Tongue-tied: a case of magnetic balls constricting the lingual frenum

The health risks associated with aspiration and ingestion of foreign bodies in children are well known. The increased availability of magnetic toys have added to these risks. A 7-year-old girl presented at the Department of Maxillofacial and Oral Surgery at the University of Pretoria Oral and Dental Hospital with a complaint of pain under the tongue. Examination revealed that magnetic balls had been lodged on either side of the lingual frenum. The patient experienced pain and was unable to dislodge the magnets. This case report documents patient presentation and management and concludes with a brief discussion of potential complications associated with the oral intake of magnets. Though multiple cases documenting the complications associated with ingestion of magnets have been reported, reports of primary oral complications are scant. This case contributes to existing evidence for the dangers associated with high strength magnets used as toys by children.

Impacted Pen Cap in Pharynx Leading to Pharyngojugular and Pharyngocutaneous Fistula in an Infant

Foreign body-related injuries to aerodigestive tract and large neck vessels are rare but can be catastrophic if not identified and treated in time. We report an infant with impacted foreign body (pen cap) in the pharynx which went unnoticed until it led to the formation of a fistula with the internal jugular vein (IJV) and massive hemorrhage. His course was complicated by ventilator-associated pneumonia, air leaks, shock, acute kidney injury, prolonged mechanical ventilation, and pharyngocutaneous fistula. The surgical removal of foreign body, ligation of IJV, closure of pharyngeal defect, and supportive treatment in pediatric intensive care unit led to a favorable outcome. This is the first case of pharyngojugular and pharyngocutaneous fistula following an impacted foreign body in the pharynx.

Edible Oils Attenuate Button Battery-Induced Injury in Porcine Esophageal Segments

Objective: The objective of the study is to test whether the use of edible oil might be an early treatment strategy for reducing button battery-induced esophageal injury. Methods: A button battery was inserted into esophageal segments collected from pigs. The esophageal segments were randomly allotted to one of the following six treatments: (1) untreated (nothing injected), (2) lemon juice, (3) orange juice, (4) colza oil, (5) peanut oil, and (6) olive oil. Every hour, the battery discharge and the pH value were measured in the esophageal tissue. After treatment for 6 h, the residual voltage of the battery was measured and the esophageal tissue was processed with H&E staining. Results: In esophageal segments of the untreated group, a large area of the mucous membrane was severely eroded. Partial erosion was observed in esophageal tissues treated with either lemon juice or orange juice. Furthermore, the esophageal tissues were basically intact, had little damage when treated with oils. The highest extra-esophageal discharge voltage was recorded in the untreated group, a medium amount of discharge voltage was recorded in the lemon juice and orange juice groups, and the lowest discharge voltage was recorded in all the edible oils groups. Conclusions: Edible oils immersed the battery, reduced the surrounding electrolysis, and thus attenuated battery discharge. As a result, treatment with edible oils attenuated the pH alkalization and tissue damage in button battery injury of pig esophageal segments. These results indicate that edible oils might be used in the treatment of button battery ingestion.

How Can We Do Better? Learning From 617 Pediatric Patients With Airway Foreign Bodies Over a 2-Year Period in an Asian Population

