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PubMed2006

[Foreign body in tracheobronchial diagnosed as pneumonia from children].

OBJECTIVE: To improve the effects of diagnosis and therapy in patients with tracheobronchial foreign body who were diagnosed as pneumonia and to summarize the experience. METHOD: Foreign bodies in the trachea and bronchi in one hundred and seventy-two children were removed in our hospital from 1995. 2 to 2005. 2, of them 67 cases were diagnosed as pneumonia. RESULT: Our experience showed that the foreign body in tracheobronchial had an increasing tendency in recent years, and it had a descendant tendency that it be diagnosed as pneumonia. The time of the patients suffered from foreign bodies was from 5 days to 8 months, and the children under 2 years accounted for 80.6%. The most common foreign body was peanuts, accounting for 70.4%. All the foreign bodies were removed by rigid bronchoscopy. The successful rate of removal at first time was 63 cases, accounting for 94%. The reason of failure at first time was anesthesia (2 cases). There was no case of death. No cases underwent tracheotomy. CONCLUSION: The foreign body in tracheobronchial can be easily diagnosed as pneumonia. We should reduce the rate of erroneous diagnosis. Rigid bronchoscopy for removing foreign bodies under general anesthesia is still the main measure at present.

Bronchi↗

PubMed2004

[Discussion on diagnosis and treatment of 12 patients with intrathoracic oesophageal perforation caused by foreign body].

OBJECTIVE: To explore the countermeasure to reduce fatality in patients with intrathoracic oesophageal perforation caused by foreign body. METHOD: Exploratory pleuracotomy were operated on all the 12 cases with intrathoracic esophageal perforation caused by foreign body. According to the different pathological morbids, one of following surgical procedures was operated: 1. esophagoscopy was used to fetch the foreign body and the oesophageal perforation was repaired (3 cases), 2. esophagotomy was adopted to fetch the foreign body and to had the oesophageal a drainage using "T" tube (5 cases), 3. esophagotomy was adopted to fetch the foreign body and to had the oesophageal a drainage using "T" tube as well jejunostomy (3 cases). Occlusive drainage were used on all the cases and pleuroclysis with flagyl soloution and normal saline were used on some cases. RESULT: Four of 12 cases (33.3%) were cured, the others (66.7%) died, among them 7 cases died of breaks of thoracaorta and hematorrhoea afterwards. CONCLUSION: An esophagoscopy to fetch the foreign body, the pleuracotomy to protect thoracaorta in time, preventing infection and hematorrhoea post-operation are keys in reduce the fatality in patients with intrathoracic oesophageal perforation caused by foreign body.

Adult↗

PubMed1984

The diagnosis of foreign body aspiration in childhood.

A 10-year experience with the treatment of 157 children for foreign body aspiration is reviewed. The object of the review is to examine diagnostic accuracy and to differentiate between the clinical features of patients diagnosed early (within 24 hours) and late (beyond 24 hours) following the onset of symptoms. Diagnostic accuracy was found to be high. In 83.5% of patients the combination of clinical and radiologic signs correctly disclosed the site of foreign bodies within the tracheobronchial tree. In 80% of patients there was a history of witnessed choking, however, only 46% were diagnosed early. The diagnostic triad of wheezing, coughing, and decreased breath sounds was more common in late diagnoses (47%) than in early diagnoses (31%). The triad was incomplete in 61% of all patients. Radiologic findings were normal in one third of the patients diagnosed early and revealed atelectasis or consolidation in one half of those diagnosed late. With early diagnosis endobronchial inflammation was absent in 56% of patients compared with severe inflammation in 36% of late diagnoses. Right-side foreign bodies were more common (56%) and were diagnosed early 50% of the time compared with left-side foreign bodies which were diagnosed early only 35% of the time. Two thirds of tracheal and bilateral foreign bodies were diagnosed early compared with only one third of peripheral foreign bodies. This review indicates that most children with foreign body aspiration were diagnosed accurately. Although diagnoses can be made early; more than half of the patients were diagnosed late when there was evidence of significant airway obstruction.(ABSTRACT TRUNCATED AT 250 WORDS)

Bronchi↗

PubMed2002

An unusual foreign body in the esophagus: report of a case.

Foreign body ingestion occurs commonly in children and in specific high-risk groups of adults. Foreign bodies in the gastrointestinal tract can result in serious complications depending on the size and shape of the ingested object. This report presents a patient with an unusual foreign body in the esophagus.

Adult↗

PubMed1983

A safe alternative to endoscopic removal of blunt esophageal foreign bodies.

