Foreign Bodies In Adults Research Articles

FP7.17 - Appendiceal Foreign Bodies in Adults: A Systematic Review of Case Reports

Abstract Adults can accidentally swallow foreign bodies (FBs) with food. In rare occasions, these can lodge in the appendix lumen causing inflammation. This is known as foreign body appendicitis. We conducted this study to review different types and management of appendiceal FBs. A comprehensive search on PubMed, MEDLINE, Embase, Cochrane Library and Google Scholar was performed to detect appropriate case reports for this review. Case reports eligible for this review included patients above 18 years of age with all types of FB ingestion causing appendicitis. A total of 64 case reports were deemed to be eligible for inclusion in this systematic review. The patient mean age was 44.3 ± 16.7 years (range, 18-77). Twenty-four foreign bodies were identified in the adult appendix. They were mainly lead shot pellet, fishbone, dental crown or filling, toothpick, and others. Forty-two percent of the included patients presented with classic appendicitis pain, while 17% were asymptomatic. Moreover, the appendix was perforated in 11 patients. Regarding modalities used for diagnosis, computed tomography (CT) scans confirmed the presence of FBs in 59% of cases while X-ray only managed to detect 30%. Almost all of the cases (91%) were treated surgically with appendicectomy and only six were managed conservatively. Overall, lead shot pellets were the most common foreign body found. Fishbone and toothpick accounted for most of the perforated appendix cases. This study concludes that prophylactic appendicectomy is recommended for the management of foreign bodies detected in the appendix, even if the patient is asymptomatic.

Upper Gastrointestinal Tract Foreign Bodies

Foreign body ingestion, a common emergency encountered in clinical practice, is a potentially serious condition. Most foreign bodies in the gastrointestinal tract pass spontaneously. However, objects that are relatively long or large may lodge in the upper gastrointestinal tract, potentially causing perforation, bleeding, and obstruction. This literature review summarizes the natural history and clinical aspects of these types of foreign bodies in adults as well as the various methods for their removal. Endoscopic removal is a relatively safe and effective procedure for removing these types of foreign bodies. The development of endoscopic techniques and devices has resulted in their widespread use, with good results, as the primary treatment.

Predictors of spontaneous passage of ingested foreign bodies in adults: twelve years of experience.

Foreign body ingestion in adults is commonly encountered in clinical practice. The therapeutic approach of whether to follow-up or extract is often controversial. We aimed to explore predictors for spontaneous passage of ingested foreign bodies by focusing on foreign body type, length, and location of impaction. We performed a 12-year retrospective single-center study. Logistic regression analysis was done to identify predictors of spontaneous passage. Overall, 365 patients with foreign body ingestion were included. The rate of spontaneous passage was 53.7% in general, while the spontaneous passage rate was 47.9% in food impaction, 44.3% in sharp objects, 88.7% in blunt objects and only 22.2% in long blunt objects (> 6cm). On regression analysis, esophageal location was associated with a higher impaction rate and lower spontaneous passage vs. stomach and small and large intestine (OR 0.15, 95% CI 0.07-0.31, OR 0.18, 95% CI 0.09-0.37 and OR 0.02, 95% CI 0.003-0.14), respectively. Performing Receiver operating characteristics (ROC) analysis found that the maximal length above which the foreign body will fail to pass spontaneously was 3.5cm in the stomach and 3cm in the small intestine, with area under the curve (AUC) of 0.8509 in stomach and 0.8073 in small intestine. Endoscopic removal was needed for all esophageal foreign bodies, and all foreign bodies more than 3.5cm above the duodenum. Spontaneous passage of ingested foreign body in a selected cohort of patients depends on foreign body type, location, and length.

