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Yadav A, Thakur R, Sasani A, Siddharth, Kiran U, Yadav A, Shah JH, Jearth V, Rana SS. Decision-to-scope score: a novel tool with excellent accuracy in predicting foreign bodies in the esophagus. J Gastroenterol Hepatol 2023; 38:1664. [PMID: 37490941 DOI: 10.1111/jgh.16306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/10/2023] [Indexed: 07/27/2023]
Affiliation(s)
- A Yadav
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - R Thakur
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - A Sasani
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - Siddharth
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - U Kiran
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - A Yadav
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - J H Shah
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - V Jearth
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - S S Rana
- Department of Gastroenterology, PGIMER, Chandigarh, India
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2
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Pranavan S, Mayorathan U, Munasinghe BM. A fatal aorto-oesophageal fistula due to a mutton bone: A case report. Int J Surg Case Rep 2023; 108:108478. [PMID: 37421771 PMCID: PMC10382798 DOI: 10.1016/j.ijscr.2023.108478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 07/10/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE OF THE CASE Aorto-oesophageal fistula (AEF) following foreign body ingestion is rare and conservative management is always fatal. The delayed presentation further confounds poor outcomes. PRESENTATION OF CASE A 46-year-old South-Asian woman presented with pain and difficulty in swallowing following ingestion of a mutton-containing meal. The patient refused urgent upper GI endoscopy and was initially managed conservatively on the basis of the resolution of symptoms and hemodynamic stability and was discharged home. On review a week later, the patient did not consent to a UGIE. She presented the next day with a severe upper GI bleed. Due to profuse haemorrhage, a bleeding point could not be identified, and she suffered a cardiac arrest. Attempts at resuscitation were unsuccessful. The autopsy revealed an AEF caused by a sharp mutton bone lodged in the lower oesophagus. CLINICAL DISCUSSION High-risk food bolus impactions such as the ones caused by sharp objects need urgent endoscopy to confirm the position and extraction if safe. AEF occurs with time and could result in massive haemorrhage and mediastinitis. Endoscopic stenting, thoracoscopic surgery, and open repair are methods of emergent and definite management that still carry significant mortality. CONCLUSION Management of AEF requires early diagnosis with a high index of suspicion, endoscopic and CT-based angiography studies, and surgical interventions tailored to patients based on the available expertise. High-risk patients should be similarly educated on the probable complications and the symptomatology.
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Affiliation(s)
| | | | - B M Munasinghe
- Department of Anaesthesiology and Intensive Care, Queen Elizabeth the Queen Mother Hospital, Margate, Kent, UK.
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3
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Das SS, Krishnan S, Mandhane NK, Shalak HS. Intentional Ingestion of Foreign Bodies: A Physician's Agony. Cureus 2023; 15:e37677. [PMID: 37206521 PMCID: PMC10189832 DOI: 10.7759/cureus.37677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
Intentional foreign body ingestion is the phenomenon wherein one swallows a non-digestible object with the intent to cause self-injury. It is intentional in adult patients with a positive psychiatric history and can be a recurrent issue. Although the incidence of this condition is increasing, there are few existing articles on the subject that highlight its importance. This case report aims to present a unique patient encounter to emphasize the multispecialty approach required for management and provide an overview of the literature available on the subject regarding types of objects swallowed, selection of appropriate imaging modalities, and plans of management.
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4
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Chirica M, Bonavina L. Esophageal emergencies. Minerva Surg 2023; 78:52-67. [PMID: 36511315 DOI: 10.23736/s2724-5691.22.09781-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The esophagus is a deeply located organ which traverses the neck, the thorax, and the abdomen and is surrounded at each level by vital organs. Because of its positioning injuries to the esophagus are rare. Their common denominator is the risk of the organ perforation leading to spillage of digestive contents in surrounding spaces, severe sepsis and eventually death. Most frequent esophageal emergencies are related to the ingestion of foreign bodies or caustic agents, to iatrogenic or spontaneous esophageal perforation and external esophageal trauma. Early diagnosis and appropriate management are the keys of successful outcomes.
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Affiliation(s)
- Mircea Chirica
- Department of Digestive Surgery, Grenoble Alpes University Hospital, Grenoble, France -
| | - Luigi Bonavina
- Medical School, Division of General Surgery, IRCCS San Donato Polyclinic, University of Milan, Milan, Italy
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5
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Primary aortoesophageal fistula from metallic bristle ingestion. J Vasc Surg Cases Innov Tech 2022; 8:77-80. [PMID: 35128220 PMCID: PMC8799993 DOI: 10.1016/j.jvscit.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/15/2021] [Indexed: 11/24/2022] Open
Abstract
Although many patients are treated for the removal of ingested foreign objects each year, ingestions that perforate the esophagus and lead to intra-abdominal complications are rare. Aortoesophageal fistulas and aortic pseudoaneurysms are deadly complications of esophageal foreign body impaction. However, the surgical approach to aortic repair from foreign object damage has not been standardized. We have described the diagnostic, open surgical, and therapeutic approach to treating a man who had accidentally ingested a 3-cm metallic bristle that lodged in his aortic wall. The patient recovered after excision of the aortic pseudoaneurysm with CryoGraft (CryoLife, Inc, Kennesaw, Ga) replacement, drainage of abscesses, and antibiotic treatment for multiple infections.
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6
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Selected Injuries. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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7
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Li X, Ye J, Yang X, Yu J. Sonographic diagnosis of an unusual cervical foreign body that migrated through a pyriform sinus fistula. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:141-144. [PMID: 32266717 DOI: 10.1002/jcu.22841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/24/2020] [Accepted: 03/29/2020] [Indexed: 06/11/2023]
Abstract
Foreign body ingestion is common in the pediatric population. We report a case of ingestion of sunflower seeds that migrated in the left neck through a pyriform sinus fistula, ultrasound plays an important role in preoperative diagnosis and is a useful tool for diagnosing both pyriform sinus fistulas and radiolucent foreign bodies.
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Affiliation(s)
- Xiaoying Li
- Department of Ultrasound, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jingjing Ye
- Department of Ultrasound, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xiuzhen Yang
- Department of Ultrasound, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jin Yu
- Department of Ultrasound, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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8
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Marjara J, Al Juboori A, Aggarwal A, Davis RM, Bhat AP. Metalophagia: Splenic artery pseudoaneurysm after foreign body ingestion and retrieval. Radiol Case Rep 2020; 15:1149-1154. [PMID: 32528603 PMCID: PMC7280363 DOI: 10.1016/j.radcr.2020.04.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 02/08/2023] Open
Abstract
Persistent eating of non-nutritive, nonfood substances (Pica) is seen in children and adult patients with psychiatric problems. Ingestion of multiple metallic FBs with resultant bezoar formation is rare. While many FBs are passed without complication, mucosal injury, bleeding, obstruction or perforation can occur in some cases. Endoscopic FB removal is performed in 20% of patients following FB ingestion. Generally, these are safe procedures, and very effective in extracting ingested FBs. We report, a 25-year-old male patient with a metal ingestion predominant Pica, requiring multiple prior extraction procedures (including open gastrostomy). He developed a splenic artery pseudoaneurysm following his latest endoscopic FB removal, that was successfully treated with transarterial coil embolization. The unique circumstances leading to this rare complication and its successful endovascular management make this case worthy of report.
