Removal Of Foreign Body Research Articles

Combined Aspiration and Ingestion of Multiple Metallic Beads Resulting in Tracheoesophageal Fistula

The introduction of magnetic toys has led to an increase in the incidence of pediatric magnet ingestion. A previously healthy 3-year-old girl was referred to our emergency room after ingesting multiple magnets more than a week ago. Although she did not show any subjective symptoms, imaging revealed three metallic foreign bodies in the trachea and upper esophagus, with multiple aggregated foreign bodies in the lower-middle abdomen. A total of 17 magnetic beads were successfully retrieved through operative exploration. A secondary tracheoesophageal fistula was identified during foreign body removal. Based on the size and granulation tissue coverage, the fistula was managed conservatively. The follow-up examination on postoperative day 7 showed spontaneous fistula resolution. Ingestion of multiple magnets may result in fatal consequences due to pressure necrosis of vital organs. Early identification and prompt management are crucial to minimize morbidity in these cases.

Retrospective evaluation of surgical treatment of linear and discrete gastrointestinal foreign bodies in cats: 2009-2021.

Gastrointestinal foreign bodies (FBs) are an important cause of emergency surgical intervention in cats, but little information exists in the literature evaluating the risks and outcomes in this species. The study purpose was to describe cases of feline FBs and compare perioperative factors and outcomes between linear foreign body (LFB) and discrete foreign body (DFB) surgery in cats. The medical records from the University of Georgia Veterinary Teaching Hospital were searched for cats that had undergone surgery for FB removal between August 2009 and August 2021. Perioperative data were collected and described. Data were compared between cats with an LFB and cats with a DFB. A binomial probability series was used to estimate the likelihood of postoperative septic peritonitis or mortality in an additional cat in the series. A total of 56 cats were included in this study; 38 cats had a DFB and 18 had an LFB. No cats developed postoperative septic peritonitis, and all cats survived. The likelihood of postoperative septic peritonitis or mortality in an additional cat was estimated to be <5.2%. Cats with an LFB were found to have a significantly higher body condition score (P = 0.047), albumin (P = 0.025), American Society of Anesthesiologists status (P = 0.027), surgery length (P <0.001) and total cost of visit (P = 0.006) when compared with cats with a DFB. Cats with LFBs were more likely to develop a surgical site infection (SSI; P = 0.007) and be administered postoperative antibiotics (P = 0.017). Cats undergoing surgery for gastrointestinal FBs had a low incidence of postoperative complications. Cats with LFBs had longer surgeries and were more likely to develop postoperative SSIs.

Clinical Drugs for Promoting Corneal Repair after Corneal Foreign Body Removal Surgery

Clinical Drugs for Promoting Corneal Repair after Corneal Foreign Body Removal Surgery

Safety and Efficacy of In-Office Hand Procedures

BackgroundThe primary concerns with operating on patients in the office setting are insufficient sterility and lack of appropriate resources in case of excessive bleeding or other surgical complications. This study serves to investigate these concerns and determine whether in-office hand surgeries are safe and clinically effective. MethodsA retrospective review of patients who underwent minor hand operations in the office setting between December 2020 and December 2021 was performed. The surgical procedures included in this analysis are needle aponeurotomy, trigger finger release, foreign body removal, mass removal, and reduction in a finger fracture with or without percutaneous pinning. All fractures, which primarily included metacarpal and phalangeal fractures, were subsequently splinted. Sterility and hemostatic support were achieved via the Wide-Awake Local Anesthesia No Tourniquet (WALANT) method. Major complications were defined as infection, major bleeding, and neurological deficits. Minor complications were defined as prolonged pain, prolonged inflammation, residual symptoms, and recurrence of symptoms within 1 month. ResultsFive patients (3.8%) returned to the office for pain, inflammation, or stiffness of the affected finger, with two of the five returning with symptoms associated with osteoarthritis or pseudogout flare-ups. Five additional patients returned due to residual symptoms or recurrence of the primary complaint within 1 month of surgery. No patients experienced exogenous infection. ConclusionThe absence of major complications and high success rate for minor hand procedures shows the high degree of safety and efficacy that can be achieved via the in-office setting for select procedures. While proper patient selection is key, our result shows the in-office procedure room setting can offer the necessary elements of sterility and hemostatic support for several common hand surgeries.

