Clinical manifestations, endoscopic findings and outcomes of tonsillar fossa foreign bodies in dogs: seven cases (2020-2023)

OBJECTIVES

Clinical presentation and outcomes of dogs with tonsillar foreign bodies are not described in the literature. The objective of this case series is to describe the presence, clinical manifestations, endoscopic findings and outcomes of foreign bodies in the palatine tonsillar fossa of dogs.

MATERIALS AND METHODS

Medical records of dogs in which tonsillar fossa foreign bodies were removed by endoscopy between 2020 and 2023 at a referral centre were reviewed. Dogs were included if complete medical records were available.

RESULTS

Seven dogs were included. Among all clinical signs reported, acute onset of throat clearing occurred in all dogs. Palatine tonsil enlargement and protrusion from the tonsillar fossa were observed in four of seven dogs. Foreign bodies were removed under endoscopic guidance in all dogs; a vegetal foreign body was found in all but one dog (6/7). Complete resolution of clinical signs was reported in the five dogs for which follow-up information was available.

CLINICAL SIGNIFICANCE

The tonsillar fossa is a rare but possible location for foreign bodies in dogs and should be explored even in the absence of macroscopic lesions of the tonsils, since some dogs could have a normal palatine tonsil appearance. Acute throat clearing should raise the suspicion of tonsillar fossa foreign bodies. The prognosis appears good after removal.

Blister Pack Ingestion in an Elderly Patient With a Communication Barrier: A Case Report

Foreign body ingestion is a common problem among elderly patients and can pose a serious health risk, particularly for those with communication barriers, cognitive impairments, or obscure medical histories. This report presents the case of a 67-year-old female inpatient who had a language communication barrier and accidentally ingested a blister pack. Effective communication was facilitated through an interpreter, and prompt endoscopic intervention was conducted to remove the foreign body safely. The patient was discharged with no further symptoms during follow-up. This case highlights the importance of prompt evaluation and intervention for foreign body ingestion in elderly patients, particularly those with communication barriers.

Endoscopic Removal of an Intramurally Ingrown Foreign Body in the Angular Fold of the Stomach

Eine 67-jährige Patientin mit chronischer Gastritis stellte sich wegen zunehmenden epigastrischen Schmerzen in der Notaufnahme vor. Auf Grund einer nicht wegweisenden Initialdiagnostik wurde eine Computertomographie des Abdomens durchgeführt. In dieser stellte sich ein Fremdkörper am Magenausgang dar. Unter radiologischer Kontrolle erfolgte ein anspruchsvolles, zeitintensives endoskopisches Freipräparieren des Fremdkörpers. Nach postinterventionellem Abschwellen der Schleimhaut konnte in einer zweiten Sitzung ein Fischknochen geborgen werden. Die aufwendige endoskopische Intervention bewahrte die Patientin vor einer Operation.

Management of Foreign Bodies in the Ear, Nose and Throat in Pediatric Patients: Real-Life Experience in a Large Tertiary Hospital

BACKGROUND

Foreign body (FB) injuries occur frequently in children. The aim of this paper is to provide an update on the experience of the Department of Otolaryngology, San Camillo Forlanini Hospital in Rome concerning the management of FB injuries in children.

METHODOLOGY

This study was carried out by collecting data from the medical reports of our Pediatric Emergency Room stored between 2007 and 2021. Inclusion criteria were diagnosis of FB in pediatric patients based on the ENT evaluation. Pediatric patients included children and preteens ranging from six months to 15 years.

RESULTS

Between 2007 and 2021, 1,623 cases of FBs in young patients (840 males, 783 females, mean age: 5.5 years) were observed at the Pediatric Emergency Room and treated by the ENT Department. The ear was the most frequently involved site (700 patients), followed by the nose (517 cases), pharynx (319 cases), mouth (76 patients) and airways (11 cases). The most common management strategy was FBs' removal in the emergency room and home discharge (1,409 patients), 99 cases required outpatient discharge, 64 patients moved away from the Emergency Care refusing treatment, 35 patients were hospitalized, 10 patients refused hospitalization, five were transferred to the pediatric hospital and one died in the emergency room.