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Affiliation(s)
- Jasraj Marjara
- University of Missouri-Columbia School of Medicine, One Hospital Drive, Columbia, MO 65212, USA
| | - Alhareth Al Juboori
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Missouri-Columbia, One Hospital Drive, Columbia, MO 65212, USA
| | - Arpit Aggarwal
- Department of Psychiatry, University of Missouri-Columbia, One Hospital Drive, Columbia, MO 65212, USA
| | - Ryan M Davis
- Department of Radiology, Section of Vascular and Interventional Radiology, University of Missouri-Columbia, One Hospital Drive, Columbia, MO 65212, USA
| | - Ambarish P Bhat
- Department of Radiology, Section of Vascular and Interventional Radiology, University of Missouri-Columbia, One Hospital Drive, Columbia, MO 65212, USA
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9
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Ruan WS, Li YN, Feng MX, Lu YQ. Retrospective observational analysis of esophageal foreign bodies: a novel characterization based on shape. Sci Rep 2020; 10:4273. [PMID: 32144333 PMCID: PMC7060256 DOI: 10.1038/s41598-020-61207-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 02/24/2020] [Indexed: 11/09/2022] Open
Abstract
This single-center retrospective study aims to investigate the clinical features of esophageal foreign bodies (EFBs) and determine the influence of EFB shapes on management and prognosis. A total of 427 patients aged 13 to 95 years with suspected EFB ingestion were enrolled between January 2013 and June 2018, 183 of whom were male. EFBs were divided into six shapes: pin (n = 161), sheet (n = 97), trident (n = 51), spindle (n = 66), irregular (n = 46), and sphere (n = 6). Spindle-shaped EFBs correlated with a significantly higher rate of perforation and severe complications (P < 0.001 and P = 0.021, respectively) than any other EFB shape, while sheet-shaped EFBs were linked to less severe complications (P = 0.006). The number of pressure points was provided to stratify the risk of poor prognosis for each shape. EFBs with only two pressure points (pin and spindle EFBs) required more advanced management strategies and were correlated with a higher number of patients suffering esophageal perforation (27.11%) and severe complications (12.44%) when compared with other shapes (χ2 = 11.149 and P = 0.001; χ2 = 5.901 and P = 0.015, respectively). Spindle shape was an independent risk factor for poor prognosis, and contributed a more clinical risk than the pin shape. In conclusion, clinical features, management, perforation rate, and severe complications differed based on EFB shape. The EFBs with two pressure points, especially the spindle-shaped EFBs, were more dangerous compared with those with more pressure points.
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Affiliation(s)
- Wei-Shuyi Ruan
- Department of Emergency Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China.,Department of Geriatric Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China.,Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Yu-Ning Li
- School of Mathematical Sciences, Zhejiang University, Hangzhou, 310058, Zhejiang, People's Republic of China
| | - Meng-Xiao Feng
- Department of Emergency Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China.,Department of Geriatric Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China.,Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Yuan-Qiang Lu
- Department of Emergency Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China. .,Department of Geriatric Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China. .,Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, People's Republic of China.
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10
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Selected Injuries. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_57-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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Cunqueiro A, Gomes WA, Lee P, Dym RJ, Scheinfeld MH. CT of the Neck: Image Analysis and Reporting in the Emergency Setting. Radiographics 2019; 39:1760-1781. [PMID: 31589582 DOI: 10.1148/rg.2019190012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Interpreting findings seen at CT of the neck is challenging owing to the complex and nuanced anatomy of the neck, which contains multiple organ systems in a relatively small area. In the emergency department setting, CT is performed to investigate acute infectious or inflammatory symptoms and chronic processes. With few exceptions, neck CT should be performed with intravenous contrast material, which accentuates abnormally enhancing phlegmonous and neoplastic tissues and can be used to delineate any abscesses or necrotic areas. As part of the evaluation, the vascular structures and aerodigestive tract must be scrutinized, particularly for patency. Furthermore, although the patient may present because of symptoms that suggest non-life-threatening conditions involving structures such as the teeth or salivary glands, there may be serious implications for other areas, such as the orbits, brain, and spinal cord, that also may be revealed at the examination. With a focus on the emergency setting, the authors propose using an approach to interpreting neck CT findings whereby 12 areas are systematically evaluated and reported on: the cutaneous and subcutaneous soft tissues, aerodigestive tract and adjacent soft tissues, teeth and periodontal tissues, thyroid gland, salivary glands, lymph nodes, vascular structures, bony airspaces, cervical spine, orbits and imaged brain, lung apices, and superior mediastinum. The use of a systematic approach to interpreting neck CT findings is essential for identifying all salient findings, recognizing and synthesizing the implications of these findings to formulate the correct diagnosis, and reporting the findings and impressions in a complete, clear, and logical manner.Online supplemental material is available for this article.©RSNA, 2019.
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Affiliation(s)
- Alain Cunqueiro
- From the Division of Emergency Radiology (M.H.S.), Department of Radiology (A.C., P.L.), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210 St, Bronx, NT 10467; Department of Radiology, Westchester Medical Center, Valhalla, NY (W.A.G.); and Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ (R.J.D.)
| | - William A Gomes
- From the Division of Emergency Radiology (M.H.S.), Department of Radiology (A.C., P.L.), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210 St, Bronx, NT 10467; Department of Radiology, Westchester Medical Center, Valhalla, NY (W.A.G.); and Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ (R.J.D.)
| | - Peter Lee
- From the Division of Emergency Radiology (M.H.S.), Department of Radiology (A.C., P.L.), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210 St, Bronx, NT 10467; Department of Radiology, Westchester Medical Center, Valhalla, NY (W.A.G.); and Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ (R.J.D.)
| | - R Joshua Dym
- From the Division of Emergency Radiology (M.H.S.), Department of Radiology (A.C., P.L.), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210 St, Bronx, NT 10467; Department of Radiology, Westchester Medical Center, Valhalla, NY (W.A.G.); and Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ (R.J.D.)
| | - Meir H Scheinfeld
- From the Division of Emergency Radiology (M.H.S.), Department of Radiology (A.C., P.L.), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210 St, Bronx, NT 10467; Department of Radiology, Westchester Medical Center, Valhalla, NY (W.A.G.); and Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ (R.J.D.)
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12
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Shamim AA, Zuberi MM, Shariff AH. Laparoscopic retrieval of two intragastric spoons at least seven years after ingestion. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2019. [DOI: 10.1016/j.lers.2019.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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13
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Chirica M, Kelly MD, Siboni S, Aiolfi A, Riva CG, Asti E, Ferrari D, Leppäniemi A, Ten Broek RPG, Brichon PY, Kluger Y, Fraga GP, Frey G, Andreollo NA, Coccolini F, Frattini C, Moore EE, Chiara O, Di Saverio S, Sartelli M, Weber D, Ansaloni L, Biffl W, Corte H, Wani I, Baiocchi G, Cattan P, Catena F, Bonavina L. Esophageal emergencies: WSES guidelines. World J Emerg Surg 2019; 14:26. [PMID: 31164915 PMCID: PMC6544956 DOI: 10.1186/s13017-019-0245-2] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 05/20/2019] [Indexed: 02/06/2023] Open
Abstract
The esophagus traverses three body compartments (neck, thorax, and abdomen) and is surrounded at each level by vital organs. Injuries to the esophagus may be classified as foreign body ingestion, caustic ingestion, esophageal perforation, and esophageal trauma. These lesions can be life-threatening either by digestive contamination of surrounding structures in case of esophageal wall breach or concomitant damage of surrounding organs. Early diagnosis and timely therapeutic intervention are the keys of successful management.
