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Accidental foreign body ingestion occasionally occurs in adults and is especially likely in those wearing dentures. While most foreign bodies pass readily through the gastrointestinal tract, complications such perforation, abscess, obstruction and hemorrhage occasionally occur. Radiography may be of help in detecting and localizing these foreign bodies and in determining complications caused by them.
Oropharyngeal foreign bodies are not infrequently encountered in dogs and are usually associated with dysphagia. In this case an oropharyngeal foreign body resulted in nervous signs as a result of penetration of the cranial cavity and the development of a brain abscess.
A case report and the management of a 10-year-old girl who had inhaled a foreign body into the right intermediate bronchus at some unknown (but certainly not recent) time previously is given. A stricture at the site of the impaction of the foreign body was found. The excision of the stricture and repair of the bronchus with pericardium is described together with a 3-year follow-up report. The diagnosis and immediate management of foreign bodies in the bronchus are discussed and the importance of differentiating organic and non-organic foreign bodies is stressed. The management of bronchial strictures is discussed as is the result obtained in the above reported case.
Foreign bodies may become impacted because of congenital or acquired narrowing of the gastrointestinal tract or owing to unusual physical characteristics of the ingested material. Active intervention is necessary when impaction is complicated by intestinal obstruction or perforation or when the foreign body is composed of a toxic substance.
Aspiration of foreign bodies into the bronchial lumen continues to be a potential hazard especially in children. Bronchiectasis, lung abscesses, emphysema, or pleuropulmonary fistula may develop if untreated. The treatment of choice is extraction by bronchoscopy under general anesthesia. Our patient simultaneously aspirated two squirrel vertebrae, neither of which produced obstruction. The patient's symptoms were due mainly to the partial obstruction secondary to the formation of granulation tissue. One aspirated vertebra was extracted during the diagnostic fiberoptic bronchoscopy, but a rigid Jackson bronchoscope was necessary to remove the other foreign body. The patient has since been asymptomatic.
Corneal foreign bodies of varied nature have been reported, however, vegetable foreign bodies in the cornea have seldom been described. A case is reported of a male from the Marshall Islands in the Pacific who retained a number of deep corneal foreign bodies after being struck in the eye by a piece of a coconut shell. The foreign bodies caused considerable inflammation which ceased after they were exposed and removed by means of a centrally based lamellar corneal flap. The patient's eye has remained quiet for 4 months following removal of the foreign bodies.
A retained intraocular foreign body can cause progressive damage to an eye if not removed. Such removal, whether done with a magnet or with a vitrectomy instrument, is often more successful if surgery is not delayed excessively. A two-instrument intraocular approach for resistant foreign bodies can sometimes be avoided in favor of a simpler one-instrument technique if surgery can be performed in the first few weeks.
Foreign bodies and alkali burns in the trachea and esophagus are potentially fatal. Some camera batteries contain 45% potassium hydroxide electrolyte which can leak and cause liquification necrosis upon tissue contact. This report describes a case of an alkali battery foreign body in the esophagus with a subsequent fatal course which was masked by steroid therapy. A discussion of corrosive burns of the esophagus, their etiology, clinical course and pathology is presented.
An unusual case of orbital foreign body is presented. The foreign body had penetrated through a small wound of the upper lid and was asymtomatic for two years. Proptosis due to hyperostosis of the orbital roof was a presenting symptom of the foreign body.
Inhalation of foreign bodies is a major cause of accidental death during childhood. Aspiration of foreign bodies is common in children aged 1 to 3 years, especially in boys. A past history of foreign body aspiration is itself an indication for bronchoscopic examination of the airways, because some children with aspirated foreign bodies are without symptoms and chest x-ray films may not show abnormalities. Bronchoscopic removal of the foreign bodies requires close communication between the anesthesiologist and the endoscopist. Forgotten foreign bodies in the airways cause chronic pulmonary infections, allergic asthma, bronchiectatic changes, and lung abscess. Foreign bodies that cannot be grasped by bronchoscopic forceps should be removed by thoracotomy and bronchotomy. This report describes our experience in 500 children with suspected foreign body inhalation. We routinely use prednisolone, 1 to 2 mg. per kilogram, and nebulization just after bronchoscopic examination of the airways. This medication greatly diminishes the rate of postbronchoscopic complications such as laryngeal edema, which require tracheostomy. In our series of 500 case, the incidence of postbronchoscopic tracheostomy is 1.4 per cent and the total mortality rate is 1.8 per cent.
We examined two patients, each with a foreign body composed of smokeless gunpowder in the vitreous body of one eye and multiple similar foreign bodies in the eyelids, conjunctiva, and cornea. No damage to the eye was caused by the retention of these foreign bodies for over three years in one case and two years in the other. The composition of these foreign bodies appeared to be nontoxic to the eye and thus, extraction of the foreign bodies did not seem to be necessary.