Flexible bronchoscopy for removal of airway foreign bodies: A single center experience

Background: Airway foreign bodies are rare in occurrence and challenging to manage. The presentation varies depending upon the size, site, and nature of the aspirated material. Although rigid bronchoscopy is the preferred choice in children; distally lodged foreign bodies in adults have high success rate of extraction with flexible bronchoscope. Objective: The aim of this study is to evaluate the utility of flexible bronchoscopy for removal of airway foreign bodies in adolescents and adults. Methods: In a retrospective study conducted between January 2018 to March 2024 at National Academy of Medical Sciences, Bir hospital; medical records of patients undergoing bronchoscopy for airway foreign bodies were extracted. Methods and Material: Demographic parameters, type and location of foreign body, extraction procedure, accessory equipment used, and the success rates were analyzed. Complications during and after the procedure were also recorded. Results: During the study period, a total of 3143 bronchoscopies were performed, of which 18 (0.57%) were done for foreign body extraction. Patients were aged between 12 to 89 years; cough was the commonest symptom and lobar collapse was the commonest radiological sign. Organic foreign bodies accounted for 61% cases and inorganic 39%. Right lower lobe was the commonest site. Successful flexible bronchoscopy assisted extraction was achieved in 89%. Of the 18 patients, 12 (67%) were successfully removed with rat toothed forceps and five (28%) with basket device. No major complications were noted. Conclusions: Flexible bronchoscopy has a high success rate in management of airway foreign bodies and should always be considered as first line in adults.

Endoscopic management of duodenal perforation caused by foreign bodies in adults: A retrospective study.

Duodenal perforation caused by foreign bodies (FBs) is very rare but is an urgent emergency that traditionally requires surgical intervention. Several case reports have reported the successful endoscopic removal of duodenal perforating FBs. Here we aimed to evaluate the safety and efficacy of endoscopic management of duodenal perforating FBs in adults. Between October 2004 and October 2022, 12,851 patients with endoscopically diagnosed gastrointestinal FBs from four tertiary hospitals in China were retrospectively reviewed. Patients were enrolled if they were endoscopically and/or radiographically diagnosed with duodenal perforating FBs. The incidence of duodenal total FBs and perforating FBs was 1.9% and 0.3%, respectively. Thirty-four patients were enrolled. Endoscopic removal was achieved in 25 patients (73.5%), and nine patients (26.5%) received surgery. For the endoscopic group, most perforating FBs were located in the duodenal bulb (36.0%) and descending part (28.0%). The adverse events included 3 mucosal injuries and 1 localized peritonitis. All patients were cured after conventional treatment. In the surgical group, most FBs were lodged in the descending part (55.6%). One patient developed localized peritonitis and one patient died of multiple organ failure. The significant features of FBs requiring surgery included FB over 10cm, both sides perforation, multiple perforating FBs and massive pus overflow. Endoscopic removal of duodenal perforating FBs is safe and effective, and can be the first choice of treatment for experienced endoscopists. Surgical intervention may be required for patients with FBs over 10cm, both sides perforation, multiple perforating FBs, or severe infections.

Inferior Turbinate’s Foreign Body: Rare but Possible

Foreign body in the nasal cavity is common among paediatric groups. However, it is quite a rare incident among adults, as most of the foreign bodies in adults are in the pharynx or oesophagus. Foreign bodies in the nose are commonly found in the anterior nasal cavity, unless it is accidental or traumatic, where the foreign body usually penetrates the nasal structures. A foreign body embedded inside the inferior turbinate is a rare incident. In our case, a metal bearing like bullet accidentally struck into the patient’s inferior turbinate. It requires proper assessment and investigations such as nasoendoscopy, X-ray and CT Scan to precisely locate the site of the embedded foreign body. Removal requires exploration of the inferior turbinate and should be performed in a controlled setting.

Effect of Delayed Endoscopy Protocol on Timing and Safety of Endoscopy for Foreign Body Ingestion and Esophageal Food Impaction.