Background: Foreign body (FB) in the pediatric airway is a prevailing and crucial emergency with presenting symptoms often overlapping with other common pediatric conditions. There are limited number of large cohort studies in an Asian population which demonstrate the diversity of symptoms, investigations which will aid in obtaining the diagnosis, and management. Using this large cohort, we aim to evaluate the type and location, clinical presentations and outcomes of medical management related to pediatric airway FB in an Asian society. Methods: This is a retrospective study of all airway FB treated in Kunming Children's Hospital, China from February 2016 to June 2019. Six hundred and thirty-two clinical and operative records of all airway FB were retrieved and reviewed from the hospital's central electronic medical records. A total of 617 patients were included in our study. Results: The age ranged from 4 months to 12 years (mean = 1.74 years). The duration of symptoms ranged from 1 h to 605 days, with the diagnosis established at an average 9.16 days. Almost all had multiple symptoms, most commonly cough (98.5%) followed by noisy breathing (98.2%). Majority of the FBs (95.5%) were organic and the rest inorganic. Of the organic FBs, peanut was the most common (31.6%), followed by walnut (13.3%) and sunflower seeds (9.2%). Comparatively, 80.8% of the organic FBs were retrieved incomplete while 85.7% of the inorganic FBs were completely intact. Multiple FBs were noted in 43.3% of the patients, with 2.4% of them in different locations. Conclusions: Airway FB can be easily missed with resultant delay in diagnosis. In an Asian population, walnut and sunflower/pumpkin seeds feature more prominently compared to Western populations. Sunflower seed FBs tend to present earlier and are found intact in the trachea. Rigid bronchoscopy is the most common technique used to remove such FBs and pulmonary-related complications post-operatively, though rare, are the most common adverse outcomes. Preventive strategies targeting the appropriate age group and this type of FB may be useful in an Asian population.

Computer-assisted navigation for removal of the foreign body in the lower jaw with a mandible reference frame: A case report

RATIONALE

In surgery of the lower jaw, the application of computer-assisted navigation is complicated and challenging due to the mobile nature of the mandible. In this study, we presented a computer-assisted navigation surgery for removal of the foreign body in the lower jaw with a mandible reference frame, basing on the strategy that the mandible is independent as an entity.

PATIENT CONCERNS

A 41-year-old male patient, identified as having a broken fissure bur that displaced into the mandibular lingual soft tissue, was referred to our department. The fissure bur broke accidentally and then displaced into the soft tissue when the patient underwent extraction of the left mandibular impacted third molar.

DIAGNOSIS

A metallic foreign body in the left lower jaw, confirmed by orthopantomography.

INTERVENTIONS

A computer-assisted navigation surgery with a customized mandible reference frame.

OUTCOMES

The broken bur was removed successfully. Satisfactory wound healing and mouth opening was achieved, without postoperative complications.

LESSONS

Surgeons should be alert to the presence of broken bur in the lower jaw and avoid its displacement into deep facial space, and computer-assisted navigation with a mandible reference frame is recommended for removal of the foreign body in the lower jaw.

Endoscopic management of foreign body ingestion in children

Introduction

Foreign body ingestion is common in children. Most accidental ingestions are passed spontaneously without intervention. Some cases of ingestion require intervention in a timely fashion to reduce risks and morbidities.

Aim

To analyse the clinical presentation, aetiology, and outcome of children presenting with foreign body ingestion, who required endoscopic intervention at a tertiary hospital (King Abdullah University Hospital, Irbid, Jordan).

Material and methods

Records of all patients with ingested foreign bodies requiring endoscopic retrieval over a 3-year period were reviewed retrospectively. Data on age, sex, type of ingested foreign body, presentation, type of intervention, stuck and retrieval location, outcome, and complications were collected.

Results

Of the sixty-three patients identified, 32 (50.8%) were male. Mean patient age was 7.7 ±3.4 years (range: 1 month-17.4 years). Most patients (74.6%) presented asymptomatically after the family or the child reported ingestion. Coins were the most commonly retrieved foreign bodies (37, 58.7%). The oesophagus was the most common site of retrieval (45, 71%). A rat tooth forceps was most commonly used to retrieve coins, followed by a net basket. Endoscopy was effective in managing the foreign body in 57 (90.5%) cases. Surgery was needed in 1 (1.6%) patient, a 1-month-old infant with a plastic tube in his stomach. All patients tolerated the procedure well with no complications. Interestingly, 7 (11.1%) male patients showed endoscopic features of eosinophilic oesophagitis; eosinophilic oesophagitis was confirmed histopathologically in three of them.

Conclusions

Endoscopic intervention is effective and well tolerated in the management of ingested foreign bodies in the upper gastrointestinal system. Parents and children should be cautioned against playing with coins, to reduce the incidence of foreign body ingestion.