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Affiliation(s)
- Mircea Chirica
- 1Department of Digestive Surgery, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
| | - Michael D Kelly
- Department of General Surgery, Albury Hospital, Albury, NSW 2640 Australia
| | - Stefano Siboni
- 3Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milan, Italy
| | - Alberto Aiolfi
- 3Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milan, Italy
| | - Carlo Galdino Riva
- 3Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milan, Italy
| | - Emanuele Asti
- 3Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milan, Italy
| | - Davide Ferrari
- 3Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milan, Italy
| | - Ari Leppäniemi
- Department of Emergency Surgery, University Hospital Meilahti Abdominal Center, Helsinki, Finland
| | - Richard P G Ten Broek
- 5Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Pierre Yves Brichon
- 6Department of Thoracic Surgery, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
| | - Yoram Kluger
- 7Department of General Surgery, Rambam Health Campus, Haifa, Israel
| | - Gustavo Pereira Fraga
- 8Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, SP Brazil
| | - Gil Frey
- 6Department of Thoracic Surgery, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
| | - Nelson Adami Andreollo
- 8Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, SP Brazil
| | - Federico Coccolini
- 9General, Emergency and Trauma Surgery Department, Bufalini Hospital Cesena, Cesena, Italy
| | | | | | - Osvaldo Chiara
- 12General Surgery and Trauma Team, University of Milano, ASST Niguarda Milano, Milan, Italy
| | - Salomone Di Saverio
- 13Cambridge Colorectal Unit, Cambridge University Hospitals, Addenbrooke's Hospital, Cambridge, UK
| | | | - Dieter Weber
- 15Trauma and General Surgery, Royal Perth Hospital, Perth, Australia
| | - Luca Ansaloni
- 9General, Emergency and Trauma Surgery Department, Bufalini Hospital Cesena, Cesena, Italy
| | - Walter Biffl
- 16Division of Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA USA
| | - Helene Corte
- 17Department of Surgery, Saint Louis Hospital, Paris, France
| | - Imtaz Wani
- 18Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | | | - Pierre Cattan
- 17Department of Surgery, Saint Louis Hospital, Paris, France
| | - Fausto Catena
- 20Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - Luigi Bonavina
- 3Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milan, Italy
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14
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Liver abscess caused by fish bone perforation of stomach wall treated by laparoscopic surgery: a case report. Surg Case Rep 2019; 5:79. [PMID: 31093821 PMCID: PMC6520427 DOI: 10.1186/s40792-019-0639-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/02/2019] [Indexed: 02/02/2023] Open
Abstract
Background Formation of a liver abscess due to gastrointestinal perforation by a foreign body is rare. In addition, there are few case reports on laparoscopic surgical treatment of a liver abscess caused by perforation of the gastrointestinal tract by a foreign body. Case presentation A 51-year-old man visited our hospital because of fever and anorexia. There were no physical findings except for fever. He had no comorbidities or surgical history. Laboratory tests showed increased inflammatory marker and liver enzyme levels. Abdominal ultrasonography showed a hypoechoic lesion in the left lobe of the liver. Abdominal contrast-enhanced computed tomography revealed an air-containing abscess in the left side of the liver and a high-density linear object. We diagnosed a liver abscess secondary to stomach perforation by a foreign body. Emergency laparoscopic surgery identified a fish bone in the abscess that formed between the stomach and liver. We succeeded in removing the fish bone laparoscopically. The patient was discharged without any postoperative complications on day 11. Conclusions A liver abscess secondary to perforation of the gastrointestinal tract by a foreign body usually requires surgical treatment. Foreign body removal is important to prevent recurrence of liver abscess. In cases with the foreign body located at the liver margin, a laparoscopic approach to the abscess is very useful.
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15
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Aiolfi A, Ferrari D, Riva CG, Toti F, Bonitta G, Bonavina L. Esophageal foreign bodies in adults: systematic review of the literature. Scand J Gastroenterol 2019; 53:1171-1178. [PMID: 30394140 DOI: 10.1080/00365521.2018.1526317] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Esophageal Foreign Body (FB) impaction represents a major challenge for healthcare providers. Aim of this systematic review was to analyse the current literature evidence on prevalence, presentation, treatment, and outcomes of impacted esophageal FB. MATERIALS AND METHODS Literature search was conducted between 2000 and 30th June 2018 according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. RESULTS Sixty-one studies matched the inclusion criteria. The total number of included patients was 13,092. The cervical esophagus was the most frequent impaction site (67%) and sharp-pointed objects were the most common FB (38.1%). Retrosternal pain (78%), dysphagia (48%), and odynophagia (43.4%) were the most common symptoms. A flexible or rigid endoscopic approach was adopted in 65.1% and 16.8% of patients, respectively. Overall, 17.8% of patients had a complication related to the impacted esophageal FB or to the endoscopic manoeuvers. A surgical approach was required in 3.4% of patients. The overall mortality was 0.85%. CONCLUSIONS Surgery is the upfront treatment in patients with esophageal perforation or endoscopically irretrievable esophageal FB. A minimally invasive approach can be adopted in selected patients. Effective prevention of FB impaction should focus on accurate diagnostic work-up to search for an underlying motility disorder after a first episode of esophageal impaction, even if transient and self-resolving.
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Affiliation(s)
- Alberto Aiolfi
- a Department of Biomedical Science for Health, Division of General Surgery IRCCS Policlinico San Donato , University of Milan , Milan , Italy
| | - Davide Ferrari
- a Department of Biomedical Science for Health, Division of General Surgery IRCCS Policlinico San Donato , University of Milan , Milan , Italy
| | - Carlo Galdino Riva
- a Department of Biomedical Science for Health, Division of General Surgery IRCCS Policlinico San Donato , University of Milan , Milan , Italy
| | - Francesco Toti
- a Department of Biomedical Science for Health, Division of General Surgery IRCCS Policlinico San Donato , University of Milan , Milan , Italy
| | - Gianluca Bonitta
- a Department of Biomedical Science for Health, Division of General Surgery IRCCS Policlinico San Donato , University of Milan , Milan , Italy
| | - Luigi Bonavina
- a Department of Biomedical Science for Health, Division of General Surgery IRCCS Policlinico San Donato , University of Milan , Milan , Italy
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16
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Long B, Koyfman A, Gottlieb M. Esophageal Foreign Bodies and Obstruction in the Emergency Department Setting: An Evidence-Based Review. J Emerg Med 2019; 56:499-511. [PMID: 30910368 DOI: 10.1016/j.jemermed.2019.01.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/11/2019] [Accepted: 01/22/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with esophageal foreign bodies or food bolus impaction may present to the emergency department with symptoms ranging from mild discomfort to severe distress. There is a dearth of emergency medicine-focused literature concerning these conditions. OBJECTIVE OF THE REVIEW This narrative review provides evidence-based recommendations for the assessment and management of patients with esophageal foreign bodies and food bolus impactions. DISCUSSION Esophageal foreign bodies and food bolus impaction are common but typically pass spontaneously; however, complete obstruction can lead to inability to tolerate secretions, airway compromise, and death. Pediatric patients are the most common population affected, while in adults, edentulous patients are at greatest risk. Foreign body obstruction and food bolus impaction typically occur at sites of narrowing due to underlying esophageal pathology. Diagnosis is based on history and examination, with most patients presenting with choking/gagging, vomiting, and dysphagia/odynophagia. The preferred test is a plain chest radiograph, although this is not required if the clinician suspects non-bony food bolus with no suspicion of perforation. Computed tomography is recommended if radiograph is limited or there are concerns for perforation. Management requires initial assessment of the patient's airway. Medications evaluated include effervescent agents, glucagon, calcium channel blockers, benzodiazepines, nitrates, and others, but their efficacy is poor. Before administration, shared decision making with the patient is recommended. Endoscopy is the intervention of choice, and medications should not delay endoscopy. Early endoscopy for complete obstruction is associated with improved outcomes. CONCLUSIONS This review provides evidence-based recommendations concerning these conditions, focusing on evaluation and management.
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Affiliation(s)
- Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois
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Fung BM, Sweetser S, Wong Kee Song LM, Tabibian JH. Foreign object ingestion and esophageal food impaction: An update and review on endoscopic management. World J Gastrointest Endosc 2019; 11:174-192. [PMID: 30918584 PMCID: PMC6425280 DOI: 10.4253/wjge.v11.i3.174] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/08/2019] [Accepted: 03/11/2019] [Indexed: 02/06/2023] Open
Abstract
Foreign body ingestion encompasses both foreign object ingestion (FOI) and esophageal food impaction (EFI) and represents a common and clinically significant scenario among patients of all ages. The immediate risk to the patient ranges from negligible to life-threatening, depending on the ingested substance, its location, patient fitness, and time to appropriate therapy. This article reviews the FOI and EFI literature and highlights important considerations and implications for pediatric and adult patients as well as their providers. Where published literature is insufficient to provide evidence-based guidance, expert opinion is included to supplement the content of this comprehensive review.
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Affiliation(s)
- Brian M Fung
- UCLA-Olive View Internal Medicine Residency Program, Sylmar, CA 91342, United States
| | - Seth Sweetser
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
| | - Louis M Wong Kee Song
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
| | - James H Tabibian
- Division of Gastroenterology, Olive View-UCLA Medical Center, Sylmar, CA 91342, United States
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Lares Dos Santos C, Gouveia RHD, Vieira DN. Unusual case of a fatal upper esophageal trauma caused by a toothpick. J Forensic Leg Med 2019; 62:82-86. [PMID: 30703715 DOI: 10.1016/j.jflm.2019.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 11/03/2018] [Accepted: 01/11/2019] [Indexed: 11/25/2022]
Abstract
The authors report the case of the unexpected death of a fifty-year-old female found by her partner in the bathroom floor. External examination revealed some contusions dispersed by different corporal areas and an unusually placed green discoloration of the anterior cervical region. After neck dissection and opening the esophagus, a three and a half centimeter wooden toothpick fragment was found at the upper region, covered by a purulent substance associated with puncture wounds. Histopathological and microbiological studies revealed "acute bilateral cervical cellulitis" and Klebsiella Oxytoca, respectively. Further investigation revealed that during the five days prior to her death, the victim was observed twice in an emergency department with complains of throat discomfort after eating some bread with salami. X-Ray and a laryngoscopy were performed but did not reveal any significant findings. Due to the victim's medical history, she was evaluated by a psychiatrist that dismissed a non-somatic setting due to the type of complains and the elevation of blood inflammatory parameters. Rinopharyngitis was then assumed as the most likely diagnosis and was treated accordingly. The victim died the following day. This case reports an unusual fatal traumatic lesion to the upper esophagus that is a very important remainder, particularly for clinical practitioners, to maintain a high degree of suspicion, avoid diagnostic biases such as those related to psychiatric disorders and meticulously evaluate patients in order to deliver the most evidence-based diagnosis possible. To the best of the authors' knowledge there are no other cases described in the literature of a death caused by esophageal toothpick lesion.
