Accidental Ingestion and Uneventful Retrieval of an Endodontic File in a 4 Year Old Child: A Case Report

The majority of foreign body ingestions occur in the pediatric population, with a peak incidence between the ages of 6 months and 6 years. Safety during dental treatment of children cannot be overemphasized. Uncooperative, mentally and physically handicapped children are more prone to ingestion or aspiration of dental instruments than other populations. In any event, it is recommended that dental practitioners examine their instrument before use, as a safeguard against any slippage, breakage. Treatment with any endodontic device requires the use of proper isolation such as rubber dam.

Pharyngeal Aspiration of Complete Upper Denture in 90-Year-Old Man; a Case Report

Foreign body aspiration is unusual in adults, except those who are debilitated or have neuropsychiatric disorders. It can be a life-threatening situation and it often requires a high index of suspicion, because the diagnosis can be obscure. Prompt diagnosis and intervention through foreign body retrieval are critical to prevent significant morbidity and mortality. We present a case of denture aspiration by a debilitated 90 years old man. He had aspirated his complete upper denture to pharynx causing incomplete obstruction with pleasure whistling respiratory sound, dyspnea, dysphagia and dysphonia. He underwent successful retrieval of the dental plate manually by fingers with complete resolution of symptoms.

Inadvertent intravesicular placement of a vaginal contraceptive ring: a case report and review of literature

The NuvaRing® is a deformable, ring-shaped hormonal contraceptive device which is typically vaginally self-inserted by the patient. While there are several potential side effects of usage, essentially all of them result from hormone delivery. Complications from incorrect placement are rare. We present the case of a 31 year old female who presented to our emergency department after being unable to retrieve a NuvaRing® for its scheduled removal. CT scan showed a hypodense intravesicular NuvaRing® which the patient had inadvertently placed transurethrally 3 weeks prior. Cystoscopy was performed and retrieval using a 3-pronged grasper was eventually successful after several failed attempts with an alligator grasper. Our purpose in presenting this case is to introduce the reader to a rare complication of incorrect NuvaRing® placement, explain how this complication may occur as a result of NuvaRing® construction/functionality, describe how alternative cystoscopic instruments may aid in cystoscopic retrieval, and review the 3 other case reports of intravesicular NuvaRing® placement to discuss the utility of various imaging modalities when clinical suspicion of the complication is high.

Foreign bodies in the ear, nose and throat: an experience in a tertiary care hospital in central Nepal

Introduction A foreign body (FB) is an object or substance foreign to the location where it is found. FBs in the ear, nose, and throat are a common problem frequently encountered in both children and adults. Objective To analyze FBs in terms of type, site, age, and gender distribution and method of removal. Methods A retrospective study was performed in a tertiary care hospital in the central part of Nepal. The study period was from June 2013 to May 2014. The information was obtained from hospital record books. Results A total of 134 patients had FBs in the ear, nose, or throat; 94 were males and 40 were females. Of the 134 patients, 70 (52.23%) had FB in the ear, 28 (20.89%) in the nose, and 36 (26.86%) in the throat. The FB was animate (living) in 28 (40%) patients with FB in the ear and 1 (3.5%) patient with FB in the nose, but the FB was inanimate (nonliving) in any patient with FB in the throat, in 42 (60%) patients with FB in the ear FB, and in 27 (96.4%) patients with FB of the nose. The FB was removed with or without local anaesthesia (LA) in 98 (73.13%) patients, and only 36 patients (26.86%) required general anaesthesia (GA). The most common age group affected was <10 years. Conclusion FBs in the ear and nose were found more frequently in children, and the throat was the most common site of FB in adults and elderly people. Most of the FBs can be easily removed in emergency room or outpatient department.

[Large intra-rectal foreign body : a case report]

L'insertion d'objets dans le rectum est peu courante dans les pays au contexte socio-culturel tels que le Maroc. Elle se caractérise par la gravité des complications éventuelles et les différentes possibilités thérapeutiques. Nous rapportons le cas d'un patient, ayant eu une incarcération d'un énorme objet introduit volontairement par voie anale, cet objet étant soigneusement façonné par le patient. Il a bénéficié d'une extraction manuelle. Cette dernière permet, quand elle est possible, d’éviter la chirurgie qui s'impose en cas d’échec ou de complications.

Visibility of different foreign bodies in the maxillofacial region using plain radiography, CT, MRI and ultrasonography: an in vitro study

OBJECTIVES

To compare the usefulness of four imaging modalities in visualizing various foreign bodies of different sizes.

