Retained rectal foreign body with rectal perforation; a complication of the traditional management of haemorrhoids: a case report

Retained rectal foreign bodies are most commonly seen in homosexuals and after assault. A few have been reported after self-treatment of anorectal conditions and prostatic massage. Harmful traditional medical practices have been reported in many communities in Africa but therapeutic anal insertion of foreign bodies for the management of haemorrhoids is rare. We present a patient with features of peritonitis following insertion of a wine bottle into his rectum in an attempt to manage his prolapsed haemorrhoids.

Transparent cap-assisted endoscopic management of foreign bodies in the upper esophagus: a randomized, controlled trial

OBJECTIVES

Ingestion of foreign bodies (FBs) in the upper esophagus is common in South China. It is difficult to manage because of limited working space and inadequate visual field in this area. This randomized, controlled study aimed to evaluate the usefulness of a transparent cap in the endoscopic management of FBs in the upper esophagus.

METHODS

Adult patients suspected of FBs in the upper esophagus based on the history of FBs ingestion, symptoms, and barium contrast examination were screened for the study between March 1, 2009 and December 31, 2010. Seventy patients with endoscopic-confirmed FBs in the upper esophagus were recruited and were randomly assigned to two groups: transparent cap-assisted esophagogastroduodenoscopy group (n = 35) or conventional esophagogastroduodenoscopy group (n = 35). The type, size, and location of FBs, the operation time for removing the FBs, and the clearness of visual field were compared between these two groups.

RESULTS

The type, size, and location of FBs were similar between the two groups (P > 0.05). The average operation time for removing the FBs was significantly shorter in the transparent cap-assisted group than in the conventional group (2.6 min vs 4.1 min, P = 0.008). Visual field was rated as "clear" in more cases in the transparent cap-assisted group than in the conventional group (97.1% vs 25.7%, P < 0.0001).

CONCLUSIONS

Transparent cap-assisted endoscopy was a safe and effective method in the management of FBs in the upper esophagus, with a shorter operation time and clearer visual field.

Toothpick perforation of the intestines presenting as recurrent abdominal pain: possible roles of abdominal ultrasound and MRI

We report the case of a middle-aged man admitted for five months of unexplained left lower quadrant pain. He had been hospitalized on two prior occasions and treated with broad spectrum antibiotics. His clinical presentation was suggestive peritoneal irritation with severe, focal pain on abdominal palpation. Computed tomography scans showed non-specific inflammation in the left lower abdomen with adjacent small bowel wall thickening. Upper endoscopy and colonoscopy were unremarkable on prior admission. Given the severity and focality of the patient’s recurrent abdominal pain he underwent laparoscopy and was found to have a wooden toothpick perforation of the small bowel thirty centimeters from the ileocecal valve requiring partial small bowel resection. The patient did well post-operatively. On retrospective questioning he may have eaten a cabbage roll or bacon wrapped shrimp pierced with a toothpick weeks before the onset of symptoms. Toothpick perforation should be a consideration in edentulous persons with focal, severe abdominal pain and trans-abdominal ultrasound or MRI may be a better choice for detecting wooden foreign objects.

Perforation of Meckel's diverticulum by a wood splinter in a 4-year-old child: a case report

Perforation of Meckel's diverticulum by a foreign body represents an unusual and serious clinical occurrence. We present a case of a 4-year-old male who was admitted with symptoms of abdominal pain in the right iliac fossa, raising the suspicion of acute appendicitis. Exploratory laparotomy disclosed normal appendix and perforation of Meckel's diverticulum caused by a wood splinter. Meckel's diverticulectomy was performed and the child had an uneventful postoperative course. Preoperative diagnosis of perforated Meckel's diverticulum remains a challenging issue. Diagnosis should be considered in the presence of a right lower quadrant abdominal pain or a positive history of ingestion of a sharp foreign body.