Interventional Bronchoscopy in Children: The Way Forward.

Bronchoscopy in children has been utilized primarily to diagnose airway anomalies and obtain bronchoalveolar lavage. Gradual development of thinner bronchoscopes and instruments has opened the gates to the world of bronchoscopic interventions in children. Endobronchial ultrasound guided mediastinal aspiration has been used in adults and children. In younger children, esophageal approach has also been used for sampling of mediastinal lymph nodes. Lung biopsies using cryoprobe have been increasingly used in children. Other bronchoscopic interventions discussed include dilatation of tracheobronchial stenosis, airway stenting, foreign body removal, hemoptysis control, re-expansion of atelectasis etc. Patient safety during the procedure is of paramount importance. Expertise and availability of equipment to handle complications is of huge significance.

Use of accessory devices in the endoscopic removal of esophageal foreign bodies

Background/Aims: The accessory devices used for esophageal foreign body removal have not been thoroughly investigated. This study investigated the appropriate use of endoscopic accessory devices for removing esophageal foreign bodies

Intragastric fish bones migrate into the liver: A case report

A foreign body in the digestive tract is a common disease in the clinic. However, it is rare for a foreign body to migrate into the liver. Most patients are diagnosed before or after perforation of the digestive tract. Laparoscopic removal of intrahepatic foreign bodies is an effective treatment method. A 55-year-old male patient was admitted to the hospital due to fever for 3 d, in addition to pain and discomfort in the right side of his waist. After admission, abdominal computed tomography showed a foreign body in the liver, and gastroscopy did not indicate obvious erosion or ulcers. The patient then underwent laparoscopic surgery. During the operation, an abscess was seen near the gastric antrum and between the caudate lobes of the liver. It was approximately 30 mm × 31 mm × 23 mm in size. The abscess was cut open, and a fish bone was found inside. The fish bone had penetrated the liver and was successfully removed. It was confirmed that the fish bone migrated from the stomach to the liver. Although intrahepatic foreign bodies are rare, they should be diagnosed and treated as early as possible to avoid serious complications such as intrahepatic abscess, which may lead to liver resection and even life-threatening events.

Clinical application of flexible bronchoscopy in the treatment of airway foreign body

Airway foreign body is the unintentional entry of objects into the larynx, trachea, or bronchi, causing airway obstruction, severe coughing, wheezing, breathing difficulties, or even asphyxiation. It is a common emergency condition in respiratory, critical care, emergency, otolaryngology, and pediatric departments, etc. With the popularization of flexible bronchoscopic techniques, endoscopic foreign body removal has been widely used in adults and children. The combined application of various instruments, such as alligator forceps, mesh baskets, balloons, and cryoprobes could safely and effectively remove foreign body. This article briefly described the treatment modalities for airway foreign body and summarized effective approaches using flexible bronchoscopy in its treatment.

Outcomes of surgical treatment with patterns of bacterial culture and antimicrobial susceptibility testing in cases of cervical abscessation in dogs: 82 cases (2018–2021)

Objective: The objective of this study was to summarize the presentation, diagnosis, and outcome for dogs surgically treated for chronic cervical abscessation following suspected or reported cervical or oropharyngeal trauma, as well as to report on culture results and antimicrobial susceptibility patterns.Results: Eighty-two dogs were identified by retrospective review. Successful surgical outcome was achieved in 92.7% of dogs. Abscess recurrence was confirmed or suspected in 6/82 (7.3%) cases, and surgical intervention for abscess recurrence was performed in 4/82 (4.9%) cases. Foreign material was identified at surgery in 5/82 (6%) cases. Incisional healing complications were noted in 9/82 (10.9%) cases and required additional surgery in 5/82 (6%) cases. Twenty-three (28%) dogs had negative culture results. The results of antimicrobial sensitivity testing led to a change in antimicrobial treatment in only 9% of cases.Surgically treated cervical abscessation carries a good prognosis with a low incidence of recurrence in this cohort (in contrast to previous reports), despite low frequency of foreign body removal or identification of the underlying cause of the abscess. Excision of chronic inflammatory tissue may not be necessary for a successful outcome, contrary to previous recommendations. Multi-pathogen infections and anaerobic infections are commonly encountered.