Endoscopic procedures for foreign body ingestion (FBI) and esophageal food impactions (EFI) performed during on-call hours are associated with increased stress, risk, and cost. We implemented a Foreign Body Algorithm (FBA) designed to delay all but the most urgent endoscopy for EFI and FBI until regular working hours. Using endoscopy records from multiple academic and community hospitals within a large integrated health system in the United states, we identified esophagogastroduodenoscopy (EGD) performed for food impactions and foreign body ingestions occurring between May 2011 and February 2021. We identified 479 EGDs performed for FBI and EFI. The introduction of the FBA was associated with a shorter length of stay (LOS) for overall cases (0.35 vs. 0.8d P<0.001), day cases (0.16 vs. 1.0d P<0.001), and night cases (0.40 vs. 0.6d P=0.03). The introduction of the FBA did not change the rate of overall adverse events (AE) or night AE. AE from the entire cohort was rare (3%; 16 total). Of the AE, most were sedation related. The introduction of the FBA did not affect the overall rate of night cases or AE, but the rate of after-hours endoscopy for intentional ingestions decreased from 17.2% to 3.1% (P=0.01). This is one of the largest studies of esophageal impactions and foreign bodies in adults in the United States, and the first to examine the effects of a protocol designed to avoid after-hours endoscopy. These results suggest that postponing after-hours EGD until the daytime is not associated with adverse safety outcomes or increased LOS.

Appendiceal Foreign Bodies in Adults: A Systematic Review of Case Reports.

Adults can accidentally swallow foreign bodies (FBs) with food. In rare occasions, these can lodge in the appendix lumencausing inflammation. This is known as foreign body appendicitis. We conducted this study to review different types and management of appendiceal FBs. A comprehensive search on PubMed, MEDLINE, Embase, Cochrane Library and Google Scholar was performed to detect appropriate case reports for this review. Case reports eligible for this review included patients above 18 years of age with all types of FB ingestion causing appendicitis.A total of 64 case reports were deemed to be eligible for inclusion in this systematic review. The patient mean age was 44.3 ± 16.7 years (range, 18-77). Twenty-four foreign bodies were identified in the adult appendix. They were mainly lead shot pellet, fishbone, dental crown or filling, toothpick, and others. Forty-two percent of the included patients presented with classic appendicitis pain, while 17% were asymptomatic. Moreover, the appendix was perforated in 11 patients. Regarding modalities used for diagnosis,computed tomography (CT) scans confirmed the presence of FBs in 59% of cases while X-ray only managed to detect 30%. Almost all of the cases(91%) were treated surgically with appendicectomy and only six were managed conservatively. Overall, lead shot pellets were the most common foreign body found. Fishbone and toothpick accounted for most of the perforated appendix cases. This studyconcludesthat prophylactic appendicectomy is recommended for the management of foreign bodies detected in the appendix, even if the patient is asymptomatic.

SUCH A TWEEZE: BRONCHOSCOPE-MEDIATED EXTRACTION OF ASPIRATED FOREIGN BODY

SUCH A TWEEZE: BRONCHOSCOPE-MEDIATED EXTRACTION OF ASPIRATED FOREIGN BODY

TOOTH IN THE LUNG: CASE REPORT OF A TOOTH ASPIRATED DURING DENTAL EXTRACTION

TOOTH IN THE LUNG: CASE REPORT OF A TOOTH ASPIRATED DURING DENTAL EXTRACTION

ACCIDENTAL ASPIRATION AFTER INTENTIONAL INGESTION OF A NAIL IN A YOUNG FEMALE

ACCIDENTAL ASPIRATION AFTER INTENTIONAL INGESTION OF A NAIL IN A YOUNG FEMALE

A Rare Foreign Body in a Patient with Poor Dentition: A Satay Skewer

Foreign body (FB) ingestion and impaction in the upper gastrointestinal tract is a common urgent referral to otorhinolaryngology. The types of FB are significantly different between children and adults, and it largely depends on the region, sociocultural influences and dietary habits of the patient. Rare FBs in adults should be suspected in certain groups of people with psychiatric illnesses and in patients with dental pathology who are unable to chew food properly before swallowing. In this report, we present a rare case of oesophageal impaction by a long satay skewer with sharp ends along with chicken meat in a 37-year-old man with poor dentition. It was successfully removed using rigid oesophagoscopy.