Foreign rectal body - Systematic review and meta-analysis

BACKGROUND

Self-inserted foreign rectal bodies are an infrequent occurrence, however they present a serious dilemma to the surgeon, due to the variety of objects, and the difficulty of extraction. The purpose of this study is to give a comprehensive review of the literature regarding the epidemiology, diagnostic tools and therapeutic approaches of foreign rectal body insertion.

METHODS

A comprehensive systematic literature review on Pubmed/ Medline and Google for 'foreign bodies' was performed on January 14th 2018. A meta-analysis was carried out to evaluate the epidemiology, diagnostics and therapeutic techniques. 1,551 abstracts were identified, of which 54 articles were included.

RESULTS

The motivation of foreign rectal body insertion is mostly sexual stimulation. Patients are typically young and predominantly male, with a male to female ratio of 6:1. Sexual devices (35.7%, n=108) and glass objects (17.5%, n=53) are the most commonly self-inserted rectal foreign bodies. Patient history should be taken sensitively after diagnostic evaluation and identification of the object. Removal was performed under general anesthesia in 45.2% (n=95) and sedation in 29.0% (n=61). The total complication rate was described to be 30.4%.

CONCLUSIONS

Diagnostics must be performed with caution in order to rule out perforation and establish a treatment algorithm. Manual transanal extraction under sedation or general anesthesia may be performed in conjunction with cautious abdominal compression. Because of the variety of objects, i.e. in form and material, each case must be treated individually. Sometimes creativity and surgeon imagination may be required, although different algorithms have been established.

Application of point-of-care ultrasound for different types of esophageal foreign bodies: three case reports: A CARE-compliant article

RATIONALE

Esophageal point-of-care ultrasound (POCUS) has recently been reported as a useful, quick, safe, and simple technique to detect esophageal foreign bodies (FBs). However, case series to detect esophageal FB using POCUS have been rarely reported. Chicken bones and pills, especially, have not yet been reported as esophageal FBs. The objective of this case series was to describe the POCUS findings of 3 different materials-food, pill, and chicken bone.

PATIENT CONCERNS

Case 1, a 75-year-old woman with odynophagia and neck pain occurring 30 min after eating chicken porridge; Case 2, a 32-year-old woman with neck discomfort occurring 2 h after taking a pill; Case 3, a 29-year-old woman reporting FB sensation in the neck that occurred 1 h after eating sausage and rice soup.

DIAGNOSIS

Case 1. Cervical esophageal FB (chicken bone), Case 2. Cervical esophageal FB (oral pill), Case 3. Cervical esophageal FB (food).

INTERVENTIONS

Case 1. POCUS, urgent esophagogastroduodenoscopy (EGD) with alligator forceps. POCUS findings; hyperechoic material (suspected FB) that did not disappear by swallowing and esophageal dilatation with pooling of secretions. Case 2. POCUS. POCUS findings; hypoechoic material (suspected FB) that did not disappear by swallowing, and esophageal bulging above the FB, especially observed in the longitudinal view. Case 3. POCUS. POCUS findings; hyperechoic material (suspected FB) with reverberation artifact that did not disappear with swallowing efforts. Prior FB esophageal bulging with persistent air-fluid level was especially observed in the longitudinal view.

OUTCOMES

Case 1. FB was removed by EGD with alligator forceps. Case 2. Symptoms disappeared under observation without EGD. Follow-up POCUS revealed normalized bulging esophagus. Case 3. These symptoms improved after vomiting a large piece of food material. Three patients were discharged without complications.

LESSONS

In this case series, the impacted materials were chicken bone, pill, and food. However, POCUS findings were similar (esophageal dilation, hyperechoic or hypoechoic lesion with mixed echogenic contents in food or secretion, and no change with swallowing efforts). A longitudinal view was useful to assume the presence of cervical esophageal FB in all three cases. Thus, POCUS findings could be indirect signs of a FB in the esophagus.

Non-healing wounds: Can it take different diagnosis?