CONCLUSIONS

A quick diagnosis of FB followed by an effective removal is crucial to avoid injuries and complications. Surveillance registries have a key role in the prevention and management of FB injuries. Moreover, it is necessary to train medical and nursing staff of emergency, pediatric and otolaryngologist departments to best recognize and manage FB injuries.

Consultations for Foreign Bodies in Aerodigestive Tract: Assessment of Diagnostic Modalities

OBJECTIVE

To evaluate test characteristics of various diagnostic modalities in the workup of foreign body (FB) sensation in the aerodigestive tract.

METHODS

Database containing all inpatient otolaryngology consultations between 2008 and 2020 was used. Cases of FB sensation were identified by documented encounter diagnosis or hospital problem of FB or globus sensation. Variables including basic patient demographics, clinical presentations, diagnostic imaging modalities, procedures, and outpatient follow-up were collected.

RESULTS

One hundred and six patients were included in the study. A FB was visualized in 55 patients (52%) and removed in 52 patients (49%); 3 patients had a FB that was visualized initially but not found in the operating room. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were found to be 41%, 50%, 58%, and 33%, respectively, for X-ray (XR); 91%, 61%, 70%, and 87%, respectively, for computed tomography (CT). Sensitivity and NPV were 25% and 57%, respectively, for flexible fiberoptic laryngoscopy (FFL). Seventy-one of 106 patients (67%) underwent invasive interventions during their workup for FBs. Ten out of 11 (91%) chicken bones were found in the digestive tract compared to 7 out of 19 (37%) fishbones (p = 0.0046).

CONCLUSION

In patients with history of FB ingestion, CT may be more beneficial than XR as a screening tool for locating foreign bodies and guiding further management. FFL alone is inadequate for ruling out a FB in the aerodigestive tract given FB's high likelihood of being in the esophagus or buried in soft tissue or mucosa.

LEVEL OF EVIDENCE

3 Laryngoscope, 133:1361-1366, 2023.

Dental Prosthesis in Esophagus: A Right Cervicotomic Approach

Foreign body ingestion in the upper digestive tract is a relatively common emergency. Less than 1% have to be treated surgically. We report the case of a 68-year-old man who ingested a dental prosthesis, probably during a seizure, and thus unknowingly, and presented two days later to the emergency department complaining of a mild dysphagia. A chest radiograph showed the presence of a removable dental prosthesis in the upper esophageal tract. The patient was brought to the operating room where a multidisciplinary equipe was assembled. Two attempts of retrieval with a flexible and a rigid endoscope failed because the removable dental prosthesis was stuck in the right pyriform sinus. Therefore, the surgeon performed an uncommon right cervicotomy and retrieved the foreign body through a right-side esophagotomy. The surgical approach depends on the nature and location of the foreign body. Urgent treatment is required whenever the patient develops dyspnea or dysphagia because of the high risk of inhalation and asphyxia. Removal of any esophageal foreign body has to be performed within 12-24 h. Repeated attempts to retrieve large dental prosthesis using an endoscope may result in esophageal perforation therefore when such risk of complication is too high, a surgical approach becomes inevitable. In our opinion, surgery remains the extrema ratio after a failed endoscopic retrieval attempt but can be lifesaving despite high risk of complications.

Ear, Nose, and Throat Foreign Bodies in Children: A Retrospective Study

Background: This study analyzed the presentation, characteristics, and management of foreign bodies in different age groups of pediatric patients with ear, nose, and throat foreign bodies. Methods: A retrospective study was performed using data from October 2012 to September 2020. A total of 1285 patients with ear, nose, and throat foreign bodies who were less than 12 years of age and who presented to the emergency room were included in this study. Their biographical data, clinical presentations, foreign body types and locations, and management outcomes were obtained from medical records and analyzed as three age groups (infancy: <2 years old; early childhood: 2–5 years old; and late childhood: 6–12 years old). Results: The early childhood group had the highest number of patients (n = 672; 52.2%). Throat was the most common location (59.2%), and bone was the most common type of foreign body. Among the children who visited our hospital, foreign bodies were actually found in only 657 patients (51.1%) and removed by an otolaryngologist in 625 (95.1%) cases. Conclusion: Our study could provide guidance for the diagnosis and management of pediatric patients who present to emergency departments with foreign bodies.