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Affiliation(s)
- César Lares Dos Santos
- Forensic Clinical and Pathology Service, Central Branch of the National Institute of Legal Medicine and Forensic Sciences - Portugal, Largo da Sé Nova, 3000-213, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Portugal.
| | - Rosa Henriques de Gouveia
- Forensic Clinical and Pathology Service, Central Branch of the National Institute of Legal Medicine and Forensic Sciences - Portugal, Largo da Sé Nova, 3000-213, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Portugal.
| | - Duarte Nuno Vieira
- Forensic Medicine and Forensic Sciences and of Ethics and Medical Law, Institute of Legal Medicine, Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Celas, 3000-548, Coimbra, Portugal.
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Migratory Fish Bone in the Thyroid Gland: Case Report and Literature Review. Case Rep Med 2018; 2018:7345723. [PMID: 29560016 PMCID: PMC5842739 DOI: 10.1155/2018/7345723] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 01/16/2018] [Indexed: 11/24/2022] Open
Abstract
Introduction Foreign body stuck in the throat is a common emergency case, which can be removed by the endoscopic treatment. Fish bones are one of the common observed foreign bodies in the pharynx or cervical esophagus. Fish bones have a risk of damaging the mucosa when lodged in the upper digestive tract. Foreign bodies of fish bones located outside the laryngopharyngeal tissue are relatively unusual, and it is even more rare that they remain in the thyroid. It may cause local infection, abscess formation, large blood vessels rupture, and other serious life-threatening complications when the position of the fish bone migrates to the neck. We present a unique case of a 31-year-old woman in whom a fish bone was found in the thyroid. The fish bone had been removed successfully two months after the onset of symptoms. The relevant literature is reviewed and summarized. Case Presentation A foreign body which is located in the neck area by swallowing is usually found in the emergency case. One of the commonest foreign bodies is the fish bone. The common presenting symptoms include foreign body (FB) sensation and or a sharp pain during swallowing. But we report a rare case in which a migratory fish bone stuck in the thyroid gland was found after 3 months. We retrieved previous literature and made a summary. Conclusions Fish bones are not easy to be found as a foreign body. Surgeons should be aware that fish bones can become lodged in the thyroid gland. Combined with the history should be a wary fish bone to migrate to the case of the thyroid, to avoid misdiagnosis. To confirm the diagnosis, we can take ultrasound, computerized tomographic scanning (CT), and other tests.
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Analysis of the management and risk factors for complications of esophageal foreign body impaction of jujube pits in adults. Wideochir Inne Tech Maloinwazyjne 2018; 13:250-256. [PMID: 30002759 PMCID: PMC6041575 DOI: 10.5114/wiitm.2018.73132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 11/19/2017] [Indexed: 02/06/2023] Open
Abstract
Introduction Foreign body impaction is a common emergency in the field of otolaryngology. The prevalence of a jujube pit as an esophageal foreign body has increased in the Jiaodong Peninsula. However, reports on this are scarce. Aim To investigate the methods for diagnosing and treating esophageal foreign body impaction of a jujube pit and to determine the risk factors for complications. Material and methods We conducted a retrospective review of the medical records of patients who were diagnosed with esophageal impaction of a jujube pit. Demographic, clinical, radiological, and endoscopic data were collected and analyzed. Results Neither plain radiography nor esophagogram provided enough information on the surrounding issues and complications. The rate of secondary radiological examination was 51.61% for the patients who did not undergo prior computed tomography. The success rate of rigid esophagoscopy was 95.45%; 18 of these patients (27.27%) had previously undergone flexible esophagoscopy without foreign body removal. Logistic regression showed that the time from ingestion to presentation and the jujube pit size were independent risk factors for complications. Conclusions Computed tomography without contrast material is the preferred diagnostic method for adults with esophageal jujube pit impaction, and rigid esophagoscopy can be used for therapy even though the first flexible esophagoscopy failed. Large diameter of the jujube pit constituting the esophageal foreign body (≥ 25 mm) and long duration between pit ingestion and presentation (> 12 h) were associated with increased complications in the patients in this study.
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Xia Y, Zhang F, Xu H, Xu W. Use of the blue cotton screen method with endoscopy to detect occult esophageal foreign bodies. Wideochir Inne Tech Maloinwazyjne 2017; 12:428-436. [PMID: 29362659 PMCID: PMC5776492 DOI: 10.5114/wiitm.2017.72326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 10/19/2017] [Indexed: 11/17/2022] Open
Abstract
More than 20,000 cases of upper gastrointestinal foreign bodies (FBs) have been reported in the last 5 years in China. Early detection and treatment is vital in these patients. Differential diagnosis of esophageal injury and occult esophageal foreign bodies is challenging, particularly in the case of non-radio-opaque foreign bodies. A diagnostic technique with high accuracy and low risk is needed for clinical practice. We describe successful use of the "blue cotton screen method" to detect esophageal foreign bodies in 2 patients. The advantages and disadvantages of various diagnostic modalities in the management of patients with foreign body ingestion are presented. This technique is safer and more effective than traditional methods for foreign body impaction in the esophageal cavity. It could be applied for screening and in the differential diagnosis of esophageal injury and FBs in the esophageal lumen.
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Affiliation(s)
- Yan Xia
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Fan Zhang
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Hong Xu
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Weiran Xu
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, Jilin, China
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Selected Injuries. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mohanty HS, Shirodkar K, Patil AR, Mallarajapatna G, Kumar S, Deepak KC, Nandikoor S. Oesophageal perforation as a complication of ingested partial denture. BJR Case Rep 2016; 2:20150348. [PMID: 30460018 PMCID: PMC6243323 DOI: 10.1259/bjrcr.20150348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 04/20/2016] [Accepted: 05/18/2016] [Indexed: 11/24/2022] Open
Abstract
We report herein the case of a 53-year-old female who came to the emergency room with the chief complaints of severe dysphagia and chest pain following accidental swallowing of her denture. The patient had swelling of the face, neck and eyelids with difficulty in breathing. A skull radiograph was taken, which revealed a missing partial denture from the right lower jaw. Anteroposterior radiograph of the chest showed two metallic objects in the mid-thorax, adjacent to the descending aorta. CT scan of the neck and chest revealed two metallic objects (measuring approximately 17mm each) in the middle one-third of the oesophagus (right posterolateral aspect), causing perforation of the oesophagus and leading to pneumomediastinum, and left pneumothorax with subcutaneous emphysema of the neck and chest. An emergency thoracoscopic removal of the foreign body (partial denture) was performed with subsequent repair of the oesophageal tear in the same sitting. Post surgery, the patient was shifted to intensive care unit and she recovered well over a course of time. In summary, accidental ingestion of a partial denture can lead to grave complications such as oesophageal perforation, which should be managed on an emergency basis with thoracoscopic removal of the foreign body.