Foreign body aspirations in children and adults

ObjectiveForeign body aspiration (FBA) can be encountered in all age groups, especially in children under 3 years of age. In this study, we aimed to evaluate our results in children and adults who underwent rigid bronchoscopy due to a history of foreign body aspiration. Materials and methodsIn a single-center study, 822 consecutive patients with suspected foreign body aspiration and undergoing rigid bronchoscopy between January 2000 and August 2021 in our clinic were retrospectively evaluated. ResultsThere were 451 (54.9%) male and 371 (45.1%) female patients. The mean age was 8.1 ± 14.0 (range 1 month–84 years). 525 (63.9%) of the cases consisted of cases under 3 years old, including 3 years old. There were 726 (88.3%) pediatric patients (≤18 years old), and 96 (11.7%) adult patients. The most important symptoms were cough in 690 (83.9%) cases and wheezing in 492 (59.9%) cases. The most frequently aspirated foreign bodies in children were sunflower seeds (14.2%, n = 71), food particles (11.4%, n = 57) and needles (52%, n = 10.4). The most frequently aspirated foreign bodies in adults were needles (39.5%, n = 28), non-needle metallic objects (21.1%, n = 15) and food particles (11.3%, n = 8). No mortality was observed in any of the patients who underwent rigid bronchoscopy. ConclusionFBA is higher in children and direct radiological findings are less than in adults. Current findings show that FBAs in children are more difficult to diagnose and more dangerous clinically.

Foreign body aspiration in an adult: An endobronchial "Melon-oma".

Background: Foreign body (FB) aspirations in adults are relatively uncommon. The most commonly aspirated FBs in adults are organic, especially vegetable matter, peanuts, and fragments of bones. We report a rare case of a FB discovered in the left main bronchus of an adult male admitted to the intensive care unit. Case report: A 52-year-old male smoker with COPD presented to the emergency department with a two-day history of increasing dyspnea and cough. He was hypoxic and febrile with a temperature of 38°C. Auscultation revealed decreased breath sounds over the left lung and a few rhonchi on the right side. Chest x-ray showed left lung collapse. His condition rapidly worsened, and he was immediately intubated for acute respiratory failure. CT chest identified a large endobronchial mass obstructing the left main bronchus. Flexible bronchoscopy confirmed a soft and mobile brownish lesion in the left main bronchus. The histological appearance of the specimen retrieved was consistent with an organic foreign body. This was later identified as a melon chunk. It was removed successfully via flexible bronchoscopy by cutting it into smaller pieces to aid retrieval. Conclusion: FB aspiration can occur in all age groups but is less common in adults accounting for only 0.16%–0.33% of adult bronchoscopic procedures. Early detection of an aspirated FB is essential to avoid significant complications, morbidity, and mortality.

Spontaneous passage of accidentally ingested metallic nail in an adult: A case report.

Introduction and importanceForeign body ingestion is most common in children, as well as adults with neurodevelopmental and psychiatric problems. The most commonly swallowed foreign bodies in adults include fish bones, chicken bones, toothpicks, and dentures. Sharp and elongated ones are the most typical causes of gastrointestinal perforation among the aforementioned. In about 1% of cases, foreign bodies are known to remain lodged within the bowel and cause luminal erosion and perforation.Case presentationA 23-year-old male construction laborer presented to the Emergency Surgical Unit of Debre Markos Hospital 7 h after he accidentally swallowed a nail while at work. He didn't have abdominal pain, vomiting, or rectal bleeding. On exams his vital signs were stable. His chest and abdominal exams as well as the digital rectal examination were unremarkable. He was evaluated with a plain erect abdominal x-ray based on his complaint, which revealed a long nail lying longitudinally in the right lower quadrant of the abdomen. Twenty-nine hours after swallowing the iron nail, he passed it through his rectum spontaneously.ConclusionPlain radiography should be performed to locate and follow-up on radiopaque foreign entities before sophisticated imaging and invasive procedures. When treating people who have accidentally ingested a sharp foreign body, clinicians should find a balance between prompt action and careful follow-up.

Evaluation of the risk factors for severe complications and surgery of intestinal foreign bodies in adults: a single-center experience with 180 cases.

