Accidental Foreign Body Research Articles

Endoscopist experience with pediatric recurrent and intentional foreign body ingestion (RIFBI): Management considerations and future directions.

Accidental foreign body ingestion (FBI) is a common pediatric referral concern. In contrast, recurrent and intentional FBI (RIFBI) is infrequent and associated with greater endoscopic and surgical intervention in adults. Although pediatric guidelines exist for FBI, the risk and therapeutic implications of RIFBI are not addressed. An anonymous international survey on pediatric gastroenterologist experience with RIFBI was distributed. A 33-item REDCap© survey was distributed via email to pediatric gastroenterologists identified through mailing and email lists obtained from pediatric gastroenterology professional organizations. During 9-12/2021 we accrued 202 completed surveys. Respondents were from 27 countries and across the career span. Eighty percent reported experience with RIFBI; 74% reported seeing ≤ 3 patients with RIFBI within the past 24 months and 4% reported seeing ≥ 6. Of those who treated RIFBI, 38% reported an average number of annual ingestions per patient was ≥5. Frequent morbidity but not mortality was reported. Half reported adherence to FBI guidelines. Later-career endoscopists treated RIFBI more aggressively than accidental ingestion. Ninety-six percent noted that patients with RIFBI had psychiatric comorbidities. Providers at academic medical centers reported referring to behavioral health more than those in other settings. Most gastroenterologists surveyed reported encountering RFBI several times a year and in patients with psychiatric comorbidities. Greater likelihood of adverse outcomes associated with endoscopy was reported. Most reported referral to behavioral health and few had RIFBI management protocols. A broader spectrum of psychologic comorbidities in the pediatric population with RIFBI, notably depression and autism spectrum disorder, were reported.

Endoscopic Retrieval of a Transpalatal Arch as an Orthodontic Emergency: A Case Report

Ingestion of a foreign object forms a potential complication, be it any branch of dentistry. The present article describes an incident of accidental foreign body ingestion by an orthodontic patient while trying to consume a firm Indian delicacy leading to fracture, and eventual swallowing of a Transpalatal arch. The case was immediately referred to Department of Gastroenterology, wherein the major part of fractured arch was retrieved endoscopically from stomach while the minor part’s trajectory was followed on subsequent radiographs until it was eliminated. This report concludes in the management and further discussion of possible clinical complications, causes, and practices for prevention.

Foreign body ingestion due to detachment of pill dispenser tips in cats: a retrospective study of 13 cases.

The aim of this study was to evaluate and describe 13 cases in which a pet piller broke during the administration of medication, and the tip was accidentally ingested by the cat. A total of 15 presentations to the clinic were identified in a private practice database involving 13 cats in which the silicone tip broke. Two of these cats ingested foreign bodies on two separate occasions. Routine radiographic examination enabled the identification of silicone tips in all animals. On 2/15 occasions, the cats did not receive an emetic drug. Intramuscular xylazine (0.2 mg/kg) and dexmedetomidine (6 μg/kg) were administered to 12/15 and 1/15 cats, respectively. The cats were aged 3-17 years (mean age 11.00 ± 4.35 years). Vomiting occurred in 13 cats that received alpha-2 adrenoceptor agonists, although the silicone tip was recovered in only five occurrences. In 9/15 occurrences, endoscopy was performed under general inhalation anesthesia, and the silicone tip was successfully removed. Natural elimination occurred in only one case. The use of pet pillers with detachable silicone tips increases the risk of accidental foreign body ingestion by animals. Therefore, guidelines regarding safety standards for manufacturing would be beneficial. No cat in this series developed clinical signs related to the ingestion of the piller tip, probably because of the quick presentation by the owners and early intervention, including endoscopic retrieval. Surgical intervention was not required in any case, including one in which the foreign body was lodged within the small intestine before being passed naturally by the cat.

Head Scarf Pin in the Airway and Challenges in Rigid Bronchoscopy: A Case Series.

Accidental Foreign body aspiration, especially sharp metallic objects may lead to life threatening complications. A metallic object is identified readily on a Xray chest or CT chest and helps us in ascertaining its location. A straight pin with blunt head in the shape of pearl is used in wearing a head scarf also known as hijab to hold it in place. The head scarf pin (hijab pin) if accidentally aspirated into the airway may lead to grave complications. Hence timely intervention with suitable instrumentation is essential to prevent any lethal complications. We have reported four different cases of adolescent females who had accidentally aspirated hijab pin and challenges faced by us during removal.

Foreign Body Accidents in a Pediatric Emergency Department.

