Intraperitoneal foreign body following repeated self-mutilation: a case report

Excerpt Spontaneous perforation of the esophagus is a rare condition with a high mortality rate when untreated. The following patient illustrates the need for an early diagnosis and immediate surgi...

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A 62 year-old hog butcher had a sharp pain in his right little finger while he was removing the hair from a white hog 1 month ago. He immediately sought help at a nearby emergency department (ED). His finger was cleaned, but doctors found nothing in his finger at that time. Because of frequent painful swelling in his finger, he sought treatment at many clinics. However, surgical exploration for a cause was negative, and the pain and tenderness did not improve. He then came to our ED with a painfully swollen right little finger. A physical examination showed a local tender spot on the radial side of the distal interphalangeal joint. We suspected that the patient had a foreign body in his finger; hence an ultrasonographic investigation was performed by an experienced orthopaedics ultrasonologist (T.C.C.). To detect and localise the foreign body, the suspected area was scanned. A hyperechoic foreign body without posterior acoustic shadowing, surrounded by a hypoechoic halo of inflammation was identified in the axial (transverse to the foreign body) and oblique (longitudinal to the foreign body) directions (Figure 1, right panels: green arrows). After the foreign body had been localised, an ink mark was made on the skin directly over it (Figure 2, upper panels). Care was taken to mark the skin nearest to the foreign body and on the proposed line of minimal incision for the exploration. The object's depth from the skin surface was measured using electronic callipers. Ultrasonograms were obtained using a real-time scanner (t3000TM; Terason, Burlington, MA) with a 5–12-MHz linear array transducer. We removed the foreign body, a tiny white pig bristle about 1 cm long (Figure 2, lower panel). A follow-up showed that the patient had rapidly recovered. Ultrasonography has proved to be an accurate non-invasive method for detecting and localising radiolucent foreign bodies in soft tissue. Because of its low cost, convenience and lack of risk, an ultrasonograph machine should be used in the ED and for in-office physical examination of patients suspected of harbouring radiolucent foreign bodies. Moreover, ultrasonography not only contributes preoperatively in detecting the presence, size and exact location and depth of foreign bodies but also provides intraoperative guidance during their percutaneous removal 1-9. Although a plain X-ray is considered the standard technique, ultrasonography is an indispensable tool for managing radiolucent foreign bodies. In one report 10 on ultrasonographic localisation and guided removal of foreign bodies embedded in the hand, 8 of 11 foreign bodies were removed using real-time intraoperative ultrasonographic guidance. The foreign bodies were seven pieces of wood and one piece of glass (length range: 4·5 mm–3 cm); all were radiolucent and would have been difficult to localise with any other preoperative or intraoperative technique. Our illustrative case, a hog bristle being a very small radiolucent foreign body on which there are no published reports, evidences the usefulness of this technique for these difficult-to-find items. Technological developments have modified the quality of ultrasonographic images, which can be superimposed without using a dedicated spool or a particular acquisition parameter. Most case reports and series studies have used 5–10 MHz linear transducers, which are widely available, simple to use and inexpensive, and will identify radiopaque and radiolucent foreign bodies (glass, metal and stone) as short as 4·5 mm. However, a recent series 11 reported detecting a 0·5-mm glass splinter using a high-frequency linear-array probe of 12–17 MHz. We believe that a high-frequency transducer offers a more accurate topographic assessment and has more potential for detecting tiny foreign bodies. However, in this case report, we used a 5–12-MHz linear array transducer to find a hog bristle. In our experience using ultrasonography to detect radiolucent foreign bodies, we agree with Blankstein et al. that examinations and routine check-ups of the extremities for foreign bodies are time consuming and require expertise8. We successfully used high-frequency ultrasonography to identify a tiny foreign body and our conclusion echoed a previous study that high-resolution (12–17 MHz) ultrasonography is substantially better than standard resolution (5–12 MHz) ultrasonography12, and is a worthy practical tool for diagnosis and a therapeutic adjuvant for removing foreign bodies from soft tissue. Moreover, as these devices continue to evolve and techniques improve, much smaller and softer foreign bodies than before may be detected. A detailed ultrasonographic examination is mandatory and well worth the effort for detecting embedded foreign bodies. Sui-Yi Chao, MD1, Tai-Chung Chern, MD2, I-Ming Jou, MD, PhD1, Yao-Lung Kuo, MD, Dr Med3 1Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine National Cheng Kung University Tainan, Taiwan 2Chern Tai-Chung Orthopedic Clinics Ping-Tung, Taiwan 3Department of Surgery, National Cheng Kung University Hospital, College of Medicine National Cheng Kung University, Tainan and Dou-Liou Branch Tainan, Taiwan [email protected]

The case to be reported is unique in my experience, and I am unable to find any such case to date reported in the literature. Furthermore, I am unable to explain the chain of events leading to involvement of the submaxillary glands. Whether the foreign body first entered Wharton's duct and then penetrated to the tonsillar fossa, or whether it entered the peritonsillar area, thus setting up an inflammatory process which dissected through to the gland, is a point of controversy. In view of the history of the case, the latter explanation is the more plausible. <h3>REPORT OF CASE</h3> A man aged 26, a lieutenant in the United States Army, was first seen at an overseas station in June 1945 with the complaint of a prickling sensation in the left tonsillar area. At this time nothing could be seen or felt on examination. A few weeks later he noticed a