Behavior of Children during Dental Care with Rubber Dam Isolation: A Randomized Controlled Study

BACKGROUND

The establishment of the dental dam improves dentist working conditions and patient protection. The purpose of this study was to analyze the behavior of the child during dental care with or without a dam.

METHODS

In this interventional randomized study, 51 patients are divided into two groups, one with a rubber dam and the other with cotton roll isolation. Their behavior was observed during the treatment of temporary molars. The duration of the treatment, the patient's feeling with a visual analogue scale (VAS), the behavior (B) of the child measured with a hetero-evaluation scale (modified Venham scale) and the cardiac frequency (CF) were measured.

RESULTS

The group treated with a rubber dam has a significant decrease in the various stress parameters that have been identified (B, p value = 0.034; CF, p value = 0.015). Subgroups of patients with and without nitrous oxide sedation were compared and similar results were obtained.

CONCLUSIONS

Isolation with a rubber dam reduces child's stress during dental care. Although it is slightly more time-consuming and training is necessary for a quick and effective placement, it allows dentists to perform dental care in the best possible conditions, while reducing dental anxiety in young patients.

Upper gastrointestinal foreign bodies in adults: A systematic review

BACKGROUND

Foreign body(FB) ingestion in the upper digestive tract is a common emergency that lacks sufficient attention in adult population. Improper management may bring additional injuries and financial burdens to patients. This review was performed to determine the clinical characteristics of upper gastrointestinal FBs, including the demographic of adult patients, the type and location of FBs, underlying diseases of patients and other risk factors, and outcomes.

METHODS

We searched PubMed, MEDLINE, EMBASE and Cochrane databases with the terms "foreign body AND upper gastrointestinal NOT child". Finally, we got 7 articles between 2001 and 2020 and extracted the information.

RESULTS

A total of 1391 patients were included. 736 (52.9%) patients were males and 655 (47.1%) were females. Fish bone was the most common type of FBs. Esophagus accounts for the most location in the upper digestive tract. 18.2% (235/1291) patients had the underlying diseases, and 11.7% (58/494) had other risk factors. The overall complication rate was 4.5% (63/1391).

Unusual Foreign Body, a Spoon, in the Esophagus of a Middle-Aged Female: A Case Report and Review of the Literature

In adults, a large metal foreign body in the esophagus is rarely seen and is usually caused accidentally. Here, we have described an unusual case of foreign body (spoon) in the esophagus of an adult patient. A 48-year-old woman initially presented to the emergency department with marked dysphagia, drooling, and radiating pain to the chest. She had swallowed a spoon while trying to vomit because of feeling sick. Radiological images revealed a spoon stuck in the esophagus. The edge of the spoon was grabbed with forceps and safely extracted under hypnic anesthesia. No esophageal perforation was detected on evaluation with esophagography using Gastrografin on the next day. This case highlights an unusual situation in an adult patient showing long nonfood-type foreign body in the esophagus. It is important that an appropriate workup and removal of foreign body is performed according to the location and type.

Haemoptysis in a toddler: An uncommon presentation of unusual foreign body ingestion

Introduction:

Haemoptysis is uncommon in toddler. Lower respiratory tract infections and foreign body are among the common causes.

Case Presentation:

We are reporting a case of a child presented to emergency department with complaint of mild haemoptysis, whom was later found to have a piece of broken satay skewer at the tonsillar region. The foreign body was removed during the procedure without any complication.

Discussion:

Foreign body ingestion, particularly a piece of broken satay skewer, is difficult to suspect without a proper history and eyewitness. Therefore, parent’s supervision is important. Emergency residents should have a high index of suspicion of foreign body ingestion in a child with vague symptoms.

Conclusion:

Foreign body is among the commonest cause of haemoptysis in an afebrile toddler. Acute haemoptysis in otherwise healthy toddler should alert the emergency residents about foreign body ingestion. History of food intake should be more thorough even if trivial.

Ingested Fish Bone Lodged in the Vallecula

Although foreign body ingestions are less common in adults than children, when they do occur, it is often due to a fish or chicken bone. The authors present a case of a fish bone ingestion, and highlight its appearance on imaging.