Introduction Foreign body accidents (FBAs) are frequent in children and can be severe, being a common cause of morbidity and mortality and a public health problem. As these accidents are multifactorial, their cause can only be determined by analyzing the clinical details and characteristics of the object. Knowing the associated mechanisms and factors is essential to determine a risk profile and have a preventive, therapeutic, and diagnostic purpose. Objective The present study aimed to describe the incidence of FBAs in otorhinolaryngology according to their anatomical location, focusing on the aerodigestive system. Methods This is a retrospective study performed by reviewing the medical records of 668 cases seen in the emergency department of a tertiary pediatric hospital in São Paulo, state of São Paulo, Brazil, between 2014 and 2017. Results Foreign bodies (FBs) were found in the digestive system (238/668), in the nasal cavities (206/668), in the ears (182/668), in the oropharynx (34/668), and in the respiratory system (8/668). A total of 91.77% of the patients were treated in the emergency room. The main age group affected was < 5 years old, with no difference between genders. The most frequent complications affected the digestive system and the most serious occurred in cases involving the respiratory system. Conclusion Multidisciplinary teams should be ready in the emergency room to provide adequate care in FBAs. Early diagnosis, FB removal in the emergency room or the surgical center and follow-up are essential. Developing prevention campaigns including a risk profile for certain products and/or materials, helping to ensure safety for consumers, is necessary. For this, a national database with compulsory notification containing relevant information on FBAs in the pediatric population should be created.

Foreign Body Ingestion in an Adult not Associated with Mental Disorder: An Unusual Clinical Case Report

Introduction and objective: Esophagus is a muscular and mucosal tubular organ with 4 physiological narrowing’s that are preferred sites for the retention of foreign bodies accidentally or deliberately ingested. The latter form is frequent in people with mental disorders and prisoners. The aim of this study is to describe a rare clinical case of foreign body ingestion.Case Report: This case describes an incident in which a young man deliberately swallowed a key to hide evidence of theft. This is a unique case in the literature of deliberate ingestion in mentally healthy people and not part of the prison population. Discussion: Foreign bodies are a public health problem, related with huge ENT doctor's activities. It represents the first cause of ENT emergency services care. Although large foreign body ingestion is rare. The worldwide literature is full of articles related with little accidental foreign bodies ingestion, especially in children, such as coins, toys, fish bones and bones Conclusions: In the presence of intentionally and/or accidental foreign bodies ingested in adults, it is necessary to discard mental disorders or social factors.

Foreign body ingestion: Is intervention always a necessity?

Intentional and accidental foreign body ingestion are commonly encountered in clinical practice. In adults, intentional foreign body ingestion is frequently observed among individuals with psychiatric disorders and prisoners. Controversies exist regarding the management of sharp or pointed objects. We contribute to this existing controversy by presenting a case of a 43-year-old male who accidently ingested a metallic screw and was managed successfully through endoscopic retrieval. We discuss a case of a 43-year-old male presented to our emergency department after accidently swallowing a metallic screw, 1h and a half prior to his presentation. He was initially asymptomatic then started to complain of vague abdominal symptoms. X-rays of the chest and abdomen demonstrated the presence of a metallic screw at the mid-abdomen. Computed tomography scan of the abdomen then confirmed its presence within the gastric lumen, with no evidence of gastric or bowel perforation. The patient was managed via esophagogastroduodenoscopy in which the ingested screw was extracted. He was discharged after 24 hours in a good condition. A limited number of epidemiological studies have shed light on the prevalence and incidence of foreign body ingestion among adult individuals. Probability of spontaneous passage depends on several factors including the size, shape and composition of the impacted item, as well as the age of patient and duration of ingestion prior to presentation. Considering the variation of ingested objects and the availability of several therapeutic approaches, a patient-tailored management plan should always be established.

Automatic detection of foreign body objects in neurosurgery using a deep learning approach on intraoperative ultrasound images: From animal models to first in-human testing.

Objects accidentally left behind in the brain following neurosurgical procedures may lead to life-threatening health complications and invasive reoperation. One of the most commonly retained surgical items is the cotton ball, which absorbs blood to clear the surgeon's field of view yet in the process becomes visually indistinguishable from the brain parenchyma. However, using ultrasound imaging, the different acoustic properties of cotton and brain tissue result in two discernible materials. In this study, we created a fully automated foreign body object tracking algorithm that integrates into the clinical workflow to detect and localize retained cotton balls in the brain. This deep learning algorithm uses a custom convolutional neural network and achieves 99% accuracy, sensitivity, and specificity, and surpasses other comparable algorithms. Furthermore, the trained algorithm was implemented into web and smartphone applications with the ability to detect one cotton ball in an uploaded ultrasound image in under half of a second. This study also highlights the first use of a foreign body object detection algorithm using real in-human datasets, showing its ability to prevent accidental foreign body retention in a translational setting.