METHODS

Foreign bodies of four sizes (0.5, 1, 2 and 3 mm) including metal, tooth, wood, plastic, stone, glass and graphite were embedded in six fresh sheep heads on bone surface between the corpus mandible and muscle, and inside the tongue muscle. A human dry skull served as an air-filled space. Plain radiography, CT, MRI and ultrasonography were used, and four skilled radiologists rated the findings individually.

RESULTS

All embedded foreign bodies except wood were best visualized using CT. Wood could only be detected using ultrasonography, and then only when fragments were >0.5 mm in size. Plain radiography and CT were almost equally accurate in visualizing metal and graphite. MRI was the least useful imaging technique.

CONCLUSIONS

In cases with suspected foreign bodies in the maxillofacial region, CT seems to be the optimal initial imaging study. Wood, however, could only be detected using ultrasonography.

[Metallic foreign body inhalation: 36 months of intrabronchial evolution in an eight year-old child]

Les corps étrangers dans les voies respiratoires constituent une urgence relativement fréquente chez les enfants. Nous présentons ici le cas d'une fillette de 8 ans qui avait inhalé un clou que la radiographie avait localisé dans la bronche droite. L’évolution est marquée par une symptomatologie muette et une migration vers le bas de ce clou. Ne disposant pas d’équipement pour une chirurgie adaptée, le malade vit encore avec ce corps étranger en lui. La nature et l’évolution clinique et paraclinique rapportées ici en constituent l'intérêt.

Intraoperative ultrasound to facilitate removal of a submucosal foreign body

A 61-year-old man with a history of fish bone ingestion and poorly localized symptoms was seen. His clinical examination was unremarkable, but CT demonstrated a foreign body deeply embedded within his tongue. Intraoperative ultrasound (US) guidance facilitated identification of a bone, allowing a needle to be placed as a guide to dissection. Repeat US scanning through the incision permitted precisely targeted surgery. CT and US are the most effective imaging techniques for localizing fish bones. Intraoperative US can be used to accurately locate a submucosal fish bone in mobile tissue such as the tongue, and focused, image-guided dissection can reduce surgical tissue trauma.

Laparoscopic retrieval of an unusual foreign body

Ingestion of foreign body is a serious problem commonly encountered in our clinical practice. Most of them pass spontaneously, whereas in others endoscopic or surgical intervention is required because of complications or non-passage from the gastrointestinal tract. We present here a case of teaspoon ingestion, which did not pass spontaneously. Laparoscopic retrieval of teaspoon was done from mid jejunum after enterotomy and the patient recovered uneventfully. Right intervention at the right time is of paramount importance.

Chronic cervical esophageal foreign bodies in children: surgical approach after unsuccessful endoscopic management

OBJECTIVES

We reviewed the surgical management of chronic cervical esophageal foreign bodies (CCEFBs) in a pediatric population after failed endoscopic retrieval.

METHODS

A descriptive analysis via a retrospective chart review of patients with CCEFBs who failed initial endoscopic management was performed between 2008 and 2013. Details were recorded regarding presenting symptoms, time from symptom onset to diagnosis of the CCEFB, surgical approach, and complications.

RESULTS

Three patients with CCEFBs unsuccessfully managed with endoscopy were identified. The range of ages at diagnosis was 14 months to 4.5 years. The foreign bodies (FBs) were present for at least 1 month before diagnosis (range, 1 to 10 months). Respiratory symptoms were predominant in all cases. Neck exploration with removal of the FB was performed in each case. Complications included esophageal stricture necessitating serial dilations (patient 1), left true vocal fold paresis that resolved spontaneously (patient 3), and tracheoesophageal fistula with successful endoscopic closure (patient 3). No long-term sequelae were experienced.

CONCLUSIONS

A high index of suspicion is required to recognize CCEFBs in children with respiratory distress. Although endoscopic management remains the first-line treatment, it may fail or may not be possible because of transmural FB migration. In this setting, neck exploration with FB removal is a safe and effective alternative.

Unusual foreign body in the vesico-urethral; 195 cm liquid pipe

Insertion of foreign bodies into the genitourinary system is a pathological action believed to increase sexual gratification usually for psychiatric patients and mentally retarded cases especially during masturbation. In this report, we represented a male case who is inserted a 195 cm cannula by himself into the bladder through the urethra because of his psychiatric disorder.