An alternative to the endoscopic removal of blunt esophageal foreign bodies is proposed. A Foley catheter is inserted into the esophagus and its balloon is utilized to extract the foreign body under fluoroscopic control. Experience with over 100 children with blunt esophageal foreign bodies has led us to conclude that the technique is easily performed, safe, and highly cost-effective. To protect the esophagus, care must be taken to ensure that the foreign body has no sharp or ragged edges, that it has been in place less than two weeks, and that there is no underlying esophageal disease. To ensure that no compromise of the airway occurs, several safeguards are employed, including orally inserting and withdrawing the catheter, monitoring the procedure fluoroscopically, and placing the patient in a prone oblique position with the fluoroscopic table steeply inverted.

Catheterization↗

PubMedDate not supplied

Retained foreign bodies following intra-abdominal surgery.

BACKGROUND/AIMS: A retained foreign body in the abdominal cavity following surgery is a continuing problem. Despite precautions, the incidence is grossly underestimated. The purpose of this study is to report the result of surgical treatment on 24 consecutive cases treated by the authors during a 10-year period. METHODOLOGY: All consecutive patients with a confirmed diagnosis of foreign body after abdominal surgery were studied. Data collected included the patients' age and sex, the initial diagnosis and primary surgical treatment, period of time between the probable causative operation and the definitive treatment, nature of the foreign body, clinical presentation, predisposing factors, and diagnosis and management; morbidity and mortality are presented as well as guidelines for prevention. RESULTS: All patients were symptomatic. Eight patients presented as intraabdominal sepsis (4 with intestinal obstruction, 4 with entero- or colo-cutaneous fistula), non-specified abdominal pain in 3, persistent sinus and granuloma in 2, abdominal palpable mass in another 2 cases, and 1 patient with vaginal discharge. The diagnosis was established pre-operatively in 15 cases by means of plain abdominal radiographs, ultrasound or computed tomography (CT) scan. Morbidity was observed in 50% and the rate of surgical reinterventions because of fistulas or residual sepsis in 18%. The mortality was almost 10%. CONCLUSIONS: The clinical manifestations ranged from mild abdominal pain, palpable mass, persistent drainage and granuloma to intestinal obstruction secondary to adhesions or occlusion of the intestinal lumen because of migration of the foreign body and intraabdominal sepsis. Despite this being a rare situation, when it happens it presents as a very serious problem to patients with high rates of morbidity and mortality. Prevention remains the key to the problem.

Abdomen↗

PubMed1984

Foreign-body pneumonitis associated with tracheostomy.

Foreign-body aspiration in adults is usually associated with asphyxiation after aspiration of food particles. The present report documents a case of foreign-body aspiration that resulted from poor tracheostomy care in an alcoholic patient, and caused fulminant pneumonitis.

Bronchi↗

PubMed1991

The management of ingested foreign bodies in the upper digestive tract: a retrospective study of 49 cases.

Forty-nine cases of accidental foreign body ingestion treated in our unit were reviewed. Fish bones were the commonest foreign body ingested by adults while coins and pins accounted for most cases in the paediatric age group. All except one patient had endoscopy performed, majority with flexible endoscope. Foreign bodies were detected and successfully removed endoscopically in 23 patients except one. In another 12 patients, foreign bodies were demonstrated by chest X-ray or Barium meal but at the time of endoscopy, they had passed beyond the reach of the endoscope. For the remaining 13 patients, despite having a history of foreign body ingestion and retrosternal pain, subsequent investigation failed to demonstrate the foreign bodies. Barium contrast studies were performed in 31 cases, with 5 false negative and 2 possible false positive findings. There were 2 serious complications related to foreign body ingestion, one had empyema thoracis and another died of massive bleeding due to esophageal carotid fistula.

Adolescent↗

PubMed1998

Pitfalls in the diagnosis of aerodigestive tract foreign bodies.

In the young child, particularly those between the ages of 1 and 3 years, aerodigestive tract foreign bodies continue to be a significant problem. Early diagnosis and treatment can decrease morbidity and length of hospital stay in these children. Three cases of delayed diagnosis in children with bronchial (2) and esophageal (1) foreign bodies are presented. In dealing with young children it is important to maintain a high clinical suspicion of a foreign body and to perform a detailed history and physical examination. Options in radiographic analysis of the patient with a suspected foreign body, probable locations of the foreign body, and the likelihood of definitive radiographic findings are discussed. Importantly, a negative radiographic analysis does not rule out the presence of an aerodigestive tract foreign body. Two flow charts for the evaluation of patients who have possibly ingested or inhaled a foreign body are presented to aid the primary care physician in diagnosis.

Bronchography↗

PubMed1999

Siderosis bulbi resulting from an intralenticular foreign body.

