body in an unusual location in an adolescent in whom conventional attempts to remove it failed. The foreign body was eventually recovered using a flexible bronchoscope and an intravascular wire loop snare under fluoroscopic control. The patient was saved from thoracotomy and possible lobectomy. To our knowledge, this combined fluoroscopic and endoscopic approach for the removal of a difficult tracheobronchial foreign body is the first reported case in the literature.

Adolescent↗

PubMed1992

Water used to visualize and remove hidden foreign bodies from the external ear canal.

Small foreign bodies lodged anteriorly in the tympanic sulcus are usually not visible, due to the curve of the external ear canal. Such objects can be seen with the aid of an otomicroscope and micromirror or with an endoscope, and removed by irrigation. If irrigation fails, epithelial migration on the tympanic membrane may remove lodged foreign bodies, although this may take months. Our new method, which uses water to locate small objects lodged in the tympanic sulcus, includes irrigation of the ear, adjustment of the water level to the middle curve of the external ear canal, and use of the water surface as a concave lens, making the tympanic sulcus visible. With otomicroscopy a curved ear probe can then be used to remove lodged foreign bodies from behind the curve.

Adult↗

PubMed2006

[Eight cases report of segmental bronchi foreign body].

OBJECTIVE: To review the clinical features and the treatment of segmental bronchi foreign bodies cases. METHODS: Rigid bronchoscope and endoscope were applied to all 8 cases under general anesthesia. The foreign bodies shape and position were well evaluated under direct view, and the metal ones were located with X ray. RESULTS: Generally, the foreign bodies in segmental bronchi are small size and have a long history, the symptoms are non typical and may be accompanied with recurrent lung infection and haemoptysis. The foreign bodies were successfully removed in 6 patients with bronchoscopy, and the foreign bodies in other 2 cases were removed with thoracotomy. No complications occurred in all cases. CONCLUSIONS: For the segmental bronchi foreign body cases, the non typical history should be well reviewed and a detailed investigation should he performed. Suitable surgical instruments should be well selected so to get higher success rate and effectively prevent potential compilations.

Adolescent↗

PubMed1976

Management of ocular foreign bodies.

Fluorescein staining is helpful in diagnosis. Many conjunctival foreign bodies can be removed by swab or irrigation, without anesthesia. Cycloplegics can prevent painful ciliary spasm. A surgical opening may be required for deeply embedded objects. Topical anesthesia is required for corneal foreign body removal. Caution: x-rays must be made to rule out intraocular foreign bodies in cases of flying metal. Rust rings must be removed. Mydriatics or cycloplegics can precipitate glaucoma. Corneal abrasions are easily infected. Secondary iritis may follow deeply embedded foreign bodies.

Anesthesia, Local↗

PubMedDate not supplied

Fragmatome lifting: surgical option for intraocular lens and foreign body removal.

A new technique for intraocular lens (IOL) and foreign body removal using the fragmatome is described. Removal of the formed vitreous, including cortical vitreous, was performed using a conventional vitrectomy probe. The fragmatome tip was placed on the center of the anterior surface of both the IOL optics and the foreign bodies, and active 250 mm Hg vacuum suction was applied. IOLs and foreign bodies were easily held and manipulated after being aspirated into the fragmatome tip, avoiding the use of a forceps or other grasping instrument that may damage the retina. Fragmatome lifting is a reasonable treatment option for IOL and nonmagnetic foreign body removal.

Eye Foreign Bodies↗

PubMed2001

A prospective evaluation of foreign bodies presenting to the Ear, Nose and Throat Clinic, Hospital Kuala Lumpur.

The results of a prospective study of 94 patients with history of ear, nose or aerodigestive tract foreign bodies were analysed. Sixty six to 94% of patients presented within 24 hours to a primary care doctor, 80 to 94% was referred to the ENT Department within 24 hours and 89 to 93% of patients had their foreign bodies removed within 24 hours. Overall, 58% of aural foreign bodies, 67% nasal foreign bodies and 94% of aerodigestive tract foreign bodies were removed within 48 hours of insertion. As a result of the prompt removal of foreign bodies in the majority of patients, no significant complications occurred. Foreign bodies in the aerodigestive tract tend to present earlier and more promptly removed compared with ear and nose foreign bodies. There was a significantly higher proportion of foreign body in the right ear and nostril compared to the left.

Adolescent↗

PubMed2002

Foreign body aspiration: what is the outcome?

