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.

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.

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.

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.

Foreign body granuloma in the maxillofacial region: a case report

Foreign bodies can penetrate in soft tissues of the maxillofacial region through injuries and cutaneous lacerations from trauma. Most commonly found bodies are glass, metal and wood. We report the case of a 50-year-old male patient who came to our maxillofacial department complaining about the presence of an intraoral nodule located in the right upper gingival mucosa. The patient reported the story of a road accident, three months earlier, falling from a scooter without the aid of a protective helmet.

Textiloma-Induced 1,25-Dihydroxyvitamin D-Mediated Hypercalcemia: A Case Report and Literature Study

Foreign body causing 1,25-dihydroxyvitamin D [1,25(OH)2D]-induced hypercalcemia is an uncommon yet clinically significant cause of hypercalcemia. We report an unusual case of hypercalcemia due to a textiloma (a surgical gauze inadvertently left in place during surgery). A PubMed search for (HYPERCALCEMIA) and (FOREIGN BODY) was performed. A foreign body (surgical gauze) left over after removal of a kidney transplant caused 1,25(OH)2D-induced hypercalcemia. The diagnosis was complicated by end-stage renal disease, low PTH, and high 1,25(OH)2D.

Multiple Magnet Ingestion leading to Bowel Perforation: A Relatively Sinister Foreign Body

Foreign body ingestion is a common reason for seeking emergency care among children. One of the more serious foreign bodies are the ingestion of multiple magnets or concurrent ingestion of a magnet and a metallic foreign body. Conservative management with serial imaging can be misleading in such cases. Multiple magnets tend to have strong attractive forces among them and may encase loops of bowel within them. Once entrapped, pressure necrosis and perforation will ensue, and thus, a low threshold should be adopted for surgical exploration in such cases. We present the case of a two-year-old male who had an accidental, unwitnessed ingestion of multiple magnets and also report the subsequent surgical management and associated morbidity.

Nonabsorbable Suture Knot on the Tendon Affects Rotator Cuff Healing: A Comparative Study of the Knots on Tendon and Bone in a Rat Model of Rotator Cuff Tear

BACKGROUND

Nonabsorbable suture knots are usually used to link the tendon and bone during rotator cuff repair surgery. There are many variations in the arthroscopic knot-tying technique; however, the location of suture knot placement for rotator cuff healing has rarely been studied.

HYPOTHESIS

The authors compared the rotator cuff healing between knots tied on tendon and bone in a rotator cuff tear rat model. It has been hypothesized that knots can cause chronic inflammation and create the weakest link between tendon and bone, thus affecting rotator cuff healing.

STUDY DESIGN

Controlled laboratory study.

METHODS

Bilateral supraspinatus tenotomy and rotator cuff repair at the greater tuberosity were performed on 24 Wistar rats. Nonabsorbable surgical suture knots were made on the right supraspinatus tendon tissue and left humerus inferior to the greater tuberosity, respectively. Twelve rats each were sacrificed at 3 and 9 weeks. Six of the 12 rats were used for biomechanical testing and the remaining 6 for histologic evaluation.

RESULTS

The surgical knots placed on the bursal side of the tendon migrated to the articular side, as noted on gross observation in 22 of 24 samples. The knots on the tendon group showed significantly inferior tendon-bone integration and significantly inferior biomechanical results in terms of maximum load to failure and stiffness. An obvious chronic foreign body inflammatory reaction was found in the knots on the tendon group at 3 and 9 weeks. Furthermore, inferior bone-tendon interface regeneration and weakest link formation were obtained in the knots on the tendon group compared with those on the bone group.

CONCLUSION

Nonabsorbable suture knots placed on the tendon migrate to the articular side, causing chronic inflammation and weakening tendon-bone healing, which may explain some retears after rotator cuff repair.

CLINICAL RELEVANCE

The present animal study suggests that it is not recommended in clinical practice to make several bulky nonabsorbable suture knots on the rotator cuff tendon during rotator cuff repair surgery. It may be better to tie the knots at the bone side or do knotless repair.

Visual and Anatomic Outcomes in Perforating Ocular Injuries

Purpose

This article reports the presentation, management, and outcomes in patients suffering perforating ocular injuries.

Methods

A retrospective review was conducted at a single ophthalmology Level 1 trauma center. Patients with evidence of traumatic ocular perforation, with surgical intervention attended by a single vitreoretinal surgeon (W.F.M.), were reviewed between 2009 and 2017.