Wound healing is a complex cellular and biochemical process and can be affected by several systemic and local factors. In this study, we aimed to discuss the aetiologic factors of non-healing wounds and the management of this complicated process with current information. The medical data of the patients who were admitted to our clinic due to non-healing or chronic wounds were analysed retrospectively. A total of 27 patients were evaluated retrospectively during the 14 months of the study. The data of 6 patients who were followed up for chronic wound that developed after abdominal incisional hernia repair and pilonidal sinus surgery were not included in the study as their data could not be reached. A total of 21 patients were included in the study. Malignancy was diagnosed in two patients and granulomatous disease was found in four patients. The aetiology of the other cases included foreign body reaction, infection, and mechanical causes. Non-healing wounds are a serious social and economic problem for patients. Further studies on the pathophysiology of various aetiologies in non-healing wounds in both clinical settings and experimental animal models would be a useful step in treatment.

Radio-opacity of the Bones of Commonly Consumed Fish from the Red Sea

Introduction

Foreign body (FB) ingestion is one of the most common complaints presenting at an emergency department (ED), with fish bone impaction being a frequent cause of presentation. Fish bones might be challenging to identify on routine radiography and ED physicians are often left in a state of uneasiness owing to the fear of complications occurring if the fish bone is not removed.

Objective

This study aimed to establish the factors affecting the radio-opacity of fish bones on X-ray.

Materials and methods

The study involved the top three fish species consumed on Saudi Arabia’s western coast. Fish bones from three specimens of each species were radiographically examined by hand-picking bones from different parts of the fish, with particular attention paid to bones that are difficult to spot. Bones were then arranged beside each other, and radiographs were taken for comparison. Inter-species and intra-species radio-opacity variation was tested. Further, the weight of each fish and method of cooking (baked vs. fried) were tested for their effect on radio-opacity.

Results

No significant difference in radio-opacity was found among and between different species, and the method of cooking did not alter the radio-opacity of fish bones. Significant differences in radio-opacity were noted with the difference in the diameter and size of the fish bones, which tended to be less radio-opaque in smaller-sized fish, regardless of the species.

Conclusion

The exact fish species and method of cooking did not alter the fish bone density on an X-ray. The size of the fish and the size of the fish bone are better predictors of higher fish bone density.

Etiological causes and epidemiological characteristics of patients with occupational corneal foreign bodies: A prospective study in a hospital-based setting in India

Purpose:

Corneal foreign bodies (CFBs) due to occupational exposure have been largely ignored in Indian literature, especially nonmetal workers. Our study looks at a broad range of occupations and settings that contribute to CFB in our local Indian population. The study objective was to determine the occupations, level of education and demographics of patients presenting with CFB acquired during occupational work.

Methods:

Prospective hospital-based study at a tertiary eye hospital in Gurgaon, Haryana, India, within duration of 9 months. Patients presenting with CFB were asked a set of questions relating to their occupation, level of education, understanding of the potential complications of CFB, and demographics.

Results:

A total of 83 patients were included in the study. CFB were attributed only to males. 66% of patients were in the age group of 14--29 years. 30% of patients were in the age group 30--44 years and 4% of patients were between 45 and 60 years old. The metal work industry was responsible for 47% of presentations. The construction industry was responsible for 27% of presentations. Electricians and carpenters combined were responsible for 10% of presentations and 17% of presentations occurred in other sectors.

Conclusion:

CFB occur across a number of occupations in the construction industry, not just metallic workers. Among a population that is generally poorly educated and have nominal understanding of the impact that CFB can have on vision, occupational hazard education is necessary to address this problem.

Delayed Complications Due to Polymer Coating Embolism after Endovascular Treatment

There have recently been reports of patients who developed postprocedural symptoms or alterations due to delayed foreign body embolisms observed in imaging findings. Polymer coating of devices have been described as a possible cause of foreign body embolisms, manifesting in delayed granulomatous responses and exhibiting characteristic imaging findings. In four of 4,025 patients who underwent coil embolization in our hospital or its affiliated facilities, similar findings were observed. Delayed lesions appeared between 1 month and 1 year after the procedures. There was extensive edema in the perfusion area of the treated vessels. In two cases examined by contrast-enhanced magnetic resonance imaging, multiple solid enhancing lesions within vasogenic edema were observed. Biopsy revealed a membranous foreign body in a blood vessel with surrounding foreign body granuloma formation in 1 case. Because these findings are similar to those of cases reported previously, they were considered as a foreign body embolism due to coating separations from the devices. Polymer coating separation occurs most frequently from guidewires. Especially if a metal introducer is used, the risk of separation increases. Surgeons should carefully follow the manufacturers’ instructions when they use these devices and should acknowledge and report any events that may occur. Although these complications are extremely rare, further studies are warranted of similar cases; and we should prepare and share information on these intravascular devices for wide-scale dissemination in the industry.