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Affiliation(s)
| | | | - Aruna R Patil
- Department of Radiology, Apollo Hospital, Bangalore, India
| | | | - Sharath Kumar
- Department of Radiology, Apollo Hospital, Bangalore, India
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Tan CH, Chang SYH, Cheah YL. Laparoscopic Removal of Intrahepatic Foreign Body: A Novel Technique for Management of an Unusual Cause of Liver Abscess--Fish Bone Migration. J Laparoendosc Adv Surg Tech A 2016; 26:47-50. [PMID: 26779724 DOI: 10.1089/lap.2015.0487] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Fish bone migration from the gastrointestinal tract into the liver is an unusual cause of liver abscess. MATERIALS AND METHODS We describe successful laparoscopic removal of intrahepatic fish bones in 2 patients who presented with liver abscesses. Both patients were admitted to our institution with a 2-week history of right upper quadrant pain, fever, chills, and rigors. Radiological imaging revealed the presence of a linear calcified foreign body within a hepatic abscess in the left lateral section of the liver. These findings were suggestive of infection secondary to migration of fish bone from the stomach to the liver. RESULTS Both patients underwent percutaneous drainage of liver abscesses with control of sepsis, followed by laparoscopic removal of intrahepatic fish bones. Localization of the fish bones was facilitated by intraoperative ultrasonographic examination of the liver. Postoperative recovery was fast and uneventful. CONCLUSIONS This is the first report of two consecutive cases of liver abscess caused by fish bone migration where our patients were successfully treated by percutaneous drainage of the abscess followed by laparoscopic removal of intrahepatic fish bone.
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Affiliation(s)
- Chun Hai Tan
- 1 Department of General Surgery, Khoo Teck Puat Hospital , Singapore
| | | | - Yee Lee Cheah
- 3 Consultant, Asian American Liver Centre , Singapore
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26
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Abstract
Fish bone foreign body (FFB) is the most frequent food-associated foreign body (FB) in adults, especially in Asia, versus meat in Western countries. The esophageal sphincter is the most common lodging site. Esophageal FB disease tends to occur more frequently in men than in women. The first diagnostic method is laryngoscopic examination. Because simple radiography of the neck has low sensitivity, if perforation or severe complications requiring surgery are expected, computed tomography should be used. The risk factors associated with poor prognosis are long time lapse after FB involvement, bone type, and longer FB (>3 cm). Bleeding and perforation are more common in FFB disease than in other FB diseases. Esophageal FB disease requires urgent treatment within 24 hours. However, FFB disease needs emergent treatment, preferably within 2 hours, and definitely within 6 hours. Esophageal FFB disease usually occurs at the physiological stricture of the esophagus. The aortic arch eminence is the second physiological stricture. If the FB penetrates the esophageal wall, a life-threatening aortoesophageal fistula can develop. Therefore, it is better to consult a thoracic surgeon prior to endoscopic removal.
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Affiliation(s)
- Heung Up Kim
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
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Usefulness of Ultralow-Dose (Submillisievert) Chest CT Using Iterative Reconstruction for Initial Evaluation of Sharp Fish Bone Esophageal Foreign Body. AJR Am J Roentgenol 2016; 205:985-90. [PMID: 26496545 DOI: 10.2214/ajr.15.14353] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The purpose of this article was to evaluate the usefulness of ultralow-dose chest CT as an initial imaging study for evaluation of sharp fish bone esophageal foreign body (FB). MATERIALS AND METHODS A total of 57 subjects who underwent ultralow-dose chest CT were included in this retrospective study. All subjects had a history of ingestion and symptoms of esophageal FB. All ultralow-dose chest CT data were reconstructed twice, once with filtered back projection (FBP) and once with iterative reconstruction, and three observers reviewed the images independently. ROC analysis was used to evaluate diagnostic performance of ultralow-dose chest CT. Intraclass correlation coefficient (ICC) was calculated for analysis of interobserver agreement. RESULTS Among 57 patients, 42 were confirmed as having esophageal FB. Significant objective noise reduction of mediastinum was achieved using an iterative reconstruction technique. Subjective image noise of iterative reconstruction was significantly better than that of FBP. Overall diagnostic performance of ultralow-dose chest CT for esophageal FB of iterative reconstruction (AUC = 0.999) was significantly better than that of FBP (AUC = 0.95) (p = 0.02). Interobserver agreement was greater for iterative reconstruction (ICC = 0.944) than for FBP (ICC = 0.778). CONCLUSION Ultralow-dose chest CT using iterative reconstruction provided satisfactory diagnostic image quality for identifying fish bone esophageal FB with reduced radiation dose and high observer accuracy. Therefore, ultralow-dose chest CT would be adequate as a first-line imaging modality for fish bone esophageal FB.
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Lin JH, Fang J, Wang D, Chen HZ, Guo Q, Guo XG, Han ST, He LP, He SX, Jiang HQ, Jin ZD, Li X, Liao Z, Mei B, Ren X, Tang YJ, Wang BM, Wang L, Xu H, Xu LM, Xue XC, Yang YX, Zhang XF, Zhang ZQ, Zheng HL, Zhi FC, Zhong L, Zou DW, Zou XP, Li ZS. Chinese expert consensus on the endoscopic management of foreign bodies in the upper gastrointestinal tract (2015, Shanghai, China). J Dig Dis 2016; 17:65-78. [PMID: 26805028 DOI: 10.1111/1751-2980.12318] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 01/06/2016] [Indexed: 12/11/2022]
Affiliation(s)
| | | | - Dong Wang
- Department of Gastroenterology.,Digestive Endoscopy Center
| | - He Zhong Chen
- Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai
| | - Qiang Guo
- Department of Gastroenterology, First People's Hospital of Yunnan Province, Kunming, Yunnan Province
| | - Xue Gang Guo
- Department of Gastroenterology, Xijing Hospital, Xi'an, Shaanxi Province
| | - Shu Tang Han
- Digestive Endoscopy Center, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, Jiangsu Province
| | - Li Ping He
- Digestive Endoscopy Center, Fujian Provincial Hospital, Fuzhou, Fujian Province
| | - Shui Xiang He
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province
| | - Hui Qing Jiang
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province
| | - Zhen Dong Jin
- Department of Gastroenterology.,Digestive Endoscopy Center
| | - Xun Li
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu Province
| | - Zhuan Liao
- Department of Gastroenterology.,Digestive Endoscopy Center
| | - Bing Mei
- Department of Emergency Medicine, Changhai Hospital, Second Military Medical University, Shanghai
| | - Xu Ren
- Department of Gastroenterology, Heilongjiang Provincial Hospital, Harbin, Heilongjiang Province
| | - Yong Jin Tang
- Editorial Department of Chinese Journal of Digestive Endoscopy, Nanjing, Jiangsu Province
| | - Bang Mao Wang
- Department of Gastroenterology, Tianjin Medical University General Hospital, Tianjin
| | - Li Wang
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai
| | - Hong Xu
- Department of Gastrointestinal Surgery, The First Hospital of Jilin University, Changchun, Jilin Province
| | - Lei Ming Xu
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai
| | - Xu Chao Xue
- Department of Gastrointestinal Surgery, Changhai Hospital, Second Military Medical University, Shanghai
| | - Yu Xiu Yang
- Department of Gastroenterology, Henan Provincial People's Hospital, Zhengzhou, Henan Province
| | - Xiao Feng Zhang
- Department of Gastroenterology, Hangzhou First People's Hospital, Hangzhou, Zhejiang Province
| | - Zi Qi Zhang
- Digestive Endoscopy Center, PLA General Hospital, Beijing
| | - Hong Liang Zheng
- Department of ENT, Changhai Hospital, Second Military Medical University, Shanghai
| | - Fa Chao Zhi
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province
| | - Liang Zhong
- Department of Gastroenterology, Huashan Hospital, Fudan University, Shanghai
| | - Duo Wu Zou
- Department of Gastroenterology.,Digestive Endoscopy Center
| | - Xiao Ping Zou
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Nanjing, Jiangsu Province, China
| | - Zhao Shen Li
- Department of Gastroenterology.,Digestive Endoscopy Center
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Bakshi SS. Letter to the Editor. Ann Otol Rhinol Laryngol 2015; 125:352. [PMID: 26481176 DOI: 10.1177/0003489415612802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Satvinder Singh Bakshi
- Department of ENT and Head & Neck Surgery, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India
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Analysis of Clinical Feature and Management of Fish Bone Ingestion of Upper Gastrointestinal Tract. Clin Exp Otorhinolaryngol 2015; 8:261-7. [PMID: 26330922 PMCID: PMC4553358 DOI: 10.3342/ceo.2015.8.3.261] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 03/23/2014] [Accepted: 03/26/2014] [Indexed: 12/17/2022] Open
Abstract
Objectives Fish bone impaction in the upper gastrointestinal tract is a common reason for patients to seek emergent care. The aim of this study was to find a clinical characteristics of patients with fish bone impaction in the upper gastrointestinal tract. Methods The study was conducted on 286 fish bone ingestion patients who complained of dysphagia and irritation after eating fish. The patients were treated according to the hospital protocol regarding the removal of fish bone. The parameters for the analysis included the age and sex of the patients, location and characteristics of the foreign body, method of removal, and type of fish. Results The fish bone could be observed by the physical examination in the oral cavity and laryngopharynx in 198 patients (69.23%). For those patients in whom the foreign body could not be observed in oral cavity and laryngopharynx, noncontrast computed tomography (CT) (from nasopharynx to diaphragm) was performed. The fish bone was discovered in the esophagus of 66 patients (23.08%). The esophageal fish bone was successfully removed by transnasal flexible esophagoscopy (TNE) in 55 patients, the fish bone moved to the stomach in 10 patients and one fish bone was removed by rigid esophagoscopy due to esophageal abscess. The esophageal fish bone was mostly found in patients aged 50 years and older. Conclusion Fish bone foreign body ingestion in the esophagus appeared to be more common in older patients. Incorporating noncontrast CT and TNE can facilitate decision-making and adequate treatment for patients with fish bone impactions.