Undiagnosed and retained foreign bodies may result in serious complications such as pneumonia, atelectasis, or bronchiectasis. We reviewed a total of 174 children with foreign body aspiration (FBA). Clinical, radiological, and bronchoscopic findings of these patients were evaluated according to the nature of foreign body and elapsed time from aspiration to diagnosis. Significant differences were noted between patients with organic and inorganic FBA in terms of clinical and radiological findings. Cough, recurrent pneumonia, and fever were the most common presenting symptoms in patients with delayed diagnosis. Long-term follow-up was available for 110 patients for a mean duration of 37.8 +/- 23.7 months (range, 1-88 months). We evaluated the course of recovery after bronchoscopic removal. Organic FBA was of comparable duration as for inorganic FBA, and prolonged follow-up was associated with increased risk of persistent symptoms and bronchiectasis (P < 0.001). The risk of long-term complications increased with increasing elapsed time from aspiration to diagnosis; complications were as high as 60% in children who were diagnosed 30 days after FBA (P = 0.0035). Bronchiectasis was a major complication, found in 25% of patients whose diagnosis was delayed by more than 30 days (P = 0.0001). Three patients with bronchiectasis underwent lobectomy. Patients with persistent asthma-like symptoms such as cough and wheezing required treatment with inhaled corticosteroids and bronchodilators. The positive response to this treatment was thought to be a confirmation of the development of transient bronchial hyperresponsiveness induced by foreign bodies. We conclude that timely diagnosis and appropriate treatment of FBA is important to prevent long-term complications in affected children.

Adolescent↗

PubMed1996

Lens preservation after intraocular foreign body injuries.

PURPOSE: Ocular missile injuries often involve the lens. Some have suggested that lens capsular violation by a foreign body is an indication for immediate lens removal. Sometimes, however, the resultant lens opacity may remain localized without visual compromise. The authors report a series of patients who had lens capsular disruption from an intraocular foreign body that resulted in visually insignificant lens opacities. METHODS: A series of five patients with lens capsular disruption as a result of an intraocular foreign body injury were reviewed retrospectively. RESULTS: All five patients had lens injury from a small foreign body in a peripheral lenticular location. In three patients the foreign body was intralenticular, whereas in the other two patients the foreign body transversed the lens and was located in the posterior segment. In two patients, the foreign body was not removed. Three of the patients required pars plana vitrectomy. In all patients, final visual acuity was at least 20/40, and the lenticular opacity remained localized to an eccentric location. CONCLUSIONS: A progressive, visually significant cataract is not the inevitable result of lens injury by an intraocular foreign body. When indicated, surgical removal of the foreign body may be attempted using a lens-sparing procedure.

Adult↗

PubMed1998

Impacted aural foreign body requiring endaural incision and canal widening for removal.

Foreign bodies of the ear are a common finding in children. The majority of these can be removed relatively easily. We present a case which required endaural incision and widening of the external meatus before the foreign body could be successfully removed. Entrapment of the hard, oval-shaped, smooth and slippery foreign body deep to the hour-glass narrowing of the external canal, proximity of the object to the tympanic membrane and localised tissue oedema were the indications for the surgery. This case demonstrates the danger of unskillful attempts to remove aural foreign bodies.

Child↗

PubMed1993

[Percutaneous retrieval of intravascular foreign body from the pulmonary artery].

Percutaneous retrieval of intravascular iatrogenic foreign bodies is an important part of interventional radiology. Foreign body retrieval from the pulmonary artery is, however, not easy, and only a few cases reports have appeared in the literature. The authors have successfully removed dislodged CV catheter fragments from the pulmonary artery in 8 patients. Combined use of a long sheath and a balloon catheter is very helpful for this retrieval. The long sheath, originally designed for myocardial biopsy, is safely advanced to the pulmonary artery over the balloon catheter. Foreign bodies can be easily caught with a retrieval basket or snare, which is passed through the sheath. Another convenient device is a "balloon snare," which is a hand-made loop snare with an angiographic balloon catheter and a guide wire. For safe and easy retrieval of foreign bodies from the pulmonary artery, we recommend the combined use of a long sheath and a balloon catheter, or a "balloon snare."

Adolescent↗

PubMed2001

CT findings of the chest in adults with aspirated foreign bodies.