Results

Six eyes from 6 patients with perforating ocular injuries were studied. All patients were male, between ages 11 and 56 years. Perforation was the result of gunshots (3), other accidental injury (2), or surgical complication (1). Varying degrees of retinal detachments were seen in all 6 patients. Pars plana vitrectomy, with endolaser around posterior entry or exit wounds, was performed on average 21.7 ± 8.9 days from the time of injury (range, 0-58 days). In all cases with intraorbital foreign bodies, the foreign bodies were left in place. The most recent postoperative visual acuity ranged from 20/25 to counting fingers. Missile injuries tended to have poorer vision. All cases achieved full anatomic attachment at most recent follow-up. There have been no orbital complications related to retained intraorbital foreign bodies, including endophthalmitis, orbital infections, or mechanical strabismus.

Conclusion

This study demonstrates successful anatomic outcomes of 6 cases of perforating ocular injuries. Visual outcomes were variable, though missile injuries demonstrated worse prognosis, whereas several nonmissile macula-involving cases achieved quite favorable results. Although traumatic perforating injuries generally have guarded visual prognoses, favorable results may be achieved in select scenarios.

[Epidemiology of home accidents in childhood: experience in the Division of General Pediatrics in Southern Tunisia]

Les accidents domestiques représentent un problème sérieux de santé publique en pédiatrie. Ils sont responsables d’une lourde morbidité et mortalité parmi la population pédiatrique. Nous avons mené une étude rétrospective colligeant 231 cas d’accidents domestiques chez l’enfant au Service de Pédiatrie de l’Hôpital Hédi Chaker de Sfax durant une période de 5 ans (2008 - 2012). Durant la période d’étude, nous avons colligé 231 cas d’accidents domestiques. Il s’agissait de 124 garçons (53,7%) et 107 filles (46,3%). L’âge moyen était de 2 ans avec des extrêmes de 1 jour et 14 ans. Les enfants âgés de moins de 4 ans étaient les plus exposés (88,7%). Les intoxications accidentelles étaient les accidents les plus fréquents (105 cas). Les caustiques étaient les agents toxiques les plus fréquents (33 cas), suivis par les médicaments (28 cas) puis les hydrocarbures (16 cas). Les accidents par corps étrangers ont représenté le deuxième mécanisme accidentel (64 cas). Il s’agissait de 43 cas d’inhalation de corps étrangers et 21 cas d’ingestion de corps étranger. Nous avons enregistré 28 cas de traumatismes; il s’agissait d’une chute d’une certaine hauteur dans 25 cas. Nous avons recensé 26 cas d’envenimations scorpioniques, 5 noyades, 2 cas de brulure et un seul cas d’électrisation. Les intoxications accidentelles et les accidents par corps étrangers représentent les principaux accidents domestiques dans notre série et la tranche d’âge entre 1 et 4 ans est la plus exposée aux accidents domestiques.

Retained Rice Cake: A Unique Upper Gastrointestinal Foreign Body: Case Report and a Literature Review

As a rarely recognized foreign body in the upper gastrointestinal tract, rice cake frequently requires endoscopic removal. We herein report six patients with characteristic sonography, computed tomography (CT), spectroscopy, endoscopy, and histological findings. A review of all published cases, including ours, revealed that retained rice cake in the stomach typically shows the following: abdominal pain (93.3%), mucosal injury (93.3%) with bleeding (42.9%); high-density (120-206 Hounsfield units) CT findings; and indication for endoscopy (80%). In the esophagus, hot, toasted rice cake causes thermal injury. Primary physicians should be aware of this popular-food-induced, but rare, disorder.

Retrospective evaluation of factors associated with degree of esophagitis, treatment, and outcomes in dogs presenting with esophageal foreign bodies (2004-2014): 114 cases

OBJECTIVE

To characterize a population of dogs presenting for esophageal foreign body removal and evaluate factors associated with degree of esophagitis and minor and major complications.

DESIGN

Retrospective evaluation of dogs who presented for esophageal foreign body removal between January 2004 and December 2014.

SETTING

University veterinary teaching hospital.

ANIMALS

Data collected from 114 dogs included signalment, history, clinical signs, physical examination findings, duration and location of foreign body, degree of esophagitis, foreign body removal success, feeding tube placement, and clinical outcomes. Owners were contacted for outcome data not available in the medical record. Data were analyzed for breed predispositions, whether duration or type of foreign body was associated with degree of esophagitis or complications, and factors associated with feeding tube placement.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

The overall success rate for foreign body removal via esophagoscopy was 95% with a complication rate of 22%. Small breed dogs were overrepresented. Dogs with a foreign body present for >24 h were significantly more likely to have severe esophagitis (P < 0.001) and major complications (P = 0.0044). Foreign body type did not predict degree of esophagitis or complications, though fishhooks were more likely to require surgical removal (P = 0.033). Feeding tubes (15 gastrostomy, 1 nasoesophageal) were placed in 14% of dogs and were more likely to be placed if the foreign body had been present for >24 h (P < 0.001).