Unnoticed Foreign Body (Metallic Hair Clip) Ingestion in An 18 Month Old Child: A Case Report

Accidental foreign body ingestion is common in the pediatric age group particularly between 6 months and 5 years. Most ingested foreign bodies pass easily through the esophagus, into the stomach, and are expelled from the body without complications. However, endoscopic removal will require only 10% - 20% of cases to avoid complications. We present the endoscopic removal of a metallic hair clip in the duodenum of an 18 month old child that was unnoticed initially and diagnosed incidentally.&#x0D; BANGLADESH J CHILD HEALTH 2021; VOL 45 (3) : 182-185

Characteristics and Treatment of Pediatric Tracheobronchial Foreign Bodies: A Retrospective Analysis of 715 Cases.

BACKGROUND This study aimed to analyze the clinical characteristics of tracheobronchial foreign bodies in children in Shenzhen and to explore the diagnosis and treatment methods for special cases. MATERIAL AND METHODS This study included a total of 715 children who were diagnosed with tracheobronchial foreign bodies at Shenzhen Children's Hospital between October 2016 and October 2021. Data on sex, age, inducement, symptoms, foreign body type, foreign body location, foreign body retention time, foreign body history, and complications were recorded and analyzed. RESULTS Tracheal foreign bodies were found to occur primarily in children aged 0-2 years (90.6%). The overall incidence rates were 69.1% and 30.9% in boys and girls, respectively. Among them, 42.5% of the foreign bodies were detected in the left bronchus and 45.6% in the right bronchus. Inducements included playing while eating (n=398, 55.7%) and also crying (n=209, 29.2%). Operations were performed on 710 (99.3%) children, including 80 (11.2%) immediate surgeries and 2 tracheotomies. One child had no vital signs upon admission and died after emergency foreign body removal. All of the other children who underwent surgery recovered well postoperatively. CONCLUSIONS This study presents the characteristics and methods of diagnosis and treatment of tracheobronchial foreign bodies in pediatric patients in Shenzhen. Tracheobronchial foreign bodies are a major cause of accidental injury in infants and young children. In critical cases, airways should be immediately and rapidly cleared with multidisciplinary collaboration. In addition, public safety awareness should be strengthened, particularly among parents, teachers, and other child caregivers, to reduce and prevent instances of tracheobronchial foreign body accidents in children.

An Unusual Foreign Body Removal from Neck: A Pellet of Balloon Shooting Gun

Beside infections, foreign body incidences are amongst the most frequently encountered pathologies in Head and neck region. Accidental foreign body with metallic in nature can be associated with dangerous consequences. We present a case of a man who presented with an unusual foreign body, a pellet of balloon shooting gun which get impacted at anterior aspect of lower neck while playing and was not noticed till three days. Unnoticed foreign body are more harmful and related with complications. Radiological investigation is the tool to diagnose it properly apart from clinical examination. Head and neck region is known for its complex anatomy and to deal with it one has to sound knowledge of it.

S2515 Chicken Bone Causing Gastric Perforation With Liver Penetration: Successfully Managed With Endoscopic Removal and Clipping

Introduction: Perforation of gastric wall by a chicken bone has rarely been reported. Most foreign bodies (FB) pass through the gastrointestinal tract uneventfully within one week. However, we report a case of chicken bone-induced gastric perforation managed by endoscopic retrieval and closure with clips. Case Description/Methods: A 70-year-old-man presented with sharp epigastric abdominal pain with nausea and vomiting 4 hours after eating chicken wings. He was hemodynamically stable. The abdomen was soft and non-tender, with normoactive bowel sounds on examination. CT scan revealed a small pneumoperitoneum in the upper abdomen and a 3.4 cm linear radiopaque density within the lumen of the gastric antrum and partially outside directed posteriorly, abutting the left hepatic lobe. An EGD revealed a 3.5 cm long, narrow bone with a hollow center protruding through the antral wall along the lesser curvature. One endoclip was placed adjacent to the FB for easier identification of the location of the perforation. The FB was then extracted from the wall with rat tooth forceps. The gastric wall defect was then closed with 6 endoclips in a zipper-like fashion. Finally, the FB was retrieved with rat tooth forceps by allowing the sharp end to trail with the withdrawal of the gastroscope. Post-procedure, the patient was started on a clear liquid diet 48 hours later, which he tolerated well, and was discharged on post-procedure day 4 (Figure). Discussion: Accidental foreign body (FB) ingestion is common. Most ingested FB pass spontaneously, with only 10%-20% requiring non-operative intervention. Serious complications include impaction or perforation. A foreign body that perforates the bowel wall may have a wide spectrum of clinical manifestations, from acute generalized peritonitis to chronic abscess formation. Patients with foreign bodies in the stomach, duodenum, and large intestine rarely have perforation due to thick walls and may have delayed presentation. We report the second case of endoscopic retrieval of a chicken bone causing gastric perforation managed endoscopically. Endoclips are often used as a hemostatic tool or to close endoscopic mucosal resection sites. Endoscopic intervention is more likely to be successful in cases of FB ingestion in the absence of peritonitis. In this case, the endoscopic removal of FB resulted in successful non-surgical management of gastric perforation. Placement of initial endoclip prior to bone removal allowed successful closure despite loss of gas after FB removal.Figure 1.: A-Upper Endoscopy shows a sharp hollow chicken bone in gastric antrum. B-Upper Endoscopy showing removal of chicken bone followed by endoscopic clipping. C- CT Abdomen/Pelvis without contrast shows a foreign body perforating the gastric wall and penetrating the liver.