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Woo SH, Kim KH. Proposal for methods of diagnosis of fish bone foreign body in the Esophagus. Laryngoscope 2015; 125:2472-5. [PMID: 25962971 DOI: 10.1002/lary.25340] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 03/24/2015] [Accepted: 03/26/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate the methods of diagnosis of fish bone foreign body in the esophagus and suggest a diagnostic protocol. STUDY DESIGN Prospective cohort study. METHODS A prospective study was performed on 286 patients with a history of fish bone foreign body impaction. Among them, 88 patients had negative findings in the oral cavity and laryngopharynx. Subsequent radiologic assessment of these patients included plain radiography and computed tomography (CT). Sixty-six patients showed positive findings in the esophagus, and an attempt was made to remove the obstruction using transnasal esophagoscopy. RESULTS In 66 patients, a fish bone foreign body was detected in the esophagus by CT. In contrast, plain radiography detected a foreign body in only 30 patients. The overall detection rate of plain radiography compared with CT for fish bones was 45.5%. Plain radiography detected 35.9% of the simple type fish bones and 54.5% of the gill bone detected by CT. However, jaw bones had a detection rate of 100% with both methods. The fish bone foreign bodies were most commonly located in the upper esophagus (n=65, 98.5%), followed by the lower esophagus (n=1, 1.5%). CONCLUSION CT is a useful method for identification of esophageal fish bone foreign bodies. Therefore, CT should be considered as the first-choice technique for the diagnosis of esophageal fish bone foreign body. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Seung Hoon Woo
- Department of Otorhinolaryngology, Gyeongsang National University, Jinju, Republic of Korea.,the Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - Kyung Hee Kim
- College of Nursing, Gyeongsang National University, Jinju, Republic of Korea
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32
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Selected Injuries. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_57-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pinto A, Lanza C, Pinto F, Grassi R, Romano L, Brunese L, Giovagnoni A. Role of plain radiography in the assessment of ingested foreign bodies in the pediatric patients. Semin Ultrasound CT MR 2014; 36:21-7. [PMID: 25639174 DOI: 10.1053/j.sult.2014.10.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Ingestion of various types of foreign bodies (FBs) such as coins, toy parts, jewelry pieces, needles and pins, fish and chicken bones, and button-type batteries is common among children. The curiosity of children and their need to investigate the world around them place them at a higher risk for ingestion of FBs. Fortunately, 80%-90% of ingested foreign objects that reach the stomach will pass uneventfully without intervention. The remainder may become blocked in the esophagus or other region of the alimentary tract, placing the pediatric patient at risk of significant complications such as aspiration, obstruction, bleeding, perforation, fistulization, sepsis, and death. The goals of the initial pediatric patient assessment are to identify the type of object ingested, its location in the gastrointestinal tract, and the presence of associated complications. Factors reported to increase the risk of complications included a sharp FB, a FB with a wide diameter, and symptoms. Plain radiographs still play an important role in the assessment of ingested FBs in the pediatric patient: plain films of the neck, chest, and abdomen are very useful in confirming the diagnosis of FB ingestion because most ingested FBs are radiopaque.
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Affiliation(s)
- Antonio Pinto
- Department of Radiology, Cardarelli Hospital, Naples, Italy.
| | - Cecilia Lanza
- Department of Radiology, Unit of General and Pediatric Radiology, University Politecnica delle Marche, Hospital Torrette-Lancisi-Salesi, Ancona, Italy
| | - Fabio Pinto
- Department of Diagnostic Radiological Imaging, Marcianise Hospital, Marcianise (CE), Italy
| | - Roberta Grassi
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Naples, Italy
| | - Luigia Romano
- Department of Radiology, Cardarelli Hospital, Naples, Italy
| | - Luca Brunese
- Department of Health Science, University of Molise, Campobasso, Italy
| | - Andrea Giovagnoni
- Department of Radiology, Unit of General and Pediatric Radiology, University Politecnica delle Marche, Hospital Torrette-Lancisi-Salesi, Ancona, Italy
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Aronberg RM, Punekar SR, Adam SI, Judson BL, Mehra S, Yarbrough WG. Esophageal perforation caused by edible foreign bodies: A systematic review of the literature. Laryngoscope 2014; 125:371-8. [DOI: 10.1002/lary.24899] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2014] [Indexed: 12/20/2022]
Affiliation(s)
- Ryan M. Aronberg
- Department of Surgery; Section of Otolaryngology, Yale University School of Medicine; New Haven Connecticut U.S.A
| | - Salman R. Punekar
- Department of Surgery; Section of Otolaryngology, Yale University School of Medicine; New Haven Connecticut U.S.A
| | - Stewart I. Adam
- Department of Surgery; Section of Otolaryngology, Yale University School of Medicine; New Haven Connecticut U.S.A
| | - Benjamin L Judson
- Department of Surgery; Section of Otolaryngology, Yale University School of Medicine; New Haven Connecticut U.S.A
| | - Saral Mehra
- Department of Surgery; Section of Otolaryngology, Yale University School of Medicine; New Haven Connecticut U.S.A
| | - Wendell G. Yarbrough
- Department of Surgery; Section of Otolaryngology, Yale University School of Medicine; New Haven Connecticut U.S.A
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Abstract
OBJECTIVE The purpose of this article is to familiarize radiologists with the specific characteristics of foreign bodies, obtained from image interpretation, to guide further management. Details of object morphologic characteristics and location in the body gained through imaging form the backbone of the classification used in the treatment of ingested foreign bodies. CONCLUSION The characteristics of foreign bodies and predisposing bowel abnormalities affect the decision to follow ingested objects radiographically, perform additional imaging, or proceed with endoscopic or surgical removal.
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Berry AC, Draganov PV, Patel BB, Avalos D, Reuther WL, Ravilla A, Berry BB, Monzel MJ. Embedded pork bone causing esophageal perforation and an esophagus-innominate artery fistula. Case Rep Gastrointest Med 2014; 2014:969862. [PMID: 25157322 PMCID: PMC4137536 DOI: 10.1155/2014/969862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 07/19/2014] [Accepted: 07/21/2014] [Indexed: 01/14/2023] Open
Abstract
Chronically embedded foreign bodies can lead to perforations, mediastinitis, and abscess, amongst a host of other complications. A 20-year-old mentally challenged female presented with "something stuck in her throat," severe dysphagia, and recurrent vomiting. Initial imaging was unremarkable; however, subsequent imaging and esophagogastroduodenoscopy two weeks later revealed an embedded pork bone. Surgery was performed to remove the bone and fix the subsequent esophageal perforation and esophagus-innominate artery fistula. This case helps reinforce the urgency in removing an ingested foreign body and the ramifications that may arise with chronically embedded foreign bodies.
