Unusual presentations of foreign body in aerodigestive tract

Foreign bodies lodged in aerodigestive tract makes the commonest emergency in the otorhinolaryngology clinics. Diagnosis often becomes difficult with parental ignorance and lack of clear history. Patients with foreign body can have unusual presentations.

A bullet in the maxillary sinus

Maxillary Sinus is an unusual site for lodgment of foreign bodies. We present a rare case of impacted bullel in the right maxillary sinus which entered through the orbital floor which could be removed after using a nasal endoscope through a Caldwell luc approach.

Laparoscopic removal of a pancreatic foreign body

We present a case report of a laparoscopically retrieved foreign body that migrated into the pancreas. The patient is a 44-year-old man who presented with epigastric pain and was subsequently found by computed tomographic scan to have a foreign body in the head of the pancreas. After attempted endoscopic retrieval, we successfully removed the foreign body laparoscopically, thus avoiding laparotomy. Laparoscopy is an effective tool for pancreatic exploration.

Removal of foreign body from the trachea: An unusual method

Tracheobronchial foreign bodies can be sometimes very difficult to remove. This may be related to the location and type of foreign body, experience of the bronchoscopist and the availability of appropriate instruments.([1]) We report a case of an uncommon foreign body (artificial denture) in the trachea in an adult female following extubation after Lower Segment Caesarian Section (LSCS) in whom conventional methods to remove it failed. The foreign body was eventually removed via tracheostome using rigid bronchoscope and forceps.

Abdominal epilepsy and foreign body in the abdomen--dilemma in diagnosis of abdominal pain

There are many medical causes of abdominal pain; abdominal epilepsy is one of the rarer causes. It is a form of temporal lobe epilepsy presenting with abdominal aura. Temporal lobe epilepsy is often idiopathic, however it may be associated with mesial temporal lobe sclerosis, dysembryoplastic neuroepithelial tumors and other benign tumors, arterio-venous malformations, gliomas, neuronal migration defects or gliotic damage as a result of encephalitis. When associated with anatomical abnormality, abdominal epilepsy is difficult to control with medication alone. In such cases, appropriate neurosurgery can provide a cure or, at least, make this condition easier to treat with medication. Once all known intra-abdominal causes have been ruled out, many cases of abdominal pain are dubbed as functional. If clinicians are not aware of abdominal epilepsy, this diagnosis is easily missed, resulting in inappropriate treatment. We present a case report of a middle aged woman presenting with abdominal pain and episodes of unconsciousness. On evaluation she was found to have an intra-abdominal foreign body (needle). Nevertheless, the presence of this entity was insufficient to explain her episodes of unconsciousness. On detailed analysis of her medical history and after appropriate investigations, she was diagnosed with temporal lobe epilepsy which was treated with appropriate medications, and which resulted in her pain being relieved.

Broken guidewire fragment in the radio-brachial artery during transradial sheath placement: percutaneous retrieval via femoral approach

A case in which a 0.014" wire was broken during the sheath placement in the radial artery for transradial coronary procedure is described here, and a successful retrieval of it using conventional methods is also described. Through the left femoral artery, the 6 Fr guiding catheter was advanced down to the tip of the broken wire at the brachial artery, and the distal part of the broken guidewire was captivated into the guiding catheter. By inflating the balloon catheter inside of the guiding catheter, seized broken guidewire between the inflated balloon and the guiding catheter was removed successfully by withdrawing the whole system en bloc.

Gastric perforation secondary to ingestion of a sharp foreign body

Foreign body ingestions are commonly seen by pediatricians and emergency room personnel. The majority of foreign bodies transit through the gastrointestinal system without any complications. Perforations are uncommon and usually involve peritonitis. We present a case of gastric perforation secondary to ingestion of a sharp metallic pin. Our patient did not demonstrate any of the classic findings described in the literature. His complaints, physical examination, and radiological findings all pointed to acalculous cholecystitis or biliary dyskinesia as the source of pain. Laparoscopy, however, provided the definitive diagnosis. Gastroduodenal perforation secondary to foreign body ingestion should be included in the differential diagnosis of these atypical cases of abdominal pain, especially if such history can be elicited from the patient.