A neglected foreign body in oesophagus with an unusual presentation: a case report

&lt;p&gt;Foreign body ingestion is clinical emergency in otorhinolaryngology practice which requires immediate proper management to ensure speedy recovery and reduce complications. Accidental ingestion of food based foreign bodies like fish and meat bones are common among adults. Penetration of these foreign bodies may cause vascular or suppurative complications which are rare; however, if present these can cause significant morbidity to the patient. We report a case of 60-year-old male patient who presented with painful right side neck swelling. The CT nscan neck revealed a foreign body penetrating oesophageal wall on either side leading to right cervical abscess and mediastinitis. Under general anaesthesia foreign body bone piece was removed by rigid oesophagoscopy. In conclusion, it is very important to elicit the history of accidental foreign body ingestion in patients who present with acute onset of neck swelling. Besides clinical examination, radiological imaging modalities are very useful in confirming the diagnosis, site localisation of foreign body and proceed with timely and appropriate management.&lt;/p&gt;

Foreign body aspiration and ingestion in dental clinic: a seven-year retrospective study.

BackgroundThis retrospective study investigated the incidence rate of accidental foreign body aspiration and ingestion according to patient sex, age, and dental department. This study aimed to verify whether the incidence rate is higher in geriatric than in younger patients and whether it is different among dental departments.MethodsAccidental foreign body aspiration and ingestion cases were collected from electronic health records and the safety report system of Yonsei University Dental Hospital from January 2011 to December 2017. The collected data included patients’ age, sex, medical conditions, treatment procedures, and foreign objects that were accidentally aspirated or ingested. The incidence rate was calculated as the number of accidental foreign body aspirations and ingestions relative to the total number of patient visits. Differences depending on the patients’ sex, age, and dental department were statistically identified.ResultsThere were 2 aspiration and 37 ingestion cases during the 7-year analysis period. The male to female incidence ratio was 2.8:1. The incidence rate increased with age and increased rapidly among those aged 80 years or older. Seven of the 37 patients with accidental foreign body ingestion had intellectual disability, Lou Gehrig’s disease, dystonia, or oral and maxillofacial cancer. The incidence rate was highest in the Predoctoral Student Clinic and the Department of Prosthodontics. The most frequently swallowed objects were fixed dental prostheses and dental implant components.ConclusionThe incidence rate of accidental foreign body aspiration and ingestion differed according to patient sex, age, and dental department. Dental practitioners must identify high-risk patients and apply various methods to prevent accidental foreign body aspiration and ingestion in dental clinics. Inexperienced practitioners should be particularly careful.

Current management for foreign body and toxic agent ingestion in a paediatric primary emergency centre.