The aim of this study was to assess the imaging findings in adult patients with tracheobronchial foreign body aspiration. Nineteen patients (11 men and 8 women; age range 26-89 years) with foreign-body aspiration were retrospectively reviewed. Nine patients were outpatients with non-specific symptoms and ten were hospitalized with nonresolving pneumonia (n = 6), after detection of a dental fragment on a chest radiograph following intubation (n = 3), and there was one mentally retarded patient with empyema. An aspirated dental fragment was seen on a chest radiograph in 3 patients and an endobronchial foreign body on CT in 16, appearing as a dense structure within the bronchial lumen. The foreign body was right sided in 14 cases and left sided in 5. Three cases were missed at first interpretation. Associated findings on CT were volume loss, hyperlucency with air trapping and bronchiectasis in the affected lobe. Thirteen patients were managed with bronchoscopy, whereas 2 needed thoracotomy. In 1 patient bronchoscopy failed to detect a foreign body, indicating a false-positive CT diagnosis. One patient expelled an aspirated tablet and two refused invasive procedure. The foreign bodies found mainly were bones and dental fragments. A high clinical suspicion is necessary to diagnose a foreign body. Since CT is often used to evaluate various respiratory problems in adults, it may be the first imaging modality to discover an unsuspected aspirated foreign body in the bronchial tree.

Adult↗

PubMed1998

Foreign bodies in tracheobronchial tree in children: a review of cases over a twenty-year period.

BACKGROUND: Foreign body inhalation into the tracheobronchial tree of children is rather rare but serious problem. It may be hazardous and even cause fatal sequelae in the children if misdiagnosed and not managed promptly. METHODS: We retrospectively reviewed the records of 81 patients with foreign bodies inhaled into the larynx, trachea and bronchi. The children were all treated during the 20-year period from July 1976 through June 1996 at Chang Gung Memorial Hospital. Of these patients, 82% were 36 months of age or younger. The male to female ratio was 3:1. All of the patients initially received flexible fiberoptic bronchoscopy to identify the foreign objects. The foreign bodies were removed by jet ventilation bronchoscopy with apneic techniques under general anesthesia. RESULTS: Peanuts were found to be the most common causative foreign body agent which occurred in 53 instances (65%). The most common manifestation was coughing, with subsequent dyspnea and audible wheezing. The foreign bodies were lodged in the left bronchus more than in the right. The most obvious radiologic evidence observed in aspirated children were emphysematous changes at same side of the foreign bodies caused by "expansile check-valve" phenomenon. Four patients showed radio-opaque objects on chest roentgenograms. Six patients required second extraction procedures due to the retained foreign bodies. Neither serious complications nor deaths occurred in these patients due to the foreign body inhalation. CONCLUSION: Early diagnosis and management is essential in children with foreign bodies in the airways to prevent morbidity or death. Small materials or food bits should be kept far away from young child.

Bronchi↗

PubMed1993

[A new procedure for removal of foreign bodies in the area of the head].

Identification and extraction of penetrating cranial foreign bodies can cause problems in some cases. Small fragments localized deep in the orbit or cerebrum can be especially hard to detect. Severe bleeding and traumatized anatomy can make orientation difficult. We used a new localizing device, computer-assisted surgery (CAS), to good effect in six such cases. CAS is a localizing technique designed to assist the head surgeon during surgery, providing real-time position information. The method is based upon a three-dimensional volume model of the patient's skull generated by preceding computed tomography imaging procedures (CT or MRI). Intraoperative correlation of a 3D-model and the patient's skull allows for real-time position display of a surgical instrument on the monitor screen. Thereby the surgeon is able to localize even small foreign bodies without extensive exploration. In the case of multiple foreign bodies the surgeon calls up a simple documentation facility recording which of the visible fragments have already been extracted. We successfully used the system for extraction of orbital foreign bodies in four and intracerebral foreign bodies in two cases. In a 4-year-old child with gunshot injury the bullet was located in the precentral region and was easily extracted with the CAS system. In a 21-year-old man 39 glass fragments were extracted from the left orbit. In a 36-year-old man a bone fragment was dislocated to the apex of the orbit directly under the optic nerve. Location and extraction were achieved without damage to the orbital structures with the help of the CAS system.

Adult↗

PubMed1998

Evaluation of intraocular foreign bodies by spiral computed tomography and multiplanar reconstruction.