BackgroundForeign bodies (FBs) lodged in the intestine or causing intestinal complications are uncommon in clinical practice but may pose diagnostic difficulties and prove life-threatening. This study aimed to evaluate the risk factors for severe complications and surgery to aid clinicians in the diagnosis and management of intestinal FBs.MethodsWe performed a retrospective analysis of patients in whom FBs were lodged in the intestine or caused complications from 2010 to 2020 in the First Affiliated Hospital of Wenzhou Medical University (Zhejiang, China). The characteristics of the patients and FBs, symptoms, imaging findings, diagnostics, treatment strategies, and clinical outcomes were analysed. Furthermore, the risk factors for complications and surgery were investigated.ResultsIn total, 180 patients were included in our study. Most patients (76.1%) were unable to provide a history of ingestion. Bezoars were the most common FBs (35.6%). The FBs were mainly located in the duodenum (32.8%) and the ileum (27.8%). Surgical removal of FBs was successful in 89 (49.4%) patients and endoscopic removal in 54 (30.0%) patients. Eleven with perforations were treated conservatively. FBs located in the jejunum or ileum were more likely to cause severe complications than those located in the duodenum. FBs located in the jejunum, ileum, or sigmoid colon were more likely to undergo surgery, and severe complications were an independent risk factor for surgery.ConclusionIntestinal FBs, often localized in angulation, are likely to be misdiagnosed because most patients do not provide a history of FB ingestion. Surgery and endoscopic therapy are the most commonly used treatment modalities. Surgery is not mandatory in clinically stable patients with small and contained perforations. FBs located in the jejunum or ileum are risk factors for both complications and surgery.

A Retrospective Study of Oesophageal Foreign Bodies using Rigid Oesophagoscopy from Mandya, Karnataka, India

Introduction: Foreign bodies in the oesophagus is one of the commonly seen conditions in the Department of OItorhinolaryngology. Aim: To describe the clinical features and time delay of patients presenting with oesophageal foreign bodies. Materials and Methods: Present study was a retrospective study of case records of 60 patients who underwent rigid oesophagoscopy for foreign body removal at Mandya Institute of Medical Sciences Mandya, Karnataka, India, from January 2017 to December 2019. Details like age and sex of the patient, presenting symptoms, time delay in presentation to the hospital, the type of foreign body ingested, location of the foreign body in oesophagus, any complications were noted in a detailed case proforma. Preoperative X-ray of neck and chest was done in all patients. Descriptive statistical tests like percentage and mean were used to analyse the data. Results: Out of 60 patients, 36 (60%) were children and 24 (40%) patients were adults. Coin was the most common foreign body seen in children (n=32/60, i.e., 53.3%) whereas meat bone was the most common foreign body in adults (n=16/60, i.e., 26.6%). Forty two patients out of 60 presented within 24 hours of foreign body ingestion. Two patients presented after 72 hours of foreign body ingestion. Thirty one patients presented with foreign body sensation in throat, dysphagia was present in 21 patients and two patients presented with fever. Two patients who presented more than 72 hours after foreign body ingestion had mucosal oedema on rigid oesophagoscopy. There was mucosal injury in four patients intraoperatively, two were with dentures, one was with button battery and the other was with a sharp metal locket. Conclusion: Coin was the most commonly seen foreign body in children whereas meat bolus with or without bone was most commonly seen in adults. Timely diagnosis and early removal of the foreign body should be done to prevent complications.

Overview on Gastrointestinal Foreign Bodies in Children

Introduction: Greatest percentage of the upper gastro intestinal accidently swallowed foreign bodies in adults are related to food bolus impaction with meat. Most patients who swallow a true foreign body typically are younger, however young children were recorded to accidently swallow other objects rather than food poluses. Males are more often recorded, and often have significant psychiatric illness and/or drug abuse. Foreign body (FB) ingestion is a very common problem in children. FB may pass through gastrointestinal (GI) system silently without any indication, or it may need an intervention to prevent complications. The diagnosis, decision for involvement and management may have some difficulties, and it’s usually decided according to the case, especially in cases with protracted lodgment. Complications caused by lodgment of ingested GI FBs varies according to many factors and are associated with important morbidity and mortality in children.&#x0D; Objectives: to show an overview of gastrointestinal foreign bodies in children, its epidemiology, risk factors, hazards and management.