Penetrating transorbital injury by a coloring pencil in a 3-year-old child: A case report

A transorbital penetrating injury by a foreign body is an extremely rare type of injury, and its severity is often difficult to estimate by examination of the superficial wound alone. Thus, such injuries are challenging for neurosurgeons to investigate and manage. We herein present a peculiar case involving a 3-year-old girl with a penetrating transorbital skull-base injury caused by a coloring pencil and discuss the anatomical location of the foreign body, radiological examination findings, diagnosis, and treatment strategy. The pencil was completely removed by manual extraction. Follow-up investigations confirmed a good outcome. Multidisciplinary cooperation, radiological examination, correct diagnosis, timely treatment, and detailed follow-up studies are necessary to manage penetrating transorbital skull-base injuries caused by foreign bodies. The orbital walls are very thin in children, and the orbital roof and superior orbital fissure are often penetrated by foreign bodies in cases such as that described herein. The anatomical location of the foreign body influences the clinical management strategy.

Clinical Characteristics of External Auditory Canal Foreign Bodies in Children and Adolescents

OBJECTIVES

Foreign bodies (FBs) in external auditory canal (EAC) can occur at any age but are especially common in children and adolescents. The aims of the study were to evaluate the clinical characteristics of EAC FBs in children and adolescents and to discuss their proper management.

METHODS

A retrospective medical chart review was performed on patients who were treated for EAC FBs in a tertiary referral center from January 2007 to December 2017. We investigated the parameters of age, sex, type of FB, sedation method, complications, and removal strategy.

RESULTS

Of 284 patients, 176 (62.0%) were male. Peak incidences were noted at the ages of 3 to 6 years and 17 to 18 years. The frequently observed FBs were insects, followed by air-gun pellets, cotton balls, marbles, and earrings. Forty-one (14.4%) EAC FBs were removed with the naked eye, while 243 (85.6%) were removed under microscope in the otolaryngology department. Of these patients, 23 (9.5%) were administered sedatives and 1 (4.1%) needed general anesthesia. During or after the removal procedure, 4 (15.5%) patients had complications of EAC abrasion or laceration (42, 14.8%), and tympanic membrane perforation (2, 0.7%).

CONCLUSIONS

External auditory canal FB showed a distinct characteristic of incidence regarding age, related to removal strategies. Characteristics of FB must be considered for safe removal.

Laparoscopic retrieval of a fishbone migrating from the stomach causing a liver abscess: Report of case and literature review

Ingestion of foreign bodies (FBs) is a common misfortune worldwide. Fishbone migration from the gastrointestinal tract into the liver is an unusual cause of liver abscess. We present a 66-year-old woman who presented to the emergency department with epigastric pain, with no other relevant anamnestic details. Computed tomography scan revealed a liver abscess, secondary to stomach perforation from a long, sharp object. Diagnostic laparoscopy revealed a fishbone protruding from the left lobe of the liver. The FB was extracted and the liver abscess incised and drained laparoscopically with no operative and post-operative complications. Migration of FB into the liver is a rare occurrence. Treatment of such liver abscess must include the extraction of the FB. Laparoscopy in these cases is feasible and safe and may prevent unnecessary exploratory laparotomy.

Case report: successful endoscopic treatment of a large bowel perforation caused by chicken bone ingestion

RATIONALE

Large bowel perforations by a foreign body are rarely diagnosed pre-operatively due to non-specific clinical symptoms. The safety and efficacy of foreign body removal via upper endoscopy is well-established and strongly recommended. There is far less experience of endoscopic treatment of sharp foreign bodies impacted in lower parts of gastrointestinal tract.

