Mediastinitis and retropharyngeal abscess following delayed diagnosis of glass ingestion

Suicide Attempt by Glass Shard Ingestion: A Case Report

A 42-year-old man with schizophrenia and human immunodeficiency syndrome swallowed several glass shards in an attempted suicide. Two days later, he was admitted to the ER of the Florianópolis Hospital with a complaint of upper abdominal pain. The patient showed normal vital signs on physical examination; there was tenderness of palpation of the epigastrium. The investigation on admission included hemogram, CXR, abdominal X-ray, and upper GI scope. Radiographs showed several radiopaque image fragments in the stomach, as well as in the small and large intestines. Hemogram showed normal results. Upper gastrointestinal endoscopy found no signs of esophagogastroduodenal perforation; several glass shards were removed from the patient's stomach. The patient remained in the ward for four days and underwent continuous vital signs monitoring, serial physical examinations, hematimetric control, and daily imaging tests. He showed normal vital signs and progressive improvement of abdominal pain during hospitalization, although hematochezia episodes took place during defecation. The patient no longer complained of abdominal pain on the fifth hospitalization day; the complete removal of the glass fragments was confirmed through imaging examinations, and the patient was transferred to a specialized hospital in order to better treat his psychiatric condition.

A Rare Case of Gastrointestinal Tract Foreign Body; Glassy Stomach

Ingestion of foreign bodies is common and conservative treatment can eliminated most particlesfrom the gastrointestinal tractunless peritoneal signs appear. A 22-year-old man presented to emergency department who had ingested glass particles of a crushed beveragebottle.Hecomplained ofepigastric and periumbilical pain. Physical examination did not revealany peritoneal signs. Abdominal X-ray showed stomach full of small glass particles. Conservative treatment, without any surgical intervention,resulted insafely eliminating glass particlesin this patient.

Perforation of esophagus and subsequent mediastinitis following mussel shell ingestion

Esophageal perforation is a very rare occurrence because accidental swallowing of foreign bodies is uncommon in adults. Thus, perforation due to swallowing of a foreign body and subsequent development of mediastinitis is rarely encountered by physicians. We experienced such a case and described an adult male patient who had perforated esophagus after accidentally swallowing a mussel shell. The patient visited our emergency department complaining of painful dysphagia for 4 days. A review of history revealed that he consumed a spicy seafood noodle soup containing mussel shells 4 days ago. Computed tomography (CT) of the chest showed the foreign body in the esophagus and pneumomediastinum was identified. We removed the mussel shell fragment using rigid esophagoscopy; explo-thoracotomy, debridement of mediastinal abscess and irrigation were performed.

Clinical guidelines for imaging and reporting ingested foreign bodies

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.

Updates in pediatric gastrointestinal foreign bodies

Although most ingested foreign bodies in children pass spontaneously, certain foreign bodies can be harmful and they require special attention and emergent medical intervention to prevent significant morbidity and mortality. This article presents an overview of the epidemiology, diagnosis, management, and complications of foreign body ingestions in children. Particular attention is paid to coins, sharp objects, long objects, food bolus, caustic liquids, batteries, and magnets.

Holiday ornament-related injuries in children

OBJECTIVES

Holiday ornament injuries in children have not been well documented in the medical literature. Our aim was to investigate the patterns of injuries sustained from these ornaments as a first measure toward prevention.

METHODS

This was a retrospective cohort analysis of all patients examined in an urban pediatric emergency department over a 13-year period ending in March 2008 for holiday ornament-related injuries. Cases were identified using a computer-assisted text query followed by a manual chart review. Data collected from each chart included the child's age, sex, injury characteristics, physical examination findings, radiographic imaging, interventions, and disposition. To analyze injury rates over the years, we used a multiplicative Poisson model allowing varying exposures.

RESULTS

Over the study period, we identified 76 eligible patients. The median age was 2 years (interquartile range, 1.17-3.3 years); 44.7% were female. Forty-three of the 76 cases (53.9%) involved ingestions: 35 were of holiday ornaments, and 8 were of light bulbs. All but one of these ornaments were made of glass. In 28%, there was an associated bleed either from the mouth or as a delayed gastrointestinal bleed. Other patients experienced lacerations (27.6%), eye injuries (5.1%), and minor electrocution injury (2.5%). Imaging was performed in 85%. A subspecialty consult was obtained in 23%, primarily addressing a foreign body ingestion or removal after skin exploration. The incidence rate has not changed over the years.

CONCLUSIONS

Holiday ornament-related injuries primarily involve foreign body ingestions and glass-related injuries. Over half of the injuries involved small light bulbs and ornaments made of glass placed at the level a toddler can reach. Pediatricians are advised to discuss these points with families during holiday season.