Upper gastrointestinal foreign bodies in adults: A systematic review

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. 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. 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).

ALL THAT PET POSITIVE IS NOT CANCER

TOPIC: Procedures TYPE: Fellow Case Reports INTRODUCTION: PET (Positron emission tomography)/CT (Computed tomography) is a common modality used to diagnose and stage various malignancies. Radiotracer FDG (Fluoro18-deoxyglucose) is not cancer-specific and false-positive results may be observed in a wide variety of non-malignant conditions. Here we describe a patient with FDG avid left lower lobe endobronchial mass. CASE PRESENTATION: 75 years old female with a medical history significant for type 2 diabetes mellitus, seizure disorder was referred to pulmonology clinic with shortness of breath, intermittent wheezing, and non-productive cough for 2 months. She denied chest pain, orthopnea, fever, chills, weight or appetite changes, night sweats. The patient is a former smoker with less than 20 pack-year, quit two decades ago. On physical exam, the patient was saturating 92% in room air. BMI was 44.99 kg/m2. Lung examination showed reduced breath sounds at the left lung base. The rest of the exam was unremarkable. The pulmonary function test was normal. Outpatient evaluations were unremarkable. Chest X-ray showed left lower lobe infiltrates. CT chest showed left lower lobe consolidation vs atelectasis of left lung base followed with PET/CT which revealed increased FDG uptake in left lower lobe intraluminal density with SUV 6.5 concerning for malignancy with endobronchial involvement vs inflammatory process. Diagnostic bronchoscopy showed left lower lobe bronchus with significant mucosal hyperemia and edema with yellowish-white foreign body (FB) which was successfully retrieved with endobronchial biopsy forceps and noted to a piece of corn. The patient's symptoms resolved. DISCUSSION: The reported false positive rate of PET/CT was 13% and attributed to FDG uptake by inflammatory cells at the sites of inflammation or infection. Most common FDG avid non-infectious inflammatory etiologies include sarcoidosis, atherosclerosis, pneumoconiosis, and focal foreign body-related inflammation. FB aspiration in the tracheobronchial tree is rare in adults and usually presents with subtle respiratory symptoms with paucity in imaging. Risk factors include loss of consciousness from trauma, drug, seizure disorder or alcohol intoxication, dysphagia related to age-related slowing, stroke, dementia, or Parkinson's disease. In our case, false positives artifacts were related to a focal foreign body (FB) related inflammation with an elevated risk of aspiration related to a seizure disorder, and advanced age. Removal of FB from the tracheobronchial tree may be achieved with flexible bronchoscopy with biopsy forceps or retrieval basket. Rigid bronchoscopy may be needed if flexible bronchoscopy was unsuccessful. CONCLUSIONS: It is essential to understand false positive results while interpreting PET/CT results. FB aspiration in adults is rare and high clinical suspicion is necessary for the diagnosis. Removal of FB can usually be accomplished with bronchoscopy. REFERENCE #1: Common causes of False-positive F18 FDG PET/CT scans in oncology- Kevin R Carter, Eduard Kotlyarov; Vol,50, special number: pp.29-35, September 2007 Brazilian Archives of Biology and Technology- an International Journal. REFERENCE #2: Non-asphyxiating tracheobronchial foreign bodies in adults- Lan RS, Eur Respir J. 1994;7(3): 510 REFERENCE #3: Tracheobronchial foreign bodies in adults- Limper AH, Prakash UB, Ann Intern Med. 1990; 112(8):604 DISCLOSURES: No relevant relationships by Mansur Assaad, source=Web Response No relevant relationships by Rajamurugan Meenakshisundaram, source=Web Response No relevant relationships by FARAZ Siddiqui, source=Web Response