Injury to the Temporal Lobe via Medial Transorbital Entry of a Toothbrush

Objectives Intracranial penetration by foreign bodies entering via the orbit represent an unusual form of traumatic brain injury. Nevertheless, much is at stake with high risk for cranial nerve and neurovascular injury. We present a case where the bristled end of a toothbrush entered the brain as a projectile via the superior orbital fissure and discuss considerations for surgical management.

Setting A 35-year-old woman suffered a periorbital injury after her husband threw an electric toothbrush at a wall and the head of the toothbrush became a missile that projected through her superior orbital fissure and into her right temporal lobe. She complained of headache and incomplete vision loss in the affected eye.

Intervention After obtaining a cerebrovascular angiogram, we proceeded with emergent orbital decompression and anterograde extraction of the foreign body via a modified frontotemporal orbitozygomatic approach with drilling of the skull base allowing for en bloc removal of the toothbrush.

Conclusions The patient recovered well with improvement in her vision and partial third and sixth nerve palsies. This report illustrates a unique mechanism of injury with a novel intracranial foreign body. We review the neurosurgeon's need for prompt management with an approach customized to the structure of the offending object, the damaged elements, and the surrounding cranial nerves and vascular anatomy.

Burried broken extraction instrument fragment

Despite adequate effort to perform tooth removal carefully, some accidents may happen when defective instruments are unknowingly used. This article reports of a non-symptomatic case of a retained fractured dental elevator tip during an uneventful extraction a decade earlier. Patient was not aware till routine radiographic examination revealed its presence. Use of three dimensional imaging techniques in this case is highlighted. Rarely, instruments breakage may occur during surgical procedures. It is duty of the dentists to check the surgical instrument for signs of breakage and be prepared to solve a possible emergency. Retained fragments should be carefully studied prior to attempt of removal.

Foreign Body Reaction with High Standard Uptake Value Level in 18-FDG PET/CT Mimicking Relapse in an 8-Year-Old Patient Diagnosed with Hodgkin Lymphoma: A Case Report

Combined positron emission tomography and computed tomography (PET/CT) using 18-fluorodeoxyglucose (18-FDG) is one of the most effective methods to identify pathological lymph node involvement. We report the case of a child who underwent cervical lymph node biopsy and chemotherapy for Hodgkin disease. Three years after surgery, PET/CT identified an intense localization of 18-FDG in the inferior cervical region. This finding led to a reexcision of the mass. The only finding was a granuloma arising in reaction to a hemostatic sponge.

Diagnostic exercise: poor performance in a racehorse

A 9-year-old Thoroughbred gelding presented with a 97-day history of poor performance and intermittent fever. Clinicopathologic changes included increased serum activity of γ-glutamyltransferase and alkaline phosphatase, mild hyperbilirubinemia, and leukocytosis with neutrophilia and lymphopenia. Abdominal ultrasound revealed hepatomegaly with hyperechoic hepatic parenchyma and biliary distention. Pathologic findings included marked hepatomegaly (liver 3.6% of body weight), firm hepatic consistency with a diffuse enhanced reticular pattern, severe portal bridging and sinusoidal fibrosis, oval cell/bile duct hyperplasia, and bile stasis. The differential diagnoses and diagnostic workup to achieve the diagnosis are briefly discussed.