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Affiliation(s)
- Andrew C. Berry
- Kansas City University of Medicine and Biosciences (KCUMB), 1750 E. Independence Avenue, Kansas City, MO 64106, USA
| | - Peter V. Draganov
- Department of Medicine and Advanced Therapeutic Endoscopy, College of Medicine, University of Florida, Gainesville, Florida, FL 32610, USA
| | - Brijesh B. Patel
- Department of Internal Medicine, University of South Florida, Tampa, FL 33612, USA
| | - Danny Avalos
- Department of Internal Medicine, University of Miami Miller School of Medicine, Palm Beach Regional Campus, Atlantis, FL 33462, USA
| | - Warren L. Reuther
- Department of Radiology, West Palm Hospital, West Palm Beach, FL 33407, USA
| | - Avinash Ravilla
- Kansas City University of Medicine and Biosciences (KCUMB), 1750 E. Independence Avenue, Kansas City, MO 64106, USA
| | - Bruce B. Berry
- Department of Internal Medicine, Wheaton Franciscan Healthcare, Milwaukee, WI 53215, USA
| | - Michael J. Monzel
- Digestive Disease Center of the Palm Beaches, Loxahatchee, FL 33470, USA
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Park S, Choi DS, Shin HS, Cho JM, Jeon KN, Bae KS, Koh EH, Park JJ. Fish bone foreign bodies in the pharynx and upper esophagus: evaluation with 64-slice MDCT. Acta Radiol 2014; 55:8-13. [PMID: 23884842 DOI: 10.1177/0284185113493087] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Fish bone (FB) is one of the common causes of foreign body impaction in the pharynx and esophagus. PURPOSE To investigate the efficacy of 64-slice multidetector computed tomography (MDCT) for the evaluation of pharynx and upper esophageal FB foreign bodies. MATERIAL AND METHODS Sixty-six patients with suspected FB foreign body ingestion were examined by plain radiography (n = 40) and unenhanced MDCT (n = 66). We analyzed the presence, location, size, shape, and lying position of the foreign bodies. RESULTS On MDCT, 46 foreign bodies were detected. Among them, 45 were confirmed by endoscopy. The sensitivity of MDCT for the detection of foreign bodies was 100%, which was superior to that of the plain radiography (51.7%). The location of the foreign bodies was most common in the upper esophagus (n = 22, 47.8%), followed by pharyngoesophageal junction (n = 10, 21.7%), transjunctional (n = 7, 15.2%), hypopharynx (n = 5, 10.9%), and oropharynx (n = 2, 4.3%). Their longest length was 5.3-40.1 mm (mean, 21.3 mm). Thirty-three FBs (71.7%) were linear and 13 (28.3%) were flat in shape. They showed transverse (n = 23, 50.0%), parallel (n = 13, 28.3%), and oblique positions (n = 10, 21.7%) to the long axis of the pharynx and esophagus, respectively. CONCLUSION MDCT is useful for the evaluation of the pharynx and upper esophageal FB foreign bodies.
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Affiliation(s)
- Soyeon Park
- Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Dae Seob Choi
- Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
- Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Hwa Seon Shin
- Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Jae Min Cho
- Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Kyung Nyeo Jeon
- Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Kyung-Soo Bae
- Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Eun Ha Koh
- Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Jung Je Park
- Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
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Value of MDCT in diagnosis and management of esophageal sharp or pointed foreign bodies according to level of esophagus. AJR Am J Roentgenol 2014; 201:W707-11. [PMID: 24147500 DOI: 10.2214/ajr.12.8517] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The purpose of this study was to validate the usefulness of MDCT for diagnosis of a sharp or pointed esophageal foreign body according to esophageal level. MATERIALS AND METHODS Forty-two patients with a history of sharp or pointed foreign body ingestion were reviewed retrospectively. Two observers interpreted the CT and the conventional radiography datasets separately. If a foreign body was directly identified, it was regarded as a positive finding. Even if no high-density foreign body was found, detection of a secondary finding was considered to be a positive finding. Diagnostic performance of MDCT and conventional radiography were compared according to esophageal level. Final diagnosis was made by esophagoscopy or surgery in addition to the clinicoradiologic result. RESULTS MDCT was statistically superior to conventional radiography for diagnosis of a thoracic esophageal foreign body for both observers (p < 0.001 for each). No significant difference in sensitivity between CT and conventional radiography for diagnosis of cervical esophageal foreign body was noted regardless of observer. Both observers could identify all complicated conditions with MDCT regardless of esophageal level. However, in two of three cases of complicated thoracic esophageal foreign bodies, neither observer could detect foreign bodies on conventional radiography; furthermore, the observers could not identify pneumomediastinum. CONCLUSION In cases of sharp or pointed foreign body ingestion, if the result of an initial inspection of oro- and hypopharynx reveals negative findings, the first imaging modality should be MDCT for better diagnosis and management.
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Esophagography after pneumomediastinum without CT findings of esophageal perforation: is it necessary? AJR Am J Roentgenol 2014; 201:977-84. [PMID: 24147467 DOI: 10.2214/ajr.12.10345] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to determine the necessity of fluoroscopic esophagography in patients with pneumomediastinum on CT but without CT findings of esophageal perforation. MATERIALS AND METHODS From January 1, 2006, through December 31, 2010, there were 4305 fluoroscopic esophagography examinations including 533 with CT identified from a search of our PACS. Patients with pneumomediastinum on CT who were subsequently referred for emergent fluoroscopic esophagography to exclude esophageal perforation were enrolled. Fluoroscopic esophagography examinations performed within 3 days of CT were included. Patients with a history of esophageal disease were excluded. As a result, 103 patients were enrolled in the study; patients were divided into groups on the basis of whether there was additional clinical history of esophageal damage (trauma group) or not (nontrauma group). Images were reviewed by two board-certified radiologists blinded to the clinical data and radiologic reports for the presence or absence of esophageal perforation. A positive result on CT was defined as esophageal injury or periesophageal infiltration that coexisted with periesophageal air. A positive fluoroscopic esophagography result was defined as oral contrast medium leakage from the esophagus. RESULTS Esophageal perforation was diagnosed in 15 of the 103 patients. The CT findings were significantly correlated with esophageal perforation (p < 0.001 in the trauma group, and p = 0.001 in the nontrauma group). The respective sensitivity and negative predictive value (NPV) of CT versus fluoroscopic esophagography in the trauma group were 100% versus 66.7% and 100% versus 87.9%; in the nontrauma group, the sensitivity and NPV were 100% for CT and fluoroscopic esophagography. Thus, the sensitivity and NPV of CT were either superior or equal to those of fluoroscopic esophagography. CONCLUSION The results of our study suggest that performing fluoroscopic esophagography in patients with pneumomediastinum is unnecessary when CT is negative for esophageal perforation.
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Tsukiyama A, Tagami T, Kim S, Yokota H. Use of 3-Dimensional Computed Tomography to Detect a Barium-Masked Fish Bone Causing Esophageal Perforation. J NIPPON MED SCH 2014; 81:384-7. [DOI: 10.1272/jnms.81.384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Atsushi Tsukiyama
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital
| | - Shiei Kim
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital
| | - Hiroyuki Yokota
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital
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Chen HH, Ruan LX, Zhou SH, Wang SQ. The utility of repeated computed tomography to track a foreign body penetrating the esophagus to the level of the thyroid gland. Oral Radiol 2013; 30:196-202. [PMID: 24817789 PMCID: PMC4009138 DOI: 10.1007/s11282-013-0156-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 09/25/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Foreign body (FB) ingestion is a common problem in otolaryngology. One uncommon complication of FB ingestion is penetration to the level of the thyroid gland. To our knowledge, only 21 such cases have been reported in the literature. Here, we report a case of an esophageal FB penetrating to the level of the right thyroid gland. CASE REPORT The patient was a 38-year-old woman in whom an esophageal FB penetrated to the level of the right thyroid gland. We traced the path to the thyroid gland using repeated computed tomography (CT) scans and demonstrated the importance of multiplanar reconstruction in locating the FB and formulating a precise surgical plan. CONCLUSIONS To our knowledge, this is the first report of repeat CT scans being used to demonstrate the migratory route, over time, of a FB penetrating through the esophagus to the level of the thyroid gland. Our results suggest that multiplanar reconstruction may play a key role in the precise diagnosis of a FB at the level of the thyroid gland and may help surgeons choose the best approach for removal.