Pharmacological options for Candida albicans Endocarditis at the roadblock with irrecoverable prosthetics and drug interactions: a case report and review of literature

BackgroundCandidemia is the fourth most common nosocomial bloodstream infection. Endocarditis from candidemia is a rare but possibly fatal complication. The efficacy of amphotericin and echinocandins for induction and azoles for suppression has been well studied. Source control of infection, including removal of foreign bodies, remains the cornerstone for the success of any antifungal therapy.Case PresentationWe are describing a case of a 63-years old patient with multiple comorbidities who developed candidemia secondary to Candida albicans. The prospect of curing the fungemia was made difficult by prosthetic devices, including prosthetic heart valves, intracardiac defibrillator, and inferior vena filter, which could not be extracted due to poor cardiovascular status and higher postoperative mortality risk. Combination therapy with amphotericin and 5-Flucytosine (5FC) was used with the first recurrence. Suppression with fluconazole was contraindicated due to prolonged corrected QT (QTc) interval. Isavuconazole was employed for chronic lifelong suppression.ConclusionRetaining prosthetics in higher surgical risk patients presents us with unique clinical and pharmacological challenges regarding breakthrough infections, drug interaction, and side effects from prolonged suppressive therapies.

Epidemiologic Burden and Projections for Eosinophilic Esophagitis–Associated Emergency Department Visits in the United States: 2009-2030

Patients with poorly controlled eosinophilic esophagitis (EoE) may require unplanned emergency department (ED) visits for the management of dysphagia or food impactions. We evaluated the epidemiologic burden of EoE on ED utilization in the United States. Data from the US Nationwide Emergency Department Sample were used to estimate weighted annual EoE-associated ED visits from 2009-2019. Temporal trends in population-adjusted rates of EoE visits were assessed using joinpoint regression. Autoregressive integrated moving average models were used to project EoE-associated ED visits to 2030. We also evaluated endoscopic utilization, requirement for hospitalization, and ED-related charges in patients with EoE presenting to ED. A total of 11,125 unweighted (49,507 weighted) ED visits for EoE were included (69.0% male, mean age 32.4 years). The annual volume of EoE-associated ED visits increased from 2,934 [95% CI: 2,437-3,431] in 2009 to 8,765 [95% CI: 7,514-10,015] in 2019 and is projected to reach 15,445 [95% prediction interval PI: 14,672-16,218] by 2030. From 2009 to 2019, the number of EoE-associated ED visits increased by an average of 11.5%/year [95% CI: 10.3%, 12.7%]. The proportion of patients admitted to hospital from ED decreased from 25.6% in 2009-2011 to 14.0% in 2017-2019. Half of EoE patients presenting to ED required endoscopy, and nearly 40% required esophageal foreign body removal. Total mean inflation-adjusted charges for an EoE-associated ED visit were $9,025 US dollars in 2019. The volume of EoE-associated ED visits tripled between 2009 to 2019 and is projected to further double by 2030. This represents a substantial burden of unanticipated healthcare resource utilization and highlights a potential opportunity to optimize outpatient EoE care.

Efficient removal technique of foreign body in the mandible with optimization of 3D simulation

AbstractBackgroundForeign bodies may be deposited in the oral cavity either by traumatic injury or iatrogenic damage.Case PresentationWe describe a case of foreign body removal using a three‐dimensional reconstruction (3D) simulation application (ProPlan CMF™) involving a case of a 26‐year‐old male. The broken bur had been accidentally inserted when a lower wisdom tooth was extracted at a general dental office. The removal surgery was performed under preoperative simulation without complications (e.g., excessive bleeding and nerve paralysis).ConclusionThis case illustrates surgical techniques to safely remove foreign bodies in the mandible.

NOVEL TECHNIQUE FOR INTRAOCULAR FOREIGN BODY REMOVAL: Magnetized Disposable Microforceps. A Systematic Approach and First Clinical Result.