PURPOSE: To report a case of siderosis bulbi that resulted from a small intralenticular foreign body. METHOD: Case report. RESULTS: A 36-year-old man with normal visual acuity and a peripheral intralenticular iron foreign body in the left eye was treated conservatively. Nine weeks after the injury, he had ocular signs of siderosis bulbi, with changes in the electroretinogram. A clear lens aspiration with removal of the foreign body was performed. After removal of the iron foreign body, no progression or regression of the ocular signs of siderosis bulbi has occurred, and the electroretinogram has not changed over a 2-year period. CONCLUSIONS: Even in the presence of good vision, a patient with an intralenticular ferrous foreign body should be followed closely, and the foreign body should be removed before irreversible siderosis bulbi occurs.

Adult↗

PubMed1991

Foreign bodies in the gastro-intestinal tract.

Between 1971 and 1990, 70 patients with foreign bodies in the gastro-intestinal tract were admitted to our service. There were 35 children and 35 adults. Foreign bodies were found in the pharynx and the oesophagus in 22 patients, with 1 perforation; and in the stomach and intestines in 27, with 14 perforations. Fifteen foreign bodies were swallowed and defecated, 6 were inserted into the rectum. Coins were found in 8 patients, toys in 3, pins and needles in 6, chicken bones and fish bones in 15, and toothpicks, shaving blades, cutlery, dentures, plastic bag containing cocaine, parts of a foam rubber mattress and other items in the remainder. Foreign bodies retained in the oesophagus must be removed promptly lest obstruction and perforation occur. Many foreign bodies that have passed the oesophagus progress uneventfully to defaecation. Others become retained and should be removed. If retained in the stomach, endoscopic removal may be attempted before resorting to a laparotomy. Perforation is an urgent indication for operation. Those patients inclined to swallow foreign bodies intentionally and those who insert items into the rectum should undergo psychiatric evaluation.

Adolescent↗

PubMed2006

Upper GI foreign body: an adult urban emergency hospital experience.

BACKGROUND: The efficacy of flexible endoscopy by a single endoscopist in the therapy of foreign body ingestion was assessed at an adult urban emergency hospital. METHODS: Fifty-one adult patients with upper GI foreign body ingestion treated at Detroit Receiving Hospital from 1988 to 2004 were identified. Endoscopic and hospital medical records were reviewed to evaluate etiology, treatment, and outcomes for these patients. RESULTS: The etiology was related to eating in 38(75%) patients, most of whom were eating meat; phytobezoars were seen in four, often after previous upper GI surgery. True foreign bodies were found in 13 patients (25%) and included a screwdriver, a ballpoint pen, spoons, coat hanger pieces, batteries, and latex gloves. Dysphagia was the most common symptom (75%); pain was common in patients with true foreign bodies, and 62% of this group had psychiatric difficulties or problems with drug abuse. Nearly 80% of the food-related group had post-surgical or other upper GI pathology. One patient had an esophageal stricture secondary to previous Sengstaken-Blakemore tube insertion. Flexible endoscopy was successful in extracting the foreign body in almost all (49) patients, with snare extraction the most common therapeutic modality. Both failures were of true foreign bodies that could not be safely removed. In one of these cases, it became necessary to employ the gallstone lithotripter, and the overtube was required in patients with metallic or sharp foreign bodies to protect the upper aerodigestive structures. CONCLUSIONS: Most upper GI foreign bodies are related to food impaction, with meat most often found. Underlying pathology is the rule and should be dealt with immediately. Flexible endoscopy is the treatment of choice for upper GI foreign body removal with near perfect success.

Adult↗

PubMed2000

[Intraocular foreign bodies in the posterior eye segment].

BACKGROUND: A penetrating eye injury due to an intraocular foreign body (IOFB) may result in a poor vision and even in loss of the eye. A proper analysis of the cause of injury and of the injured eye enables a correct decision to be made concerning timing and method to be used not only for foreign body removal but also concerning of all sight saving surgical procedures. PATIENTS AND METHODS: Over the years 1989-1993, 51 patients with an IOFB in the posterior segment of the eye were treated at the Department of Ophthalmology of the Comenius University in Bratislava. One patient was lost from the long-term observation and in two patients was an intraocular foreign body not removed. We evaluate results in 48 patients. The operative techniques used by foreign body removal and by reoperations are mentioned. The occurrence of peroperative and postoperative complications and the final anatomical and functional results are evaluated. An average follow-up period was 40.7 months. The value of the following prognostic factors was considered in relation to the final visual acuity: size and location of the laceration of the eye, size of IOFB and time of IOFB removal. The statistical significance was tested by Chí-square. Fischer's coefficient for tetrachoric tables was used for the calculation of power of dependence. RESULTS: The foreign body was removed from 64.6% of the eyes after pars-plana vitrectomy. Foreign body caused serious damage of the intraocular structures in 37.5% of the eyes. The poor anatomical result was achieved in 18 (37.5%) and good in 30 eyes (62.5%). In twelve eyes (25%) was implanted an IOL. The final visual acuity of 6/9-6/6 was achieved in 18 (37.5%) and visual acuity lower than 2/60 was recorded in 21 (43.7%) of the eyes. The prediction of bad visual acuity (lower than 2/60) was significant related to: all lacerations except of corneal wounds smaller than 4 mm, IOFB size exceeding 3 x 2 mm. CONCLUSIONS: Management of retained intraocular foreign bodies should be individual and is dependent on the extent of the initial injury and the characteristics and location of the IOFB. The final outcome depends mostly on the extent of the primary injury and of the occurrence of the peroperative and postoperative complications.