Retrieval of foreign body from a postoperative defect in the mandible during the follow-up period: A bizarre occurrence

Though reported cases of foreign bodies left intraoperatively in the oral cavity are very few, there is no case mentioned in the literature where foreign body was left behind during follow-up visits. Here, we present an operated case of unicystic ameloblastoma of mandibular ramus region, in which a needle hub was left at the operated site (cavity created because of wound dehiscence) during some of the follow-up visits, which was detected accidently by radiograph and later on retrieved. The case reported was because of negligence of trainee surgeons, might be because of overburden or because of minimal interest in these repeated follow ups. But, a trainee should understand that their work also has similar importance as that of surgeon's work.

Foreign bodies in the heart

BACKGROUND

Foreign bodies in the heart are rare, may reach the heart by different ways, and cause serious complications. X-ray, computerized tomography, and echocardiography are main diagnostic modalities. Foreign body can be removed surgically, percutaneously or can be managed conservatively. In this work, we analyzed 100 published cases of a foreign body in the heart and 4 cases that were identified in our hospital.

METHODS

We searched the literature for foreign body in the heart and found 100 published previously cases. Additional 4 cases were identified in our echo laboratory. A total series of 104 patients with a foreign body in the heart were analyzed for the etiology, clinical presentation, symptoms, complications and management.

RESULTS

Mean patients' age was 46, there were more men than woman 73 versus 31 [P < 0.00005]. The most common foreign bodies were parts of inferior vena cava filters and devices implanted for relieving hydrocephalus. Foreign bodies in the heart were symptomatic in 56% of patients. Right heart chambers were occupied more often. A total of 20% presented within the first 24 hours and 30% of patients presented years after the penetration of the foreign body. A majority of foreign bodies reached the heart by migration [88%]. Mortality was reported in 4 patients [3.8%]. Here 54% of the patients underwent surgical and 29% percutaneous removal of the foreign body, while 14% were followed conservatively.

CONCLUSION

Foreign bodies in the heart may present with a wide variety of symptoms. Physicians should be aware of this rare and peculiar complications which may be fatal. Larger devices may result in more severe complications.

Foreign body in a Zenker's diverticulum (looking for the lost dentures)

Zenker's diverticulum (ZD), an acquired false pharyngoesophageal diverticulum, is a rare pathology. The prevalence of ZD among the general population is believed to be between 0.01% and 0.11%. Most patients are elderly men with symptoms of dysphagia. The most common treatments are open surgical diverticulectomy with or without cricopharyngeal myotomy and endoscopic myotomy. The authors report the case of a dental prosthesis lodged within an asymptomatic ZD in a 73-year-old man. It was safely removed endoscopically. So far, there have only been single reports of entrapment of an enteroscopy capsule lodged in a ZD in medical literature.

A retrospective study of anesthesia during rigid bronchoscopy for airway foreign body removal in children: propofol and sevoflurane with spontaneous ventilation

BACKGROUND

Tracheobronchial foreign body aspiration is a significant cause of childhood morbidity and mortality. We analyzed our experience in management of aspirated foreign bodies, including methods of anesthesia used, over a 4-year period.

METHODS

We retrospectively reviewed the records of tracheobronchial foreign body removal by rigid bronchoscopy with spontaneous ventilation in 435 children. All patients had received initial anesthesia with inhaled sevoflurane. One hundred and ninety-seven patients (Group PropRemi) then received intravenous propofol and remifentanyl for maintenance of anesthesia; the remaining 238 patients (Group PropSevo) received propofol and sevoflurane.

RESULTS

Tracheobronchial foreign body was found in 405 children (93.1%) and successfully removed from 402 (99.3%) children. Among three patients who failed bronchoscopy, one child suffered cardiac arrest and died during the bronchoscopy, and two required subsequent tracheotomy for foreign body removal. Adverse effects (intraoperative coughing, breath holding, body movement, bronchospasm, and laryngospasm) were significantly more frequent in Group PropRemi than in Group PropSevo. No complications such as bleeding, pneumothorax, pneumomediastinum, or the need for thoracotomy were encountered.

CONCLUSION

Sevoflurane induction followed by a combination of sevoflurane and continuous infusion of propofol resulted in fewer adverse events than sevoflurane induction followed by TIVA with propofol and remifentanyl during rigid bronchoscopy for airway foreign body removal in children with spontaneous ventilation.