Conservative management of oesophageal soft food bolus impaction

BACKGROUND

Impaction of a soft food bolus in the oesophagus causes dysphagia and regurgitation. If the bolus does not pass spontaneously, then the patient is at risk of aspiration, dehydration, perforation, and death. Definitive management is with endoscopic intervention, recommended within 24 hours. Prior to endoscopy, many patients undergo a period of observation, awaiting spontaneous disimpaction, or may undergo enteral or parenteral treatments to attempt to dislodge the bolus. There is little consensus as to which of these conservative strategies is safe and effective to be used in this initial period, before resorting to definitive endoscopic management for persistent impaction.

OBJECTIVES

To evaluate the efficacy of non-endoscopic conservative treatments in the management of soft food boluses impacted within the oesophagus.

SEARCH METHODS

We searched the following databases, using relevant search terms: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and CINAHL. The date of the search was 18 August 2019. We screened the reference lists of relevant studies and reviews on the topic to identify any additional studies.

SELECTION CRITERIA

We included randomised controlled trials of the management of acute oesophageal soft food bolus impaction, in adults and children, reporting the incidence of disimpaction (confirmed radiologically or clinically by return to oral diet) without the need for endoscopic intervention. We did not include studies focusing on sharp or solid object impaction.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures recommended by Cochrane.

MAIN RESULTS

We identified 890 unique records through the electronic searches. We excluded 809 clearly irrelevant records and retrieved 81 records for further assessment. We subsequently included one randomised controlled trial that met the eligibility criteria, which was conducted in four Swedish centres and randomised 43 participants to receive either intravenous diazepam followed by glucagon, or intravenous placebos. The effect of the active substances compared with placebo on rates of disimpaction without intervention is uncertain, as the numbers from this single study were small, and the rates were similar (38% versus 32%; risk ratio 1.19, 95% confidence interval 0.51 to 2.75, P = 0.69). The certainty of the evidence using GRADE for this outcome is low. Data on adverse events were lacking.

AUTHORS' CONCLUSIONS

There is currently inadequate data to recommend the use of any enteral or parenteral treatments in the management of acute oesophageal soft food bolus impaction. There is also inadequate data regarding potential adverse events from the use of these treatments, or from potential delays in definitive endoscopic management. Caution should be exercised when using any conservative management strategies in these patients.

Differences between intentional and accidental ingestion of foreign body in China

Backgrounds

Previous reports of foreign-body ingestion focused primarily on accidental ingestion and very few studies focused on intentional ingestion of foreign body (FB) in China. Our study aimed to compare the prevalence of different age, gender, types, locations and management of FB ingested between intentional ingestion and accidental ingestion of FB in Northern China.

Methods

A retrospective case series studied all patients with suspected FB ingestion in Digestive Endoscopy Center of Beijing Friendship Hospital, between January 2011 and January 2019. The patients were divided into 2 groups. Group A included the patients who intentionally ingested FBs, and Group B included the patients who accidentally ingested FBs. Patients’ database (demographics, past medical history, characteristics of FB, endoscopic findings and treatments) were reviewed. Statistical analyses were conducted using SPSS software.

Results

Group A consisted of 77 prisoners, 2 suspects and 11 psychologically disabled persons. Group B consisted of 1020 patients with no prisoners, suspects or psychologically disabled persons. In Group A, there were no food-related foreign bodies, and the majority of FBs were metallic objects (54.44%). However in Group B, food-related FBs were the most common (91.37%). In Group A, 58 cases (64.44%) were located in the stomach, while in Group B, 893 cases (87.55%) were located in the esophagus (P < 0.05). 1096 patients successfully underwent endoscopic removal and 14 failed, including 9 cases in Group A and 5 cases in Group B. The duration of FBs impaction was longer in Group A than that in Group B (P < 0.05).

Conclusions

In our study, the patients who intentionally ingested FB were mainly prisoners, FBs were mostly sharp metallic objects, the duration of FBs impaction was longer, and the rate of successful endoscopic treatment was lower than that of the general population. Attention should be focused on these patients.