Adolescent↗

PubMed1985

Foreign body injuries of the hand.

Retained foreign bodies and puncture wounds are common injuries to the hand. A detailed history and physical examination prior to treatment are essential. If surgical removal of a foreign body or surgical exploration of a puncture wound is decided upon, it must be performed under adequate anesthesia and tourniquet control.

Emergencies↗

PubMed2003

Comparison of direct vision and video imaging during bronchoscopy for pediatric airway foreign bodies.

Rigid ventilation bronchoscopy is a most useful means of detecting and removing foreign bodies in the airway. We performed a retrospective study of 114 children who had undergone such a procedure during a 12-year period. During bronchoscopy, 48 of these patients had been examined under direct vision and 66 by videotape recording. We found that the positive rate on first-look direct vision was 93.8% and the positive rate on first-look video imaging was 89.4%. The lower positive rate during the first-look examination by video imaging might be attributable to the facts that it is safer and that it provides a better visual field, which can encourage operators to choose video ventilation bronchoscopy, either as a diagnostic or therapeutic tool. In addition, three foreign-body-negative patients in the direct-vision group under-went a second procedure, and a foreign body was found in all three. Only one of the video-imaging patients under-went a second procedure, and no foreign body was found. The difference in the positive rates after the second procedure was statistically significant (p < 0.05). This might be attributable to the higher success rate with video imaging following the first procedure, which significantly reduced the need for a second look and the possibility of overlooked or residual foreign bodies. The condition of the mucosa postprocedurally was described in every case after video imaging but after only 41.7% of the direct-vision cases--a statistically significant difference (p < 0.001). Video imaging provides the physician with a clear, magnified view of the area under examination. It allows for later review of the videotape when necessary, and it reduces the risk that residual foreign-body material will remain in the airway.

Bronchoscopy↗

PubMed1996

[Tracheobronchial foreign body in children. Is anamnesis alone enough to indicate tracheobronchoscopy?].

From 1989-1993 we performed rigid bronchoscopies in 86 children in whom foreign body aspirations were suspected. In 72 cases, foreign bodies were identified in the tracheobronchial tree. In the remaining 14, no foreign body was found. Boys outnumbered girls. The most common type of foreign body was a peanut. The predilection of the foreign body was to fall into the right main bronchus. If the history indicated foreign body aspiration, a chest x-ray was not found to be necessary except for forensic interest.

Bronchi↗

PubMed1984

Foreign bodies in the orbit. Review of 20 cases.

The interdisciplinary problem of foreign bodies in the orbit is presented on the basis of personal experience in the treatment of 20 patients. These foreign bodies often cause severe injuries to the organ of sight and even threaten life. Early removal of a foreign body is technically easy, prevents infection and facilitates anatomical reconstruction of the damaged structures. Only in exceptional cases may removal be avoided. Of the 20 patients treated, only 9 were early admissions to our Department where the foreign body was removed and primary surgery performed. The others were admitted after some delay, which made correct treatment more difficult. Data on the injuries found in 20 patients, surgical technique, follow up and results are presented. Total recovery was obtained in 7 patients, improvement in vision in 2, enucleation of the globe was necessary in 5, and in 2 loss of vision was a sequel to a lesion of the optic nerve. Depending on the indications, reconstructive plastic surgery and prosthetic rehabilitation gave good aesthetic results. The necessity for interdisciplinary collaboration in the diagnosis and treatment of patients with foreign bodies in the orbit is emphasized.

Adolescent↗

PubMed1985

The role of rigid endoscopy in foreign body management.

The high incidence of foreign body aspiration among children is a product of their natural curiosity, the lack of posterior dentition, and a startle response which permits entry of solids into the larynx. Proper diagnostic protocols and procedures for extraction are outlined. In most cases, endoscopy is indicated when a foreign body is present.

Bronchi↗