Foreign body of endodontic origin in the maxillary sinus

Foreign bodies found in the maxillary sinus include tooth roots, burs, dental impression material, root-filling materials, dental implants, and needles. The purpose of this paper was to present an unusual case of a large foreign body of endodontic origin (root-filling material) removed from the maxillary sinus. A 45-year-old generally healthy male patient reported to the Department of Conservative Dentistry with Endodontics of the Medical University of Silesia, because of orbital and buccal pain on the right side of his face and headaches in the preceding 6 months. Those symptoms were associated with the end of endodontic treatment of teeth 14 and 16. Periapical X-rays, including of teeth 14 and 16, showed the presence of root canal filling with extrusion of endodontic obturation material beyond the apices of tooth 14. In the case of tooth 16, a completely filled palatal canal and incompletely filled buccal canals were found. There was also an irregular dimness at the upper edge of the X-ray image. Panoramic radiography and computed tomography demonstrated a foreign body in the right sinus. Sinus exploration was performed via a surgical procedure conducted using topical anesthesia. The root apices of tooth 14 were resected, and foreign substance was removed. The practitioner did not correctly recognize a complication that occurred during endodontic treatment, which resulted in extrusion of endodontic material beyond the root apices of tooth 14. This case emphasizes the potential impact that an involved maxillary sinus may have on endodontic therapy. Detailed diagnostic identification based on the medical interview, physical and histopathological examinations, and diagnostic imaging allowed rapid surgical intervention and prevented local and general complications. It is important to realize that the range of the periapical X-ray projection is not always sufficient.

Cryoextraction: A novel approach to remove aspirated chewing gum

The extraction of aspirated foreign bodies can prove challenging at times, requiring even rigid bronchoscopy. Cryotherapy probes have been reported to help with extraction of foreign bodies. We present a case where successful “cryoextraction” was performed on an aspirated chewing gum. The case highlights the fact that this technique is useful to extract all materials that have water content. This technique can be performed through flexible bronchoscopy and can save patients from more aggressive approaches.

Factors associated with development of complications after endoscopic foreign body removal

BACKGROUND/AIMS

We analyzed the clinical characteristics of patients who underwent endoscopic foreign body removal and the risk factors of complications.

PATIENTS AND METHODS

The medical records of 415 patients treated from January 2000 to August 2011 for suspected foreign bodies were retrospectively reviewed. Patient characteristics, endoscopic findings, clinical outcomes, and risk factors of complications were analyzed.

RESULTS

Foreign bodies were detected endoscopically in 315 patients. Fish bone fragment (36.9%) and coins (15.3%) were the most common type of foreign bodies in adults and children, respectively. Complications associated with endoscopic procedure occurred in 26 patients (8.3%); 20 of the patients were treated conservatively and the other six patients underwent surgical treatment. Perforation (14%) was the most common complication. By univariate and multivariate analysis, the risk factors associated with complication after endoscopic foreign body removal were long duration from ingestion to endoscopy ( P = 0.009) and existence of initial mucosal injury ( P = 0.018).

CONCLUSIONS

Most foreign bodies were successfully removed by endoscopy without complication, but long duration from ingestion to endoscopy and mucosal injury were risk factors of complications of endoscopic foreign body removal. Patients with these risk factors could require more careful treatment.

Intracranial metallic foreign bodies in a man with a headache

We report the case of a 22-year old man with intracranial metallic foreign bodies who presented complaining of a headache. His history of headaches had begun when he was five years old and continued with increasing severity. Six months before hospital admission, nausea and vomiting began to accompany his headache. Computed tomography scan revealed that 2 metallic foreign bodies were located adjacent to the vertex and another was next to the ambient cistern. The location and position of foreign bodies suggested that they were introduced in infancy through the anterior fontanelle before its closure in an unsuccessful homicide attempt. This case is one of the few reported cases combining headache and intracranial foreign bodies and we discuss the relationship between headache and these metallic materials.

Multiple live leeches from nose in a single patient- a rare entity

Foreign bodies are a common cause of unilateral epistaxis in children. Both animate: and inanimate foreign bodies are commonly found but, leech as a cause of epistaxis is rare. Cases of leech infestation have been reported in the past but infrequently. Here we report an unusual case of bilateral epistaxis in a four years old child who had infestation with multiple live leeches.

Foreign body-induced abscess resembling pancreatic neoplasia

We report the case of a 44-year-old man presenting with abdominal pain and leukocytosis. His initial computed tomography demonstrated a pancreatic head mass concerning for pancreatic adenocarcinoma. However, on further review of the patient's imaging, the mass was determined to be an abscess caused by foreign body ingestion and gastric perforation rather than cancer. This report describes the clinical and radiographic distinctions between pancreatic neoplasia and abscess. It also reviews the pertinent medical literature on how such viscus perforations affect subsequent prognostication and clinical management.