Myocardial infarction due to intracoronary embolization of percutaneous coronary intervention packaging

Intracoronary device loss is occasionally encountered and removal is commonly performed at the time of the procedure. We report a case of removal of a retained coronary balloon protective plastic tubing inadvertently left in the coronary artery for a month and associated with myocardial infarction. Optical coherence tomography was used to visualize the foreign body prior to removal with a snare. To our knowledge this is the first report of a removal of disposable packaging equipment after prolonged intracoronary dwell time.

Controlled ventilation or spontaneous respiration in anesthesia for tracheobronchial foreign body removal: a meta-analysis

BACKGROUND

Either controlled ventilation or spontaneous respiration is commonly used in general anesthesia for inhaled foreign body removal via rigid bronchoscopy. Controversy in the literature exists concerning which form of ventilation is optimally suited for bronchoscopy. We performed a meta-analysis to compare controlled ventilation and spontaneous respiration with respect to complications, operation time, and anesthesia recovery time.

METHODS

We searched MEDLINE (1946-2013) and the Cochrane Central Register of Controlled Trials, EMBASE. The articles were evaluated for validity, and the data on complications, including desaturation, laryngospasm, laryngeal edema, bucking and coughing, body movement, breath holding, operation time, and anesthesia recovery time, were extracted by the authors and summarized using odds ratios, mean differences, and 95% confidence intervals (CIs).

RESULTS

From the included studies, 423 subjects received controlled ventilation, whereas 441 subjects received spontaneous respiration. There was no significant difference in the incidence of desaturation between controlled ventilation and spontaneous respiration (odds ratio, 0.70; 95% CI, 0.30-1.63). However, the incidence of laryngospasm was lower when controlled ventilation was performed (OR, 0.27; 95% CI, 0.10-0.76). The operation time (mean difference, -9.07 min; 95% CI, -14.03 to -4.12) was shorter in the controlled ventilation group.

CONCLUSIONS

Current evidence does not show a preference for either controlled ventilation or spontaneous respiration, although laryngospasm has a lower incidence when controlled ventilation is performed. Additional clinical studies are required to substantiate this issue.

Detection of foreign bodies by spiral computed tomography and cone beam computed tomography in maxillofacial regions

Background and aims. The imaging techniques commonly used for foreign body detection include plain radiography, xeroradiography, computed tomography (CT) scans, magnetic resonance imaging (MRI) and ultrasonography. The aim of the present study was to compare cone-beam computed tomography (CBCT) with conventional CT scan in determination of the exact location of a foreign body in the maxillofacial area in vitro.

Materials and methods. In this descriptive study, seven different materials were selected as foreign bodies with dimensions of approximately 2 mm, 1 mm, and 0.5 mm. These materials consisted of metal, glass, wood, stone, plastic, graphite and tooth. These foreign bodies were placed in a sheep head between the corpus of the mandible and muscle, in the tongue and in an air space. One conventional CT scan and two CBCT scans were made on the models.

Results. Tooth, metal, stone and glass foreign bodies were seen clearly on CT and CBCT scans made by NewTom at the smallest size in air. However, CBCT scan by NewTom was a more effective technique for visualization of foreign bodies in air compared to conventional CT. Foreign bodies measuring 0.5 mm made of metal, stone, glass, graphite and teeth were detected by all devices in muscle tissue and adjacent bone.

Conclusion. According to the results, CBCT scans of NewTom and Planmeca are appropriate tools for detecting foreign bodies with relative high density in the maxillofacial area.

Bedside ultrasound diagnosis of intracardiac paperclip

Penetrating cardiac injuries are rarely reported in the literature. Foreign bodies are rarely seen in the heart and most patients with penetrating cardiac injuries die from hemorragic or pericardial tamponade before arriving at the hospital. Bedside ultrasonography is a highly valuable and readily learned tool that has expanded rapidly since its introduction more than 20 years ago. Our case was a 23-year-old convict brought to the emergency department (ED) with a history of continuous chest pain in the upper area of the left side of the chest for one week. Focused Cardiac Sonography (FOCUS) which was performed by emergency physician showed a strong echogenic linear structure with comet tail artifact, free floating in the mid-segment of the left ventricule. Exact localizations of the paperclips within the chest was obtained with multidetector computed tomography and one of them was seen in the left ventricular cavity. FOCUS plays a crucial role in these patients by diagnosing the injury and detecting the complications in emergency department.