Intrabronchial foreign bodies are occasionally encountered in adults but most available information in humans consists only of reports evaluating one or two cases. We surveyed our experience and found seven patients with intrabronchial foreign bodies who had been examined with the flexible fiberoptic bronchoscope, six of whom were managed successfully. Nine cases have been identified in the literature. Although there were no major complications in either our cases or those in the literature, several problems were identified which under other circumstances could have caused significant complications. We assessed all of these cases for situations which presented potential risk to the patient. These risks were grouped into the following problem categories: 1. selection of appropriate bronchoscope, 2. availability of appropriate instruments, 3. control of the foreign body, and 4. unexpected foreign bodies. Endoscopists planning to use the FFB in foreign body removal should be aware of the problems and hazards which may ensue if improperly managed, and should attempt to gain experience either in the animal laboratory or in models prior to approaching patients with foreign bodies with the flexible fiberoptic bronchoscope.
Out of 393 intraocular foreign bodies (1961-1975) 361 were magnetically removed and 32 non-magnetically (copper 7,brass,2,lead 5, glass 10, stone 3, wood 4 and plastic 1).60% of the foreign bodies were caused by hammer and chisel injuries.73 foreign bodies were diagnosed too late, in 71 cases no x-ray was made. The incidence of complications (infection, siderosis, retinal detachment was considerably increased where the foreign bodies were removed late. From the 73 foreign bodies (18.5%) the patient did not consult a doctor in 37 cases because of "insignificance". 4 times the family doctor was consulted, who treated the patient symptomatically. In 4 cases occurring in the weekend no eye-specialist could be ostensibly found. In 26 cases the ophthalmologist performed no x-ray control, and small foreign bodies were twice described as "x-ray plate artefacts" from the roentgen specialist. It must be an absolute rule in the eye-doctor's practice that every injury received while working with metals necessitates an x-ray control!
Localization of intraocular and orbital foreign bodies with computerized tomography (CT) was evaluated in eight patients and an experimental model. CT examination was particularly helpful in cases with multiple similar foreign bodies and in identifying foreign bodies too radiolucent to be seen by standard skull x-rays. Limitations of CT technique included insufficient resolution to localize a foreign body immediately adjacent to the sclera as either intraocular or extraocular, and obscuration of a small foreign body by artifacts from an adjacent, larger foreign body.
Six cases of cardiovascular foreign bodies secondary to trauma are presented. The various modes of entry and travel within the vascular are reviewed. Routine radiographic examination and angiography are shown to be the most useful techniques in defining the location and subsequent course of the foreign body in the vascular system.
Foreign body granulomas of the ear are seldom looked for, but probably common occurrences. They may be due to exogenous or endogenous material which became implanted in the course of trauma or treatment in the external or middle ear. They provoke inflammation which may be subclinical, clinical, or masked by concurrent infection. They can aggravate chronic infection, initiate acute local inflammation, or jeopardize surgical success. Histologically, the foreign material is seen lying freely or partially encapsulated within chronic inflammatory tissue, in close proximity to foreign body giant cells. Medical treatment can only succeed when the offending agent is surgically removed.
Among 91 children with airway foreign bodies there were 10 with radiopaque foreign bodies. Seventy-four of the cases of non-opaque foreign bodies were unilateral. Seventeen had pulmonary consolidation or loss of volume and 33 had a unilateral hyperlucent lung. In 18 of the latter there was unilateral overinflation, but in 15 the hyperlucency was the result of pulmonary vasoconstriction. Twenty-three patients had normal routine inspiration radiographs; in 14 of these fluoroscopy or expiration films were obtained and air-trapping was demonstrated in 13. In twenty-three of the children the diagnosis was delayed. Fifteen of these had normal chest radiographs or unilateral hyperlucency alone. Since normal inspiration chest radiographs are frequently seen in cases of airway foreign bodies even when the diagnosis is delayed, it is strongly recommended that fluoroscopy or expiration films be obtained in any patient where the diagnosis is in doubt.
Twenty-two cases of probable esophageal or pharyngeal foreign body seen at an emergency service were studied retrospectively, using 15 predetermined factors chosen to detect or anticipate the acute consequences of foreign body ingestion. Three findings were particularly predictive: 1) foreign body visualized directly or on plain x-ray films; 2) hypersalivation; 3) obstruction or foreign body image in the esophagus on barium swallow. No patient with none of these three abnormal findings, even in the presence of localized pain increased by swallowing, received further treatment, and no complications developed. All patients with any one of these three findings underwent direct foreign body removal (four cases) or esophagoscopy (11 cases). Five esophageal foreign bodies passed spontaneously into the stomach before esophagoscopy; four foreign bodies were removed, and two esophagi were abnormal (stricture, myasthenia gravis). In two cases no foreign body was found. Hypersalivation was the only finding always associated with an abnormal esophagoscopy. Particular attention must be paid to the interpretation of plain x-ray films, with regard to probable foreign body location at the cricopharyngeal constriction and to indirect signs such as fluid levels, soft tissue swelling, free air, if small foreign bodies are not to be missed.