Foreign body esophagus in a neonate: Unusual age and unusual presentation

Foreign body ingestion in neonatal period is an uncommon occurrence, despite foreign ingestion being common among pediatric age group. We report a rare case of foreign body esophagus in a 12-day-old female neonate causing obstructive symptoms after a homicidal attempt. The unusual age and circumstances involving the ingestion of the foreign body prompted us to report this case.

Chronic swelling from entrapment of acrylic resin in a surgical extraction site

When acrylic resin is inadvertently embedded in oral tissue, it can result in a pronounced chronic inflammatory response. This report describes a case in which temporary crown and bridge resin was forced into a surgical extraction site after the two adjacent teeth were prepared for a bridge immediately following extraction of a maxillary premolar. The patient experienced swelling at the extraction site over a ten month period despite treatment with antibiotics and anti-inflammatory drugs. After detection and removal of the foreign body, the symptoms resolved. The episode contributed to periodontal bone loss around an adjacent tooth. While morbidity of this nature is rare, this case reinforces the need to investigate persistent signs of inflammation and account for dental materials that are lost during the course of treatment.

Displaced nasal dilator caused severe pain: Case report and literature review

Internal nasal dilators are widely used but have not been reported to cause severe symptoms. We describe a case in which a male adult had accidentally, during sleep, inhaled a nasal dilator into his right nasal cavity, and we review the relevant literature. A PubMed search was performed of nasal dilators, especially of the internal types, including "Nasaline Snooze'" (ENTPro, Stockholm, Sweden). A foreign body in adults may be an inhaled nasal dilator. It may be overlooked on computed tomography scans, and thorough inspection of the nose is diagnostic.

Endoscopic management of impacted esophageal foreign bodies

There are many reports on the endoscopic management of ingested foreign bodies in the upper gastrointestinal tract, however, little is known about the management of a specific subset of esophageal foreign bodies - impacted esophageal foreign bodies (IEFBs), especially perforating esophageal foreign bodies (PEFBs). The aim of this retrospective study on 78 cases was to report experience and outcome in the endoscopic management of the IEFBs in Chinese patients. From January 2006 to July 2011, a total of 750 patients with suspected upper gastrointestinal foreign bodies were admitted to the endoscopy center. Among these 750 patients, 78 cases that met the defined criteria of IEFBs were retrospectively enrolled in the present study, including 12 cases (12/78, 15.4%) with PEFBs. The major types of IEFBs were poultry bones (35.9%) and fish bones (17.9%). Most of the IEFBs (80.8%) were located in the upper esophagus, as were two thirds (66.7%) of the PEFBs. Foreign-body retrieval forceps were the most frequently used accessory devices. Extraction of IEFBs failed in eight patients (10.3%) during the endoscopic procedure. The difficult points in endoscopic management were PEFBs, IEFBs with sharp points, and those with impaction for more than 24 hours. IEFBs should be treated as early as possible, and their endoscopic management is safe and effective. Endoscopic management is the first choice for PEFBs when the duration of impaction is less than 24 hours and there are no abscesses outside of the esophageal tract as determined by a computed tomography scan.

Arthroscopic bullet removal from the acetabulum (hip joint)