PATIENT CONCERNS

The patient was 78-year-old female with abdominal pain and nausea. Symptoms had begun 48 hours prior to hospital admission. She had lost over 10 kg of body weight in the previous couple of months DIAGNOSIS:: A multidetector-row computed tomography (MDCT) examination of the abdomen revealed mural thickening and enhancement of the cecum with haziness and linear areas of high attenuation in the pericecal fat tissue. A colonoscopy showed, the clear presence of a sharp 5.5-cm-long chicken bone perforating the cecal wall at the antemesenteric site close to the Bauchini valve.

INTERVENTIONS

A quarter of the bone that had penetrated the cecal wall was pulled out with a flexible colonoscopy using a polypectomy snare. Due to the form and length of the bone, it was withdrawn through the entire colon, using pointed end trailing.

OUTCOMES

The patient was discharged three days after colonoscopy with normal laboratory results and without any pain.

LESSONS

In cases where sharp foreign bodies stuck into the large bowel, it is highly advisable to try to remove them via colonoscopy, before deciding to resolve the issue through a surgical intervention.

Childhood Nasal Foreign Bodies: Analysis of 1724 Cases

Objective

This study evaluates the characteristics of the foreign bodies removed from the nose, the treatment methods used, and the complications associated with the foreign body, and discusses the reports in the literature.

Methods

Age, gender, type of foreign body, side of nose, clinical symptoms, complaints, diagnosis and treatment methods were retrospectively evaluated in all 1724 pediatric patients with foreign bodies.

Results

Of the 1724 patients, 841 (48.7%) were female and 883 (51.3%) were male. Their mean age was 4.3±3.06 years (age range: 4 months-16 years). Foreign body was found on the right side in 928 (53.8%), on the left-side in 768 (44.5%) and bilaterally in 28 (1.6%) patients. The foreign bodies were inorganic substances such as beads, paper, napkins, toy parts, batteries, pencils, erasers in 1287 cases (74.7%) and organic materials such as hazelnuts, walnuts and fruit seeds in 437 cases (25.3%). The foreign bodies were extracted in outpatient settings in 1709 cases. Fifteen patients in whom the foreign body was located in the posterior region and/or who were uncooperative were treated under anesthesia. The most common complication was epistaxis. Septal perforation was seen in one patient with alkaline battery.

Conclusion

In pediatric patients presented to the otolaryngology and the pediatrics clinics with complaints involving nasal obstruction, unilateral purulent nasal discharge, epistaxis, and foul odor, possibility of a foreign body in the nose should be kept in mind.

Laparoscopic diagnosis and extraction of an ingested fish bone that penetrated the stomach: A case report

RATIONALE

Foreign body ingestion is a common clinical event, but serious complication such as perforation is uncommon. Here we present a case of gastrointestinal perforation caused by fish bone, which was treated effectively and successfully by totally laparoscopic management.

PATIENT CONCERNS

A 63-year-old man who was admitted to our hospital with epigastric pain for 1 month. Computed tomography of the abdomen at the local hospital revealed a linear, hyperdense, foreign body in the lesser curvature of gastric antrum that had penetrated through the posterior wall of the gastric antrum.

DIAGNOSIS

The laparoscopic exploration found that a 2.5 cm × 0.3 cm fish bone had penetrated through the posterior wall of the gastric antrum.

INTERVENTIONS

A totally laparoscopic surgery was performed to remove the foreign body and repair the perforation eventually.

OUTCOMES

After surgery, the patient underwent uneventful recovery and was discharged on postoperative day 7. During the 3 months of follow-up visit, the patient appeared healthy and did not report abdominal symptoms.

LESSONS

In this case, the advantages of laparoscopic techniques in the diagnosis and treatment of gastrointestinal perforation caused by foreign body was confirmed, and which may be considered as the primary choice in similar cases.

Awareness of the first aid management of foreign body aspiration among students: A cross-sectional study

BACKGROUND

Pediatric foreign body aspiration (FBA) is a life-threatening condition responsible for many deaths every year, especially among children younger than 2 years.