To verify whether disposable microforceps can be magnetized to atraumatically attract and then grasp intraocular foreign bodies. An effective magnetization protocol was developed. The clinical relevance was tested, and a first practical application was performed. The magnetic flux density (MFD) of a bar magnet and an electromagnet was measured. Steel screws were used to determine the magnetization protocol. Disposable microforceps was magnetized, MFD generated at the tip was measured, and the weight that can be lifted was tested. Foreign body removal with such forceps was performed. The electromagnet MFD was much higher than the bar magnet. The most effective magnetization protocol was to pass the screw from the end along the shaft and back over the electromagnet. Magnetized microforceps had a 7.12 mT change in MFD at the tip. Steel balls up to 87 mg could be lifted in buffered saline solution. In clinical use, the intraocular foreign body could be attracted and grasped safely. Disposable microforceps can be easily and inexpensively magnetized. The achievable MFD is clinically relevant to attract typical intraocular foreign bodies. An electromagnet is best suited for this purpose. With such prepared forceps, foreign bodies can be attracted atraumatically and grasped securely.

Feasibility and safety of a self-developed sleeve for the endoscopic removal of refractory foreign body incarceration.

This study aimed to assess the feasibility and safety of a novel self-designed sleeve for the endoscopic removal of a refractory incarcerated foreign body in the upper gastrointestinal tract (UGIT). An interventional study was conducted between June and December 2022. A total of 60 patients who underwent an endoscopic removal of a refractory incarcerated foreign body from the UGIT were randomly allocated to the self-developed sleeve and the conventional transparent cap. The study evaluated and compared the operation time, successful removal rate, new injury length at the entrance of the esophagus, new injury length at the impaction site, visual field clarity, and postoperative complications between the two groups. The success rates of the two cohorts in the foreign body removal display no significant discrepancy (100% vs. 93%, P = 0.529). Nevertheless, the methodology of the novel overtube-assisted endoscopic foreign body removal has culminated in a significant reduction in the removal duration [40 (10, 50) min vs. 80 (10, 90) min, P = 0.01], reduction in esophageal entrance traumas [0 (0, 0) mm vs. 4.0 (0, 6) mm, P < 0.001], mitigation of injuries at the location of the foreign body incarceration [0 (0, 2) mm vs. 6.0 (3, 8) mm, P < 0.001], an enhanced visual field (P < 0.001), and a decrement in postoperative mucosal bleeding (23% vs. 67%, P < 0.001). The self-developed sleeve effectively negated the advantages of incarceration exclusion during removal. The study findings support the feasibility and safety of the self-developed sleeve for the endoscopic removal of a refractory incarcerated foreign body in the UGIT, with advantages over the conventional transparent cap.

Efficacy and Safety of Cap Assisted vs. Conventional Endoscopic Esophageal Foreign Body Removal -

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Risk factors for difficult removal of tracheobronchial foreign bodies in children by rigid bronchoscopy.

To characterize the risk factors for difficult removal of tracheobronchial foreign body (FB) by rigid bronchoscopy in children. We retrospectively analyzed clinical data of 1026 pediatric patients (age: 0-18 years) diagnosed with tracheobronchial FB between September 2018 and August 2021. All patients underwent rigid bronchoscopy as the first intervention at our hospital. Children aged 1-3 years accounted for 83.7% cases in our cohort. The most common symptoms were cough and wheeze. FBs were more frequently found in the right bronchus, and trachea FBs accounted for only 8.19% cases. The success rate of rigid bronchoscopy in a single attempt was 97.27%. 12.18% of the cases were defined as difficult removal of FB. On univariate analysis, age, CT findings (pneumonia), type of FB, diameter of FB, FB location, granulation tissue formation, and the seniority of the surgeon were identified as risk factors for difficult removal of tracheobronchial FBs. On multivariate analysis, age ≥3 years, FB diameter ≥10mm, FBs located in left bronchus, multiple FBs, granulation tissue, and the seniority of surgeon (<3 years, ≥5 years) were independent risk factors for difficult removal. Age, FB diameter, location of FB, granulation tissue formation, and the seniority of the surgeon were risk factors for difficult removal of FBs by rigid bronchoscopy.