Accidental foreign body ingestion (FBI) and toxic agent ingestion (TAI) are commonly encountered among children in primary emergency settings. Early detection and appropriate medical intervention are crucial to improve outcomes. Although many reports from tertiary institutions have shown improvements in therapy, data are still lacking from primary emergency facilities. We performed a retrospective analysis based on medical records of FBI/TAI over 4 years at the Kobe Children's Primary Emergency Medical Center. We collected patient information, including age, sex, time between FBI/TAI occurrence and centre visit, provision of first aid, symptoms, type of FBI/TAI, examinations, treatments, and outcomes. A total of 580 children were enrolled. The median age was 1.3 years, and patients under 2 years old accounted for 70% of total cases. Cigarettes (17.5%) were the most common ingested foreign body, followed by medicines (15.3%), detergents (8.1%), in TAI, plastics (14.1%), metal (13.4%), batteries (9.0%) in FBI, and others (22.6%). A total of 42 patients were transferred to advanced hospitals; among these, 22 patients were hospitalised but the foreign body was removed in only 3 (0.9%) patients. Transferred patients were significantly older (P<0.05) in FBI and had a higher rate of any of symptoms (P<0.05) in FBI/TAI. This large-scale retrospective study of accidental FBI/TAI conducted at a primary emergency facility clarified current management, including treatment at a primary facility. Very few cases of FBI/TAI were treated, even when they were transferred to an advanced treatment hospital. Unified protocols should be established, to improve the management of FBI/TAI.

Removal of unusual foreign body from rectosigmoid colon with colonoscope and forcep

Accidental foreign body ingestion is common among children and in many adults with or without systemic disease (altered mental status due to any cause), most of which is expelled spontaneously, some are removed endoscopically, laproscopically and surgically in complicated cases. Herein we are discussing a case of denture (of size about 5 x 5 cm) removal from sigmoid colon which was accidentaly swallowed with food in a normal conscious and alert person, with the help of colonoscope, proctoscope and forceps, without any complications except for mild bleeding which was managed conservatively

Diagnostic Imaging of Non-Accidental Injury and Percutaneous Foreign Bodies: A Case Report from Zambia

This case report presents the role imagingplayed in the diagnosis and surgical removal of multiple percutaneous foreign bodies in a 5-year-old child who presented with non-accidental injuries (NAI) to medical facilities in Zambia. Children are commonly referred for imaging with suspected accidental foreign bodies, but percutaneous foreign bodies due to NAI are rare. NAI is caused due to child physical abuse and therefore, imaging plays a major role in the diagnosis and provision of legal evidence. In this case report, conventional radiography (plain film) of askeletal survey was the first imaging requested. This was supplemented with a computed tomography (CT) scan of the thorax and abdomen. Lastly, foreign bodies were removed under the guidance of the image intensifier. Although, the cases of NAI reported and presented in medical facilities in Zambia are rare, this case shows that physical child abuse is practiced in our communities. Thus, radiographers and radiologists should pay attention to such cases during imaging and reporting, respectively.

A Mysterious Case of a 33-Year-Old Female Schizophrenic Patient Who Ingested a Kilogram of Metals: A Case Report

Introduction: Globally, 20 million people are affected by schizophrenia. In Uganda, the prevalence is reported to be 710 per 100,000 population. Unlike normal adults who are less likely to have foreign body ingestion, patients with mental illnesses such as schizophrenia are at an increased risk of both intentional and accidental foreign body ingestion. Therefore, health workers must be vigilant while assessing such patients not to miss out on the diagnosis as unwitnessed foreign body ingestion presents a diagnostic challenge. Observation: We received a 33-year-old female diagnosed with schizophrenia four years before this admission as a referral. She presented at MNRH A&E with complaints of abdominal pain, non-bilious vomiting, and progressive weight loss. She had multiple admissions in private hospitals before her referral to MNRH where several investigations were done with inconclusive results. Upper GI endoscopy revealed multiple foreign bodies in the stomach. An erect abdominal x-ray was then done to rule out distal gastrointestinal involvement and/or perforation. An emergency laparotomy was performed and over 170 different metallic objects of varying sizes were completely evacuated. She reported that she ingested them in response to the compelling auditory hallucinations but had no intention of self-harm. Conclusion: Foreign body ingestion presents a diagnostic challenge in adults. The various impairments among mentally ill patients put them at an increased risk hence the need for suspicious diagnostic evaluation of those presenting with abdominal symptoms. Both health workers and families have a role to play in the prevention of such life-threatening emergencies.

Unusual Foreign Body in Aerodigestive Tract- a Difficult Diagnosis during a Pandemic

Foreign body in aerodigestive tract is not an uncommon condition especially in paediatric age group. However in adults it is usually seen most commonly in psychiatric patients or mentally disabled individual. We present a case of accidental foreign body ingestion in an adult male. The case report highlights the importance of using the right investigation to detect the foreign body thereby aiding in proper management to prevent morbidity and mortality.

Excessive Fear/ Psychological Threat of Getting Covid-19 Infection in People Can Lead to Accidental Foreign Bodies in Nose During Screening and Sampling

Excessive Fear/ Psychological Threat of Getting Covid-19 Infection in People Can Lead to Accidental Foreign Bodies in Nose During Screening and Sampling