OBJECTIVE

This study aimed to determine the level of knowledge among students in Jeddah, Saudi Arabia.

SUBJECTS AND METHODS

This observational, cross-sectional study was conducted between December and January 2018 at Jeddah, Saudi Arabia via a paper-based questionnaire survey of male and female high school and middle school students. The Chi-square test was used to compare frequencies, and the independent t-test was used to compare means.

RESULTS

A total of 671 students participated in this survey. The second item, "It is possible for a child to choke on a small toy" had the highest rate of correct responses among both males and females (93.2% vs. 94%, respectively). The eighth item "Sudden cough is a sign of choking among children" had the lowest rate of correct responses among males (40.8%) and females (33%). Most female participants (74.2%) knew that batteries are the most dangerous items a child can swallow, which requires immediate medical attention (item 14), while only 56.2% of male participants knew that (P < 0.001). The only significant predictor on linear regression analysis was "Having treated anyone with FBA" (coefficient = -0.24, P = 0.03).

CONCLUSIONS

There is inadequate knowledge regarding FBA among middle and high school students, as is the case among mothers. Moreover, only a small percentage of participants had any first aid training.

Foreign body ingestion in children

INTRODUCTION

Evaluation of results of the group of paediatric patients treated for swallowed foreign bodies in the digestive tract.

METHODS

Retrospective analysis of patients treated for foreign bodies in the digestive tract, managed at the University Hospital of Hradec Králové between 2011-2018.

RESULTS

365 patients (182 boys, 183 girls) with a foreign body in the digestive tract have been evaluated. The mean age was 2.4 years. Most of the children were treated as outpatients (280 children, 76.7%) and only 85 children (23.3%) were hospitalized. The most commonly swallowed frequent bodies included coins (26%) and batteries (14.5%); sharp objects occurred in 5.2%. Unusual foreign bodies were noticed, too. We can mention for example a pen or a plant nutrition product. In 302 cases (82.7%) the foreign bodies passed easily per vias naturales. Endoscopy was necessary in 63 cases (17.2%) - in 51 children the object had to be removed from the oesophagus and in 12 children the object had to be removed from the stomach. None of the swallowed bodies caused complications such as digestive tract perforation or bowel obstruction. No patient in the group was indicated for laparotomy to remove the foreign body.

CONCLUSION

Foreign bodies entrapped in the oesophagus have to be removed endoscopically. In most cases, foreign bodies in the stomach require only observation in the outpatient setting because they leave the stomach easily, without complications, per vias naturales. If a battery remains at the same place of the digestive tract for more than 24 hours, endoscopic removal is indicated at our department. In addition, endoscopy is done in cases of swallowed multiple magnets or bodies that are too large and remain in stomach for several weeks or months. Surgical removal of foreign bodies should be reserved only for complicated cases.

Retrieval of an Unusual Foreign Body

Foreign body (FB) ingestion represents a common presenting complaint of the incarcerated patient population treated at Larkin Community Hospital (LCH). These patients find an array of different objects to ingest, and some of these objects represent a significant cause of morbidity and mortality. Batteries, specifically, are a FB that may cause significant injuries if ingested, and thus urgent attention is required. The effects of swallowing small batteries are well documented in the literature. This is not the case for more complex electronic devices that contain a battery, such as a cell phone. One such example is described in a case where a 44-year-old male inmate ingested a small cell phone 12 days prior to arrival at LCH. This patient presented with minimal signs or symptoms on physical exam. The phone was removed by endoscopy under monitored sedation by the anesthesia and gastroenterology teams with surgery on standby. This case demonstrates the need for removal before the patient becomes symptomatic, as well as the interdisciplinary co-operation between general surgery and gastroenterology required to retrieve complicated battery-containing FBs, such as a phone, from the gastrointestinal tract following ingestion. This case also demonstrates that a complex object such as a phone may remain in the stomach for an extended time without being digested enough to cause severe symptoms under the special circumstances seen in this case.