A simplified training method for soft tissue foreign body detection using ultrasound in emergency medicine residency program

Using ultrasound for detecting soft tissue foreign bodies seems to be the preferred choice with minimum invasion and easy availability at the bedside in emergency departments. In this study, a workshop (1 hour of lecture presentation and 3 hours of interactive hands-on) was designed to evaluate the efficacy of a short course of simple interactive training to improve the ability of emergency medicine residents to detect foreign bodies with ultrasound. Eight pieces of fresh full thickness (10 × 10 × 10 cm) lamb leg muscle were used in this study. Five different types of foreign bodies, including: a piece of glass (5 × 5 × 4 mm), wood (5 × 5 × 4 mm), gravel (5 mm diameter), plastic (5 × 5 × 2 mm) and a nail (25 mm in length) were placed deep inside each lamb leg. An ultrasound machine with a 7.5 MHz linear probe was used in this study. 35 emergency medicine residents (12 PGY1, 11 PGY2 and 12 PGY3) were enrolled in this study. Pretest and post-test results were compared and analyzed. Among all 35 participants in the training session, foreign body detection was significantly improved after the workshop (p < 0.001). Overall sensitivity and specificity for differentiating the presence and absence of a foreign body with 95% confidence were 60% (75% for PGY3) and 85.7% (91.7% for PGY3), respectively. The overall accuracy increased from 20.2% to 72.8% due to this session. This study supported the possibility of using ultrasound to detect foreign bodies by emergency physicians with a very short training course. This is highly beneficial for overcrowded emergency departments.

Reliability of ocular ultrasonography findings for pre-surgical evaluation in various vitreo-retinal disorders

OBJECTIVE

To find the reliability of ocular ultrasonography (USG) for pre-surgical evaluation in various vitreo-retinal conditions.

METHOD

In a retrospective study, a chart review of patients who underwent preoperative USG for various vitreoretinal conditions was done. We correlated findings of preoperative USG with intraoperative findings.

RESULTS

131 of 130 patients were included. Various ocular pathologies included trauma, diabetic vitreous hemorrhage, endophthalmitis, and other causes of vitreous hemorrhage. We found overall sensitivity and specificity of 92.31% and 98.31% for identification of rhegmatogenous retinal detachment, and 96.2% and 100% for posterior vitreous detachment, respectively, whereas it was 100% for vitreous hemorrhage, preretinal bleed, and vitreous exudates. In eyes with trauma, sensitivity and specificity of USG for identifying the status of retina was least (90.9% and 97.7%).

CONCLUSION

Our study highlighted that the reliability of USG findings was least in cases of trauma, hence requiring special care while reporting.

Pathologic Findings in Primary Capsulectomy Specimens: Analysis of 2531 Patients

BACKGROUND

After breast augmentation, additional operations are often needed for revision or explantation. Although the surgeon may elect to leave the capsule in situ during these procedures, excised capsule tissue may be examined histopathologically for cancer cells.

OBJECTIVES

The authors assessed pathologic findings from breast implant capsules submitted for histopathologic examination and evaluated whether it is oncologically safe to leave capsule tissue in situ.

METHODS

The authors searched PALGA, the nationwide histopathology and cytopathology data network and registry in the Netherlands, for primary capsulectomy specimens excised between 2003 and 2012. The authors applied a sensitive search strategy with low specificity that included female and breast as the sex and anatomic location keywords, and wildcards were used to detect different spellings. Cases were excluded if previous examinations showed compatibility with a history of breast cancer, prophylactic mastectomy, or prophylactic oophorectomy. The pathologic reports were manually reviewed for relevance, and each case's diagnosis was registered. A total of 6803 reports were available, representing 4948 patients; 2574 reports from 2531 patients were included in this study. The median age of patients was 51.2 ± 12.0 years (range, 15-88 years).

RESULTS

Invasive carcinoma was detected in 4 patients (0.16%). Four patients (0.16%) had ductal carcinoma in situ, and 1 patient (0.04%) had lobular carcinoma in situ. Metaplasia was noted in 51 patients (2.0%), calcifications in 375 (14.6%), and silicone in 701 (27.2%).

CONCLUSIONS

The incidence of occult invasive or in situ carcinoma in capsulectomy specimens of patients with no previous breast pathology is low. Therefore, it appears oncologically safe to leave capsule tissue in situ.

LEVEL OF EVIDENCE

3.