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Affiliation(s)
- Hai-Hong Chen
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003 China
| | - Ling-Xiang Ruan
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003 China
| | - Shui-Hong Zhou
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003 China
| | - Shen-Qing Wang
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003 China
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Pinto A, Muzj C, Gagliardi N, Pinto F, Setola FR, Scaglione M, Romano L. Role of imaging in the assessment of impacted foreign bodies in the hypopharynx and cervical esophagus. Semin Ultrasound CT MR 2013; 33:463-70. [PMID: 22964412 DOI: 10.1053/j.sult.2012.06.009] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Impaction of foreign bodies in the upper digestive tract is a serious pathologic condition in ear, nose, and throat practice and is particularly common in children, prisoners, and psychiatric patients. Commonly found objects include fish bones, chicken bones, pieces of glass, dental prostheses, coins, and needles. The goals of the initial patient assessment are to identify the type of object, its location in the gastrointestinal tract, the presence of any associated complications, and the presence of any underlying esophageal conditions. Radiographic evaluation is helpful to confirm the location of foreign bodies and associated complications. Plain films of the neck and chest commonly will show the location of radiopaque objects, such as coins. Both anteroposterior and lateral views are necessary, as some radiopaque objects overlying the vertebral column may only be visible on the lateral view. Multidetector row computed tomography is superior to plain radiographs for the detection of pharyngoesophageal foreign bodies and provide additional crucial information for the management of complicated cases especially related to sharp or pointed ingested foreign bodies.
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Affiliation(s)
- Antonio Pinto
- Department of Radiology, Cardarelli Hospital, Naples, Italy.
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Ambe P, Weber SA, Schauer M, Knoefel WT. Swallowed foreign bodies in adults. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:869-75. [PMID: 23293675 DOI: 10.3238/arztebl.2012.0869] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Accepted: 10/04/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND Foreign-body ingestion is a common event most often seen in children from 6 months to 6 years of age. In adults, foreign bodies are usually ingested accidentally together with food. This happens more commonly in persons with certain pathological changes of the gastrointestinal tract. METHODS We present a selective review of pertinent literature retrieved by a search in the PubMed database. RESULTS The foreign bodies most commonly ingested by adults are fish bones and chicken bones. The clinical approach to the problem depends on the type of material ingested and on the patient's symptoms and physical findings. In about 80% of cases, the ingested material passes uneventfully through the gastrointestinal tract; endoscopy is performed in about 20% of cases, and surgery in less than 1%. Emergency esophagogastroduodenoscopy (EGD) is recommended when the esophagus is completely occluded (because of the risk of aspiration and/or pressure necrosis), when the ingested object has a sharp point or edge (because of the risk of perforation, with ensuing mediastinitis or peritonitis), and when a battery has been ingested (because of the risk of necrosis and fistula formation). For non-occluding esophageal foreign bodies, including magnets, an urgent but non-emergency EGD within 12 to 24 hours is recommended. CONCLUSION Most patients can be treated conservatively by observation alone, but there should be a low threshold for deciding to proceed to endoscopic retrieval. Surgery is reserved for complicated cases.
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Affiliation(s)
- Peter Ambe
- Department of General-, Visceral- and Pediatric Surgery, Düsseldorf University Hospital, Düsseldorf, Germany. peter.ambe@med.-uni-duesseldorf.de
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Jha SK, Kumar SP, Somu L, Ravikumar A. Missing fish bone: case report and literature review. Am J Otolaryngol 2012; 33:623-6. [PMID: 22365390 DOI: 10.1016/j.amjoto.2012.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 01/14/2012] [Indexed: 12/18/2022]
Affiliation(s)
- Sandeep Kumar Jha
- Department of Otorhinolaryngology and Head & Neck Surgery, Chettinad Health Research Institute, Kelambakkam, Chennai 600015, Tamil Nadu, India.
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Iatrogenic migration of an impacted pharyngeal foreign body of the hypopharynx to the prevertebral space. Int J Otolaryngol 2011; 2011:274102. [PMID: 22187562 PMCID: PMC3236489 DOI: 10.1155/2011/274102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 09/19/2011] [Indexed: 11/17/2022] Open
Abstract
Impaction of foreign bodies in the upper aerodigestive tract is commonly encountered in ENT practice. The present paper describes an iatrogenic complication with migration of an impacted foreign body (chicken bone) of the hypopharynx into the prevertebral space, after unsuccessful attempt of endoscopic removal. The foreign body was visualized with cervical CT scan lying extraluminally between the major vessels of the neck. An open surgical procedure with neck exploration was necessary for the definite treatment.
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Anderson KL, Dean AJ. Foreign Bodies in the Gastrointestinal Tract and Anorectal Emergencies. Emerg Med Clin North Am 2011; 29:369-400, ix. [DOI: 10.1016/j.emc.2011.01.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Hirasaki S, Inoue A, Kubo M, Oshiro H. Esophageal large fish bone (sea bream jawbone) impaction successfully managed with endoscopy and safely excreted through the intestinal tract. Intern Med 2010; 49:995-9. [PMID: 20519815 DOI: 10.2169/internalmedicine.49.3262] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 68-year-old man consulted our hospital because of back pain. A chest computed tomography (CT) demonstrated a high-density foreign body in the esophageal wall. There was no evidence of pneumomediastinum. Endoscopic examination demonstrated a large fish bone that was stuck in the esophageal wall. It was dislodged and moved into the stomach. The bone was excreted through the intestinal tract on the seventh hospital day. Unintentional ingestion of large fish bones must be considered potentially dangerous. Complications such as esophageal perforation or mediastinitis should be confirmed by CT; and then, the esophageal foreign body should be removed as soon as possible.
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Affiliation(s)
- Shoji Hirasaki
- Division of Gastroenterology, Kubo Hospital, Imabari, Japan.
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Aortoesophageal Fistula and Aortic Pseudoaneurysm Induced by Swallowed Fish Bone: A Report of Two Cases. Cardiovasc Intervent Radiol 2009; 34 Suppl 2:S17-9. [DOI: 10.1007/s00270-009-9764-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2009] [Accepted: 11/06/2009] [Indexed: 10/20/2022]
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Shihada R, Goldsher M, Sbait S, Luntz M. Three-Dimensional Computed Tomography for Detection and Management of Ingested Foreign Bodies. EAR, NOSE & THROAT JOURNAL 2009. [DOI: 10.1177/014556130908800502] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Rabia Shihada
- Department of Otolaryngology–Head and Neck Surgery, Bnai-Zion Medical Center, Technion–Israel Institute of Technology, Haifa, Israel
| | - Moshe Goldsher
- Department of Otolaryngology–Head and Neck Surgery, Bnai-Zion Medical Center, Technion–Israel Institute of Technology, Haifa, Israel
| | - Sliman Sbait
- MAR Imaging Institute, Bnai-Zion Medical Center, Technion–Israel Institute of Technology, Haifa, Israel
| | - Michal Luntz
- Department of Otolaryngology–Head and Neck Surgery, Bnai-Zion Medical Center, Technion–Israel Institute of Technology, Haifa, Israel
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Wang Y, Deng XB, Jiang K, Wang XY. Imaging presentations of esophageal perforation. Shijie Huaren Xiaohua Zazhi 2009; 17:312-315. [DOI: 10.11569/wcjd.v17.i3.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To illustrate imaging presentations related to esophageal perforation and their significance for therapeutic decisions.
METHODS: We studied 21 patients with suspected esophageal injury from June 2002 to October 2008 at our hospital. Ten patients underwent standard chest radiography and 2 patients were submitted to cervical plain film, while 11 patients with suspected esophageal perforation were submitted to gastrografin swallow study (7 with iodine and 4 with barium). Nine patients underwent row spiral CT examination (2 with enhancement). Imaging presentations were compared and analyzed.
RESULTS: Chest radiography (n = 10) revealed hydropneumothorax in 4/10 and pleural effusions in 4/10, and pulmonary infection were observed in 3/10; Changes of mediastinum were seen in 7/10 patients, pneumomediastinum in 3 cases, mediastinum widen in 3 cases, and air-fluid level in 1 case. Subcutaneous emphysema in the neck, chest was noted in 4/10. Esophagography (n = 11) demonstrated contrast medium extravasation in 9/11, indicating a submucosal contrast medium collection in 4/11, except for 2 cases with negative finding. Enhanced CT scans (n = 9) revealed periesophageal air and fluid collections with irregular soft tissue masses in 5/11 patients, thicken wall with typical localization in 4/11, abscess formation in mediastinum or under diaphragm in 4/11. Contrast-enhanced CT (n = 2) demonstrated abscess formation with contrast enhancement of the margins.
CONCLUSION: Esophagography and CT examination are the main diagnosis methods for suspected esophageal perforation. CT findings of inflammatory reaction for esophageal perforation are especially important for surgical treatment.
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