PRESENCE of a foreign body in various parts of the gastrointestinal tract is not unusual and has been reported frequently. However, capsules ingested by a patient and retained in his bowel for many years are not a common occurrence. We recently came across such a curiosity in a patient with carcinoma of the cecum and a Meckel's diverticulum. In a thorough search through the literature we have not been able to find a report of a similar case. <h3>Report of Case</h3> An 89-year-old white man was admitted to the medical service for treatment of iron-deficiency anemia, with a hematocrit reading of 17%. On admission a mass was found in the right iliac fossa. After receiving treatment with blood transfusions and oral iron, the patient was transferred to the surgical service for further evaluation of the abdominal mass. Past history revealed a carcinoma of the sigmoid, treated in another hospital 28

A 56-year-old woman presented to the Emergency Department of Parkland Memorial Hospital complaining of chest pain. She had a remote history of a hemorrhagic cerebrovascular accident complicated by pulmonary embolism, for which a Gunther-Tulip inferior vena cava (IVC) filter had been placed 6 years previously. In the triage area, the patient collapsed and was found to be hypotensive. An ECG showed sinus bradycardia with nonspecific ST and T-wave changes …

Introduction: Non-missile penetrating brain injury (PBI) involving the anterior skull base constitutes a rare subclass of traumatic brain injury in civilians. Management of this type of trauma is poorly described in the literature, with only case series and reports available. Materials and Methods: A systematic search was conducted across PubMed, Scopus, and Web of Science databases. The study included reports of adult patients with non-missile PBI with foreign bodies crossing the anterior skull base, published between the years 2000 and 2024. The patients were divided into three groups based on the entry point of foreign bodies: transorbital, transmental, and transnasal injuries. The obtained data were analyzed through descriptive statistics. A case report of a 20-year-old male following PBI involving the anterior skull base caused by suicidal self-shooting with a crossbow is presented. Results: A total of 17 articles reporting 40 patients and the current case were included. The mean age of the patients was 37.4 ± 13.1 years, and 92.7% of them were male. Transorbital injury was the dominant type of PBI (29 cases), followed by transmental injury (7 cases) and transnasal injury (5 cases). A total of 37 patients (90.2%) were managed operatively due to retained foreign bodies after PBI. Antibiotic prophylaxis was implemented in 33 cases (80.5%), mostly in transorbital (93.1%) and transnasal (100%) PBI. In seven reported cases, antiepileptic drugs were preventively administered. At the last follow-up, 18 patients (47.4%) did not fully recover neurological functions, with vision loss as the most common deficit. Conclusions: Management of non-missile PBIs involving the anterior part of the skull base is complex, challenging, and often requires a multidisciplinary team including neurosurgeons, ENT surgeons, ophthalmologists, and maxillofacial surgeons. In this type of traumatic brain injury, following proper management may lead to favorable outcomes with minimal neurological deficits.

AN UNFORTUNATE VISIT TO THE DENTIST

Background: Patients with foreign bodies in upper digestive tract not infrequently trigger many diagnostic and treatment challenges, especially when foreign bodies translocate and are lodged outside the esophagus. Case report: We present a case of a foreign body in esophagus 56-years old woman who had developed persistent sensation of an obstacle in her throat after eating fish (Atlantic cod). She has initially dismissed her symptoms and refused medical treatment. Subsequently, a neck CT done one week later showed a 20-milimeter long fish bone in the soft tissues on the left side of her neck (between pharynx and vertebral column). Few attempts of endoscopic removal were unsuccessful. Despite antibiotic prophylaxis and due to the fish bone translocation into soft tissues of the neck and its location close to a common carotid artery and an internal jugular vein a decision was made to remove it from the external approach. The foreign body was successfully removed without any esophageal damages. Conclusions: Foreign bodies in digestive tract may result in many life-threatening complications. The fundamental management is based on the endoscopic removal of a foreign body and the antibiotic prophylaxis. In case of foreign bodies lodged in soft tissues open surgery is recommended. Key words: foreign body in the esophagus; fish bone; paraesophageal abscess ; treatment

Objective To explore the diagnosis and treatment strategies of carotid- cavernous fistula (CCF) following orbito - cranial penetrating injury with cases report and literature review.Method We report a case of occult post - traumatic CCF in a 19 - year - old male who was stabbed by a 12 cm long wooden foreign body from left orbit into the contralateral cavernous sinus region.Original cerebral angiography demonstrated no CCF.But after a tentative lightly move of foreign body,right occult post - traumatic CCF was found.With adequate preoperative preparation,foreign body was extracted completely and CCF was managed with endovascular embolization within no more than one minute.Results After embolization treatment,CCF was disappeared completely.Although several complications ensuing,such as hydrocephalus,intracranial infeion and leakage of cerebrospinal fluid,the patient was discharged with the wounds well healed and no neurological deficits and visual loss on the 21st day after the operation.Conclusions As orbito - cranial penetrating injury frequently results cerebral vascular injury which may cause fatal intracranial hemorrhage,early assessment of the patient with cerebral angiography is strongly recommended.Secondly,in case foreign body penetrated into cavernous sinus region,CCF should be highly suspected and retained foreign body had better to be pulled out in support of neurological intervention.Finally,one should keep in mind that post - traumatic CCF due to orbito - cranial penetrating injury can be latent or show no typical symptoms,and extraction rashly of residual foreign body may lead to fatal bleeding. Key words: Carotid - cavernous fistula; Orbito - cranial penetrating injury; Endovascular embolization

Acquired aorto-esophageal fistula as a complication of missed of foreign body ''a case report''