Hip arthroscopy has been shown to offer minimally invasive access to the hip joint compared with standard open arthrotomy. The use of arthroscopy for diagnosing and treating disorders about the hip continues to evolve. This study describes a case that involves arthroscopic removal of a bullet from a low-velocity gunshot wound. The patient sustained a gunshot wound that entered the abdomen and traversed the small bowel, sigmoid colon then penetrated the urinary bladder before ending up in the medial wall of the acetabulum. After surgical repair of the viscus, the bullet was retrieved from the hip joint using standard arthroscopic portals and a fracture table. A number of issues led to the decision to use arthroscopy. Most importantly was the need to minimize soft tissue dissection, which was required to access the bullet, without interfering with previous wound at the suprapubic area. The risks of potential bullet fragmentation and migration, as well as a possible abdominal compartment syndrome were considered before proceeding. Arthroscopy allowed adequate inspection of the articular surface, irrigation of the joint, and removal of the foreign body while avoiding an invasive arthrotomy with its associated morbidity and soft tissue disruption. This surgical technique afforded a very satisfactory outcome for this patient and serves as a model for others when encountering a similar injury pattern in a trauma patient. It is a procedure that can be performed safely, quickly, and with minimal complications for surgeons with experience in arthroscopy of the hip joint.

Unilateral foul smelly nasal discharge in an adult

The incidence of rhinolith is by far very low compared to the nasal foreign bodies, especially in adult. Foreign body (FB) in the nostril will lead to unilateral nasal symptom which can start with nasal obstruction or discomfort. In younger children, they may miss to report the problem to the parents but, later on, the FB will manifest itself with unilateral nasal discharge, which at most of the time fouls smells. We report a case of a healthy adult female who presented with unilateral foul smelly nasal discharge which later was diagnosed as rhinolith, with rubber-tip pencil eraser as the nidus of calcification.

Foreign body aspiration pneumonia in an intravenous drug user

Heroin use is associated with several well described respiratory complications, including noncardiogenic pulmonary edema, aspiration pneumonitis, acute respiratory distress syndrome,pneumonia, lung abscess, septic pulmonary emboli, and atelectasis. We describe an interesting case of a young female patient, an intravenous heroin user who presented with progressive dyspnea, hypoxia, and left lung consolidation.

A child presenting with a bullet in the middle ear: case report

Introduction

Foreign bodies in the external auditory canal are common in both adults and children. Removal of the foreign body requires skill, but is usually successfully performed in the emergency department. We report a case of a child with a bullet in ear canal which was pushed into the middle ear during an attempt to remove it.

Case Presentation

A 6-year-old Thai boy went to the community hospital with his parents, who reported that their child had pushed a bullet into his ear. Otoscopic examination revealed a metallic foreign body in his external auditory canal. The first attempt to remove the foreign body failed and the child was referred to an otolaryngologist. We found that the tympanic membrane was ruptured, with granulation tissue in the middle ear and the bullet was located in the hypotympanum. The foreign body was removed via a post-auricular approach.

Conclusion

Removal of a foreign body from external auditory canal is an essential skill for physicians. Careful removal can prevent further trauma and complications. When the first attempt fails, referral to an otolaryngologist is recommended.

A swallowed dental prosthesis causing duodenal obstruction in a patient with schizophrenia: Description of a new technique

INTRODUCTION

Foreign body ingestion has been a fundamental subject in the area of emergency surgery. The problem is encountered across all age groups; however, it is more common in the pediatric age group. Foreign body ingestion is rare in adults and usually occurs accidentally or in those with psychiatric problems, behavioral disorders, emotional disturbance, mental retardation, or impaired judgment caused by alcohol use.

PRESENTATION OF CASE

A 33-year-old Caucasian man with chronic schizophrenia was admitted to the emergency department with signs of upper gastrointestinal discomfort as a result of ingestion of a lower dental prosthesis. An abdominal X-ray showed the swallowed dental prosthesis in front of the vertebral column. A technique comprising gastrotomy and duodenal kocherization was used to remove the dental prosthesis; the prosthesis could not be removed endoscopically due to its fixed position on the duodenal wall.

DISCUSSION

Surgery of the duodenum is difficult and carries high mortality and morbidity. Therefore, endoscopy should be the first choice for patients in whom a foreign object is demonstrated to be fixed in the duodenum. In cases where endoscopic extraction fails, surgery should be considered. During surgery, foreign bodies should be removed, paying meticulous attention not to harm the integrity of the duodenum.

CONCLUSION

The technique presented in this study was performed successfully without any injury to the duodenum.