Foreign bodies in the upper aero-digestive tract

Foreign bodies in the upper aero-digestive tract pose major challenges to the otolaryngologist in both diagnosis and management. Aspirated and ingested foreign bodies are often emergencies, leading to inadequate study and poorly prepared, improper attempts at removal. The authors share their experience in managing upper aero-digestive tract foreign bodies in Omani population at a district hospital, present a statistical review of 58 cases, and highlight certain critical scenarios as well as cultural variations specific to the region.

Late complication of laparoscopic salpingoophorectomy: retained foreign body presenting as an acute abdomen

BACKGROUND

Laparoscopy is widely used as a tool in many clinical situations allowing for diagnosis and/or surgical management in a minimally invasive fashion. Most laparoscopic cases are ambulatory and allow patients to recover quickly. Nonetheless, attention to surgical technique is paramount to avoid both short and long term complications.

CASE

A 32-year-old woman had a laparoscopy and a reported left salpingoophorectomy for benign disease of the ovary in September, 1994. Shortly thereafter, in January, 1995, she was diagnosed with an intrauterine pregnancy and delivered in October of 1995 by spontaneous vaginal delivery. The pregnancy and delivery were both uncomplicated. The patient presented four weeks postpartum with clinical suspicion of appendicitis. However, at the time of laparotomy, the patient was found to have a retained foreign body from her prior laparoscopy in the right lower quadrant with a pelvic abscess and evidence of prior right salpingoophorectomy. The appendix appeared grossly normal.

CONCLUSION

Laparoscopy is a safe, effective modality for various surgical and gynecologic conditions. Although laparoscopy is usually done on an outpatient basis, complications can manifest several weeks or months later. This case illustrates and reminds us of the importance of adherence to surgical laparoscopic principles. These include direct visualization when removing equipment and a complete count of surgical instrumentation to confirm the integrity of such at the end of each procedure.

Foreign body impaction arising in adulthood: a result of neonatal repair of tracheo-oesophageal fistula and oesophageal atresia

Over a 3-month period, four patients presented to Salisbury District Hospital with symptoms of oesophageal foreign body impaction and dysphagia for solids. In their first few days of life all four patients had undergone successful operations for the repair of congenital oesophageal atresia with or without a tracheo-oesophageal fistula. Despite our efforts, the previous medical records were unavailable to ascertain the exact form of surgery each patient had received. All four patients had flexible oesophagogastroscopy by one of the authors (RAF). Three were found to have a food bolus obstructing the oesophagus, lodged above or within a ring stricture at the presumed level of their surgical repair and oesophageal anastomosis. The fourth patient had a ring stricture only; it was assumed that the food bolus had become disimpacted. All four patients had successful dilatations using thermoplastic oesophageal dilators. After the procedure all the patients were symptom free and remain so at varying lengths of follow-up. Case studies of these patients are presented below along with a review of the literature concerning the relatively rare presentation of dysphagia in adults who had previously undergone neonatal surgery for congenital oesophageal anomalies.

Broken hand or broken nose: a case report

We report an unusual case of a foreign body in the hand, following a type of injury commonly encountered in the accident and emergency (A&E) department.

Pharyngeal trauma as a result of blind finger sweeps in the choking child

We present a case report to highlight the risk of pharyngeal trauma, as a result of blind finger sweeps in the choking infant.

Endoscopic extraction of a perforating wire from the stomach

A Report on the succesful endoscopic removal of a wire 3.8 cm long which perforated the gastric wall.

Fistulography as an aid in the diagnosis of a nonradiopaque foreign body in a dog

A case of chronic fistula associated with foreign body penetration of the soft tissues was diagnosed in the skull of a dog by fistulography. Radiographic technique and diagnostic features are described and illustrated.

Foreign bodies in the aerodigestive tract

Foreign bodies in the aerodigestive tract are common. They may cause minimal disturbance of function, severe morbidity or even sudden death. They enter the aerodigestive tract because of haste during eating, disturbances in physical function, impairments due to extreme youth or age, or contamination of food with foreign bodies. Common symptoms are pain, dysphagia, odynophagia, cough, airway distress, hemoptysis and hematemesis. Signs include point tenderness, respiratory distress and surgical emphysema. Clinical, radiological and endoscopic investigations are described, as are principles of crisis and elective management.