Swallowed foreign body: Is interventional management always required?

A retrospective study of 20 cases diagnosed as "swallowed foreign body" seen over a five-year period (July 1993-June 1998) at Asir Central Hospital was performed. Six (30%) were children and 14 (70%) adults. In the children, five were boys and one was a girl. Objects swallowed included metal nails. coins, hair pins and a chain pendant. In the adult group, eight (57%) were males and six (43%) females. Objects swallowed included sewing needles, sharp blades, pieces of glass, paper clips and gravel. The swallowed foreign body in all the patients passed innocuously through the gastrointestinal tract in two to ten (average 4.7) days. Our method of treatment consisted of giving high fiber diet, Metamucil or lactulose and liquid paraffin. There was no mortality.

Traumatic diaphragmatic hernia: an Asir region (Saudi Arabia) experience

Ten patients (nine males, one female), seen at the Asir Central Hospital of South-Western Saudi Arabia with proven traumatic diaphragmatic hernia between 1987 and 1997, were reviewed retrospectively. The mean age was 29.6 years, range 5 to 50 years. Chest pain and vomiting were the commonest symptoms. Blunt trauma (road traffic accident--5, fall from height--1, (accounted for 60% of the cases) while gunshot wound and stab wounds were the causes in two patients each. The chest radiograph suggested the diagnosis in all the cases. Barium meal (in two patients) and barium enema (in two patients) complemented the diagnosis. Computed tomography (CT) scan was done in only one patient. Thoracotomy (in 2 patients), laparotomy (in 5 patients) and thoraco-laparotomy (in 3 patients) were the surgical approaches to management. Common herniated organs were liver, stomach, spleen and large bowel. The injuries were on the left side in seven patients and on the right side in three cases. Immediate surgical repair was done in four patients while it was done two days to four years later in others. Complications were minimal and there was only one death.