Management of Sharp-Pointed Esophageal Foreign-Body Impaction With Rigid Endoscopy: A Retrospective Study of 130 Adult Patients

OBJECTIVES

To propose a management algorithm for adult patients with sharp-pointed esophageal foreign-body impaction (EFBI) who have rigid endoscopy (RE) indications and to conduct a retrospective analysis of their data.

METHODS

All adult patients who received RE at the Department of Otorhinolaryngology in Beijing Shijitan Hospital between January 2017 and May 2019 were enrolled. The demographics, clinical characteristics, and management data were collected and analyzed.

RESULTS

A total of 130 patients were identified, 56.9% were female with median age 60 years. More than half (56.9%) of patients had foreign-body (FB) ingestion on holidays. The most frequent FBs were jujube pits (66.9%) and bones (23.8%). There is a significant female predominance in ingestion of jujube pits (65.5%, P = .005). The most common symptoms were odynophagia (49.2%) and sore throat (47.7%). The majority (96.8%) of FB founded were lodged at upper esophagus. In all, 74 patients were categorized as having mild complications and 54 having significant complications. Time interval from ingestion to presentation longer than 15 hours was an independent risk factor for significant complications, while esophagogram with barium as a protective factor.

CONCLUSIONS

Long-time interval from ingestion to presentation will lead to high risk of significant complications. Computed tomography should be a prioritized imaging method for all patients suspected with EFBI, and multidisciplinary collaboration is recommended. Besides, mass education on eating habits is necessary.

Age-Specific Differences in Foreign Bodies Ingested by Children: A Cohort Study of 252 Japanese Cases

Background and Objectives: When children accidentally ingest foreign bodies, they may be unable to communicate adequately; it is often difficult to identify the causative foreign body unless someone is watching over them. In such instances, to identify the causative foreign body during clinical practice, we aimed to determine if it varies according to age. Materials and Methods: From April 2013 to June 2018, 252 records of pediatric patients with a confirmed diagnosis of foreign-body ingestion were retrospectively examined in a Japanese university hospital. Comparisons among multiple age groups, according to type of ingested foreign body, were analyzed using Kruskal‒Wallis tests. The differences between the individual data were tested using the Steel‒Dwass test. Results: The median age of the patients was 15 months, and of the total patients, 140 were boys (55.5%). The types of foreign bodies ingested were as follows, in order of frequency: cigarettes (n = 44, 17%, median age: 12 months), plastics (n = 43, 17%, median age: 11 months), chemicals (n = 27, 11%, median age: 13 months), internal medicines (n = 26, 10%, median age: 33 months), and metals (n = 26, 10%, median age: 35 months). The median age was significantly different among the types of causative foreign bodies (p < 0.01). The patient age for the ingestion of cigarettes was significantly younger than that for ingesting metals or coins. The age for ingesting internal medicines was significantly older than that for ingesting plastics, cigarettes, paper, or chemicals (p < 0.01). Conclusions: The causative foreign body ingested differed according to age. This will be valuable information for physicians that encounter pediatric patients who may have ingested an unknown foreign body in Japanese pediatric emergency or general practice settings.

Determining a reliably visible and inexpensive surface fiducial marker for use in MRI: a research study in a busy Australian Radiology Department

OBJECTIVES

Single-use commercial surface fiducial markers are used in clinical imaging for a variety of applications. The current study sought to find a new, reliably visible, easily sourced and inexpensive fiducial marker alternative for use with MRI.

DESIGN

Five commonly requested MRI sequences were determined (three-dimensional (3D) T1-weighted, T1 coronal, 3D T2-weighted, T2 fat suppressed, proton density), to examine the visibility of 18 items (including a commercial fiducial marker).

SETTING

Clinical 3T MRI scanner in an Australian Tertiary Hospital and an Australian University Biomedical Engineering research group.

INTERVENTIONS

18 marker alternatives were scanned using five common MRI sequences. Images were reformatted to obtain both an image through the mid-height of each marker and a maximum intensity z-projection image over the volume of the marker. Variations in marker intensity were profiled across each visible marker and a visibility rating defined.