CONCLUSIONS

Consistent with previous studies, esophageal foreign bodies, appropriately identified and endoscopically removed, carry a good prognosis, particularly if they have been present for ≤24 h.

Metastatic Osteolytic Angioleiomyosarcoma Induced by a Foreign Body in a Kangaroo (Macropus giganteus)

An adult female Eastern Grey kangaroo (Macropus giganteus) was examined for lameness due to a mass located at the right tibiotarsal joint. Radiographs revealed a metal arrowhead-shaped foreign body within the mass alongside a pathologic fracture. Grossly, at necropsy, there was a multilobulated and haemorrhagic mass with intralesional metal fragments, associated osteolysis of the tibiotarsus and pulmonary metastatic nodules. Histologically the neoplasm was composed of plump elongated and fusiform cells that often formed concentrically around small vessels. The pulmonary nodules were composed of similar neoplastic cells, necrosis and haemorrhage. Neoplastic cells were positive immunohistochemically for vimentin and smooth muscle actin. The histological features, immunohistochemical profiles and behaviour of this tumour support a diagnosis of a primary angioleiomyosarcoma with lung metastasis associated with a metal foreign body.

Management of Upper Airway Leech Infestations

PURPOSE

Upper airway foreign body is one of the most encountered clinical situations in otolaryngology practice. In rare conditions, a living organism may be a foreign body in the upper airway. In this study, we demonstrate 19 patients with leech infestations in nose, nasopharynx, and larynx.

METHODS

This study was enrolled with 19 patients between 2012 and 2016 in a regional state hospital. All of the patients were admitted to clinic with these complaints: epistaxis, hemoptysis, coughing, foreign body sensation, and bloody stool.

RESULTS

There were 12 male and 7 female patients. The leech was in the nose in 12 patients, in nasopharynx in 6 patients, and in the larynx in only 1 patient. All leeches are removed under local anesthesia (except laryngeal presentation). No bleeding and complication were seen after extraction of leech.

CONCLUSION

Leech can be easily diagnosed and managed in the upper aero-digestive tract without any complication and leech-associated disease.

Management of an Unusual Intranasal Foreign Body Abutting the Cribriform Plate: A Case Report and Review of Literature

A 35-year-old man with history of schizophrenia presented 3 weeks after placing a screw in his right nostril. Initial imaging showed a screw in the right ethmoid sinus with the tip penetrating the right cribriform plate. On exam, the patient was hemodynamically stable with purulent drainage in the right nasal cavity but no visible foreign body. While most nasal foreign bodies occur in children and are generally removed at the bedside, intranasal foreign bodies in adults tend to require further assessment. The foreign body in this case was concerning for skull base involvement and the patient was brought to the operating room (OR) with neurosurgery for endoscopic sinus surgery (ESS) and removal of foreign body. The screw was removed and the patient recovered with no signs of cerebrospinal fluid (CSF) leak postoperatively. Any concern for skull base or intracranial involvement should call for a full evaluation of the mechanism of injury and intervention in a controlled environment.

The novel use of a nasal bridle system to remove a foreign body in the ear

Foreign bodies in the ear are a common presentation that prompt referral to Otolaryngology. We describe a technique that is safe and simple to perform for the removal of metallic foreign bodies in the ear. Case report of an elderly gentleman presenting with otalgia and a hearing aid battery lodged within bony external ear canal.

Small bowel perforation secondary to foreign body ingestion mimicking acute appendicitis: Case report

RATIONALE

Foreign body ingestion is often encountered in clinical practice; however, intestinal perforation owing to foreign body ingestion is rare.

PATIENT CONCERNS

Here, we present the cases of 2 patients who accidentally swallowed foreign bodies and later presented with pain in the right lower abdominal quadrant.

DIAGNOSES

Both patients were initially diagnosed with acute appendicitis and underwent immediate emergency laparotomy.

INTERVENTIONS

During the operation, the appendix was found to be only mildly inflamed. On transection of the appendix, the mucosa was found to be inflamed, and yellow-white exudate was noted. We, therefore, decided to explore the entire bowel. The bowel examination revealed small bowel perforations, and palpation of the adjacent bowel revealed a hard, sharp object. The object was removed through the perforation site, the perforation was repaired, and the abdomen was closed in layers.

OUTCOME

The postoperative recovery, in both cases, was uneventful.

LESSONS

Patients who swallow sharp or large foreign bodies should undergo endoscopy as soon as possible to avoid intestinal perforation. Clinicians should inquire about a history of foreign body ingestion. The preoperative diagnosis of intestinal perforation secondary to foreign body ingestion requires a high degree of clinical suspicion and awareness.