Safety of Surgical Removal of Aspirated Foreign Bodies after Failure of Bronchoscopy Removal

Background: Foreign body (FB) aspiration is uncommon, but potentially serious and life-threatening. Foreign body aspiration represents about 0.5% of adult bronchoscopy procedures. When bronchoscopic removal fails, the procedure should stop and a thoracic surgeon must join the procedure, and the most common surgical strategy is lobectomy. Aims: The aim of this study is to describe the outcome and safety of surgical removal of aspirated foreign bodies through minimal thoracic surgery after failure of bronchoscopic removal. Materials and Methods: This is a descriptive hospital study that involved 21 patients hospitalized in two main hospitals in Khartoum, Sudan, between September 2013 and October 2019, for the surgical removal of aspirated foreign bodies. We collected data on the demographics and clinical characteristics of the patients, the nature and anatomical location of the foreign body, and the surgical results. Results: The mean age of the patients was 14 years and 12 of them were women. The incident was accidental in all patients, and the mean time between the foreign body aspiration and surgery was approximately 2 weeks. Foreign bodies were found in the right lung in 15 of the patients. All foreign body removals were achieved by minimally invasive thoracic surgery. In 17 patients, the surgery was conservative, but two patients underwent lobectomy and pneumonectomy was performed in 2 patients. The postoperative course was favorable in all patients and no deaths were reported Conclusion: Minimally invasive thoracic surgery in our setting has provided a safe approach to the removal of aspirated foreign bodies after failure of bronchoscopic removal.

Rectal Foreign Body Causing Perforation: A Case Report

The rectal foreign body is a rare presentation with rising incidence. We present a case of a 26-year-old heterosexual male with an alleged history of sexual assault with insertion of a large foreign body through the anus two days prior with peritonitis. After investigations, the patient underwent an exploratory laparotomy, foreign body removal, primary repair of perforation with a diverting colostomy. Diversion must be considered in cases where the extent of anal sphincter mechanism injury is in question. The patient had a good outcome. Assessment of the shape, size, nature, and location of the object through appropriate imaging is necessary. Exploratory laparotomy is inevitable in cases of perforation.

A Penetrating Foreign Body with Sphenoid Sinus extension- A Case Report.

Introduction: Foreign bodies in the paranasal sinuses are rare and can result from high velocity trauma. Here, we report a case of a 12 year old child, who sustained a penetrating injury to the left eye with a tree branch while playing. On CT scan, the wooden foreign body was found to extend into sphenoid sinus. Patient was posted for removal of foreign body in emergency OT under antibiotic coverage. The foreign body was mobilised from surrounding structures and was removed by giving strong traction. Primary closure of the wound was done and patient recovered with a stable post-op course. Discussion: Prompt and complete removal of wooden foreign body in the paranasal sinus is important due to their close proximity to vital structures. Their location and nature can be difficult to diagnose as they can have diverse appearances on imaging. Conclusion: Foreign bodies in close proximity to the sphenoid sinus should be removed by a multi-specialist team with good knowledge of head and neck anatomy in a tertiary care centre to avoid complications.

Food choking incidents in the hospital: Incidents, characteristics, effectiveness of interventions, and mortality and morbidity outcomes

AimForeign body airway obstruction (FBAO) due to food can occur wherever people eat, including in hospitals. We characterized in-hospital FBAO incidents and their outcomes. MethodsWe searched the Japan Council for Quality Health Care nationwide in-hospital adverse events database for relevant events from 1,549 institutions. We included all patients with FBAO incidents due to food in the hospital from January 2010 to June 2021 and collected data on the characteristics, interventions, and outcomes. FBAO from non-food materials were excluded. Our primary outcomes were mortality and morbidity from FBAO incidents. ResultsWe identified 300 patients who had a FBAO incident from food. The most common age group was 80–89 years old (32.3%, n = 97/300). One-half (50.0%, n = 150/300) were witnessed events. Suction was the most common first intervention (31.3%, n = 94/300) and resulted in successful removal of foreign body in 17.0% of cases (n = 16/94). Back blows (16.0%, n = 48/300) and abdominal thrusts (8.1%, n = 24/300) were less frequently performed as the first intervention and the success rates were 10.4% (n = 5/48) and 20.8% (n = 5/24), respectively. About one‐third of the patients (31%, n = 93/300) died and 26.7% (n = 80/300) had a high potential of residual disability from these incidents. ConclusionFBAO from food in the hospital is an uncommon but life-threatening event. The majority of patients who suffered from in-hospital FBAO incidents did not receive effective interventions initially and many of them died or suffered residual disability.