MAIN OUTCOME MEASURES

Outcome measures were based on quantitative assessment of a clear intensity contrast ratio between the marker and the adjacent tissue and a qualitative assessment of visibility via a 3-point scale.

RESULTS

The fish oil capsule, vitamin D capsule, paint ball pellet, soy sauce sushi tube and commercial markers were typically visible to a high quality on all the imaging sequences and demonstrated a clear differential in intensity contrast against the adjacent tissue. Other common items, such as plasticine 'play doh' and a soft 'Jelly baby' sweet, were surprise candidates, demonstrating high-quality visibility and intensity contrast for the 3D T1-weighted sequence.

CONCLUSIONS

Depending on the basis for referral and MRI sequence chosen, four alternative fiducial markers were determined to be inexpensive, easily sourced and consistently visible. Of these, the vitamin D capsule provided an excellent balance between availability, size, cost, usability and quality of the visualised marker for all the commonly used MRI sequences analysed.

Evaluation of the extent of damage to the esophageal wall caused by press-through package ingestion

Press-through package (PTP) is the most common accidentally ingested foreign body in Japan. Accidental ingestion of PTP can result in esophageal damage. An approach for evaluating the risk of esophageal injury has not been established. Therefore, we used porcine esophageal tissue and silicone sheets to establish a method for assessing the risk of esophageal damage on accidental PTP ingestion. We pathologically evaluated porcine lower esophageal tissue using a scratch tester. Using porcine esophageal tissue, scratch tests were performed with 4 test objects and pathological damage was compared. It was assumed that each object was accidentally ingested. The objects were polyvinylidene chloride (PVDC)-coated polyvinyl chloride (PVC) PTP, soft PThPa, round PTP, and a disposable scalpel. The porcine esophagus was replaced with a silicon sheet, and an automatic friction machine was used for quantitative evaluation. The silicon sheet was scratched using HHS 2000 with 750-g load at 50 mm/min. We investigated the frictional force exerted on the surface for each of the objects. The degree of damage (depth) was the highest for the disposable scalpel, followed by PVDC-coated PVC PTP, while the degree of damage (depth) was the lowest for soft PThPa and round PTP. The mean frictional forces on the silicon sheet were 524.0 gf with PVDC-coated PTP, 323.5 gf with soft PThPa, 288.7 gf with round PTP, and 922.7 gf with the disposable scalpel. We developed approaches to qualitatively and quantitatively evaluate the risk of esophageal damage after accidental PTP ingestion. Our findings indicate that the risk of gastrointestinal damage after accidental PTP ingestion is low with soft PTP and round PTP.

A rare complication of the duodenal diverticulum

Introduction: An 80-year-old woman presented to the emergency department with severe right-sided abdominal pain that had started after her last meal. Physical examination revealed fever (38.6°C) and rebound tenderness in the right upper quadrant of the abdomen. The laboratory studies showed a leucocyte count of 11.3×10⁹/L (normal, 3.7-8.0×10⁹/L) and a C-reactive protein level of 2.34 mg/dL (normal, <0.03 mg/dL). There were no other significant findings. A CT scan of the abdomen with contrast revealed retroperitoneal air around a duodenal diverticulum (figures 1 and 2).Figure 1Computed tomography scan of the abdomen with contrast (coronal section). A diverticulum in the second portion of the duodenum (arrow) and retroperitoneal air (asterisk) are shown.Figure 2Computed tomography scan of the abdomen with contrast (axial section). The area with retroperitoneal air (asterisk) is marked.

QUESTION

What is the most likely diagnosis and the cause underlying the condition?

Multiple cranial nerve injuries and neck abscesses caused by a transorally penetrating organic stick

Foreign bodies cause a remarkable number of otolaryngological emergency visits and occasionally result in life-threatening conditions and later-emerging complications. Patient recovery depends on the detection and proper extraction of all foreign materials. Despite various obtainable diagnostic tools, adequate anamnesis forms the basis of clinical reasoning and should direct later examinations and radiological imaging. This case report describes a challenging patient with a unique trauma mechanism: many pieces of a fragmented organic foreign body emerged within 1 year of the initial injury, leading to repeated operations, a long period in an intensive care unit and a long-term swallowing and speech dysfunction.