OBJECTIVE: This study aimed to evaluate the ability of spiral computed tomography (CT) and multiplanar reconstruction in the assessment of intraocular foreign bodies. DESIGN: The study design was experimental. MATERIAL: Three foreign bodies (metal, glass, and plastic) implanted into the globe of a cadaveric head were studied. INTERVENTION: Spiral CT in the axial plane was used. Beam collimation and table increment were both 3 mm, whereby overlapping axial slices were reconstructed at 1-mm intervals. The data were transferred to a workstation, and reconstructions in the coronal and sagittal plane were performed. MAIN OUTCOME MEASURES: The ability to detect and evaluate localization, shape, and size of the foreign bodies in all three imaging planes was assessed. RESULTS: All foreign bodies were detected in the axial and in both reconstructed planes. The metal foreign body caused imaging artifacts in the axial plane. In the reconstructed planes. imaging artifacts were less severe, and evaluation of localization and shape was improved. Glass and plastic foreign bodies were well seen in all planes, and shape and localization were well demonstrated. Appropriate window settings improved determination of size of the different foreign bodies. CONCLUSIONS: Spiral CT of the orbit and multiplanar reconstruction offers a promising tool for evaluation of intraocular foreign bodies. Advantages of spiral CT compared to conventional CT are data acquisition in only one axial plane; shortened examination time; reduced radiation exposure; reduced imaging artifacts from metallic foreign bodies in the reconstructed planes; and demonstration of localization, shape, and size of the foreign body in three imaging planes.

Eye Foreign Bodies↗

PubMed2002

[Imaging of a foreign body in the submandibular space].

Foreign bodies in the oral cavity are infrequent in children. In spite of a negative clinical exploration, US and CT showed the suction cup of a rubber-tipped dart in the left submandibular space of a 3 year-old child. Surgery could be guided by these investigations.

Abscess↗

PubMed2003

Value of power Doppler imaging and the hypoechoic halo in the sonographic detection of foreign bodies: correlation with histopathologic findings.

OBJECTIVE: To present the power Doppler findings and evaluate the hypoechoic rim in increasing the conspicuity of foreign bodies detected on sonography and to correlate the sonographic and histopathologic findings. METHODS: Between 1998 and 2001, all sonographic examinations for evaluation of possible foreign bodies were reviewed retrospectively. Patients who had surgical exploration and pathologic evaluation were included in the study. Gray scale and power Doppler examinations were performed with high-frequency linear array transducers. Histologic evaluation was then correlated with the sonographic findings. RESULTS: Twenty-five patients were referred for evaluation of possible foreign bodies. Twelve patients underwent surgery and had pathologic correlation. Sonography had sensitivity of 92% for the overall detection of foreign bodies. There were 2 false-positive findings in which discrete foreign bodies were not seen at gross inspection, but inflammation and scar tissue were present at histologic examination. Pathologic findings were thought to represent chronic foreign body reactions. Hypervascularity immediately surrounding the foreign bodies was shown on power Doppler imaging in all cases, correlating with granulation tissue and neovascularity on pathologic examinations. The hypoechoic halo was shown in all but 2 cases and correlated with fibrinous exudate, granulation tissue, and collagenous capsule formation. CONCLUSIONS: Sonography is an effective and sensitive tool for the detection of soft tissue foreign bodies. The use of power Doppler imaging may aid in detection of possible foreign bodies by increasing the conspicuity of both the hypoechoic halo and the foreign body itself.

Adolescent↗

PubMedDate not supplied

[Extraction of foreign bodies in the esophagus. Experience in 215 cases].

OBJECTIVE: To analyze our experience in management of foreign bodies in esophagus. BACKGROUND: At present, the flexible endoscope is usually the instrument of choice for foreign bodies of the esophagus. The rigid endoscope is less expensive, but the advantages of the flexible endoscope are numerous. MATERIAL, METHODS: Management of 215 foreign bodies of esophagus are reported. The flexible endoscope was used to manage these foreign bodies. The patients comprised 151 children and 64 adults. RESULTS: In children, coins were the commonest foreign bodies (119 cases), whereas in adults, the commonest cause was impacted meat (35 cases). Two hundred fourteen foreign bodies (99.5%) were successfully managed endoscopically. The surgery rate was 0.5%. There was no morbidity or mortality. In fifteen adults we diagnosed significant associated medical conditions: benign esophageal stricture in eleven, esophago-gastric junction carcinoma in one, two patients with esophageal motility disorders and remaining with Plummer-Vinson Syndrome. CONCLUSIONS: The forward-viewing flexible endoscope has became the instrument of choice in diagnosis and management of esophageal foreign bodies.

Adolescent↗