Foreign Body Inside the Tunnel: A Rare Cause of Acute Cubital Tunnel Syndrome

Foreign bodies are common entities found in hand surgery practice. However, they are a very rare cause of the acute cubital tunnel syndrome. A 48-year-old male patient was consulted for cubital tunnel symptoms after 2-day unconscious state in the intensive care unit. The ulnar nerve was explored, a piece of glass was removed inside the cubital tunnel, and the nerve was repaired. However, compression neuropathy symptoms due to the acute trauma are interesting. Nerve laceration with a foreign body should be considered in acute-onset cubital tunnel syndrome, in which the foreign body history of a trauma patient cannot be determined explicitly.

[Diagnosis and treatment of cervical migratory foreign bodies caused by sharp esophageal foreign bodies]

Objective:Imaging findings and treatment of sharp foreign bodies penetrating the esophagus to migrate in the neck were collected. Method:All of 9 cases were determined by CT imaging. The foreign bodies were removed in 8 cases through the lateral cervical approach. The last case was taken out by bronchoscope. Eight cases successfully removed the foreign bodies. No definite foreign body was found in 1 case. Result:There were no postoperative complications in 8 patients that successful removed of foreign bodies. All patients begin to eat normally after operation and were discharged from hospital in 7 days. Tracheoesophageal fistula occurred that happened to the patient that no foreign body was found in operation. So gastric tube was retained for 7 days. Conclusion:CT imaging should be performed to determine whether there is the possibility of foreign body penetrating out of the esophagus, for the patients who had explicit history but the foreignbodies could not be found by barium meal examination. If necessary, three-dimensional CT reconstruction of the neck should be performed to locate the foreign body. Surgical exploration should be done as soon as possible to avoid aimless migration of foreign bodies, and it is difficult to find it during operation.

Failure of standard methods for retrieving an unusual foreign body in esophagus: A case report

RATIONALE

The ingestion of a foreign body (FB) with complete impaction of the esophagus is not common. Here we report a rare case of successful retrieval of a spherical stone in the esophagus of a man with mental retardation, using gallbladder grasping forceps and rigid endoscope.

PATIENT CONCERNS

A mental retarded man came to the emergency department presenting with recurrent nausea, vomiting, and dysphagia after swallowing a spherical stone. He had previously undergone an FB extraction under general anesthesia by fiberoptic esophagoscopy, which failed.

DIAGNOSIS

The diagnosis of FB ingestion was confirmed by anteroposterior plain film x-ray of the chest and chest computed tomography (CT), which showed the ingested spherical FB in the upper esophagus.

INTERVENTIONS

After multiple failed attempts using other instruments, the FB was successfully removed with gallbladder grasping forceps through a rigid esophagoscope.

OUTCOMES

The patient was discharged without any complications. The nasogastric tube was extubated at the 10-day follow-up.

LESSONS SUBSECTIONS AS PER STYLE

For esophageal retrieval of uncommon FBs, the instrument used is crucial. We report our experience retrieving a large and spherical FB in the upper esophagus using gallbladder grasping forceps. This proved to be an effective strategy, eliminating the need for thoracotomy.

Ureteral obstruction and hydronephrosis caused by foreign body: A case report and literature review

RATIONALE

Foreign bodies related ureteral obstruction and hydronephrosis is rare and usually cause numerous problems for clinical physicians.

PATIENT CONCERNS

We report a 36-year-old female who was referred to our hospital due to a 4-year history of dull pain on the left back.

DIAGNOSIS

X-ray and abdominal CT revealed a foreign body around the upper part of the left ureter with ureteral obstruction and hydronephrosis.

INTERVENTIONS

Laparoscopy was performed and a 3-cm sewing needle was removed successfully.

OUTCOMES

After 6 months' follow-up, the patient's ureteral obstruction and hydronephrosis were significantly reduced, and the double-J ureteral stent was removed.

LESSONS

This case indicated that ureteral obstruction and hydronephrosis caused by foreign bodies needed to be early diagnosed and located. Invasive therapies rather than conservative treatments are preferred to remove the FBs and relieve obstruction.