Foreign Bodies In Adults Research Articles

Esophageal Foreign Body: Treatment and Complications

The most common cause of esophageal foreign bodies in adults is meat in Western countries and fish bones in Asian countries, including Korea. Although most ingested foreign bodies pass spontaneously through the esophagus without any clinical sequelae, some sharp foreign bodies, such as fish bones embedded in the esophagus, require treatment. Endoscopic management is the first choice in the treatment of esophageal foreign bodies because it is quite safe and effective. Major complications occur as a result of esophageal perforation; in particular, sharp foreign bodies, such as fish bones, are more likely to cause perforation. Complications include mediastinitis, paraesophageal abscess, pneumomediastinum, subcutaneous emphysema, pneumothorax, tracheoesophagal fistula, aortoesophageal fistula, aspiration, and asphyxia. Unnecessary delays should be avoided in endoscopic intervention for esophageal foreign bodies to prevent complications.

Unusual aspiration of foreign body in adults.

Aspiration of foreign body can occur in children and adults. Children swallow objects due to their curiosity and are prone to aspiration. However in adults there are different risk factors for aspiration; such as alcohol consumption, addiction, drug consumption, senility, seizure, trauma, mental retardation, and artificial dentures [1]. In some cases, it may happen accidentally, and risk factors are not involved. In this particular case, air gun bullet has been swallowed (Figure 1). The shooter had put a bullet in his mouth in order to reload his gun and shoot rapidly; then swallowing and aspiration happened. In this case, because the foreign body is opaque, chest X-ray can be helpful for diagnosis (Figure 2). The alternative way to diagnose is fiberoptic bronchoscopy; which is sometimes considered a therapeutic strategy (Figure 3). Foreign body aspiration in tracheobronchial tree requires immediate diagnosis and removal; because the ignored objects may result in complications like infection, abscess, empyema, and haemoptysis or even bronchopleural fistula [2]. Therapeutic options to remove aspirated foreign bodies from the respiratory tract are carried out through fiberoptic and rigid bronchoscope [3]. In cases of immediate removal of the foreign body, the outcome will be excellent; and there will be no specific complication and sequel. In some rare cases, surgery is needed to remove the foreign body; however, surgery is mostly required in situations with late diagnosis and occurrence of complications.

Unusual aspiration of foreign body in adults.

Unusual aspiration of foreign body in adults.

Double duodenal perforation following foreign body ingestion

Intentional ingestion of a foreign body in adults is a rare clinical presentation. This case is one of a 27-year-old Sudanese man who presented having swallowed a ballpoint pen intentionally....

An important risk factor for esophageal foreign bodies in adults: removable dental prostheses

This study investigated the relationship between removable dental prostheses usage and esophageal foreign bodies in adults. We conducted a retrospective single-center study of 93 patients over 16 years old who were diagnosed with esophageal foreign objects following food ingestion between January 2002 and June 2016. The mean age was 57.1 ± 14.2. The foreign body was bone in 65 cases (69.9%) and it was meat in 28 cases (30.1%). In 77 patients (82.8%), foreign body was in the first narrowing of the esophagus, in 9 cases it was in the middle of esophagus (9.7%) and in 7 cases it was observed in distal esophagus (7.5%). In 53 patients (56.9%), there were removable dental prostheses (31 cases have complete removable dental prostheses). Bone swallowing in 51 of the 65 cases (78.5%) occurred while eating meat without knowing that bone existed. In other cases, meat stuck in esophagus because of inadequate shredding. Sometimes patients with removable dental prostheses cannot chew and cut of red meat effectively, and they cannot notice bones easily while eating meat. Patients using denture should be informed about dietary habits. They should be advised about controlling meat when eating and to swallowing small pieces.

Two Cases of Colonoscopic Retrieval of a Foreign Body in Children: A Button Battery and an Open Safety Pin

Ingestion of foreign body in children is a relatively common problem among paediatric population. The foreign bodies mostly pass spontaneously through the gastrointestinal tract. However, complications can occur according to its anatomical location, the characteristics of the foreign body, and delays in management. Although the cases of ingested button batteries or sharp objects impacted at the gastrointestinal tract can be very serious, there have been very only a few cases have reported colonoscopic removal of these dangerous foreign bodies in adults, and there have been no case reports in children. We report one case of a button battery and one case of an open safety pin, both impacted in the terminal ileum that had moved from the stomach within a few hours of ingestion and were eventually managed by colonoscopy without any complications.

成人気管支異物の検討 : 最近経験した4症例をふまえて( 「気管支異物」)

成人気管支異物の検討 : 最近経験した4症例をふまえて( 「気管支異物」)

気管支異物 : 最近の症例から( 「気管支異物」)

気管支異物 : 最近の症例から( 「気管支異物」)

Stomach with Glasses: It Can Happen

A 55-year old incarcerated man with a history of depression, hypertension and hypothyroidism presented to the emergency department with abdominal pain. The patient reported that he ingested six pieces of metal in an attempt to commit suicide. Patient has previous history of ingestion of foreign bodies in an attempt to get out of prison. Physical exam was unremarkable except mild abdominal tenderness. Initial laboratory tests including serum sodium, potassium, blood urea nitrogen, creatinine, liver function tests, thyroid stimulating hormone and lipase were normal. Acetaminophen level was also within normal limits. Abdominal X-ray showed ingested foreign objects suspicious for scrap metal. An upper endoscopy was performed which revealed a pair of reading glasses and ten metal electric connectors in the fundus and body of stomach. [Figure 1] The foreign bodies were successfully removed with the use of snares, rat tooth forceps and endoscopic baskets. [Figure 2] A foreign body hood was used throughout the entire procedure to avoid mucosal damage. Ingestion of foreign bodies in adults is usually intentional. The decision to pursue intervention versus observation is always a challenge. Endoscopic removal of foreign body is indicated if the foreign body is 6 cm in length and 2.5 cm in diameter. Our case reinforces the use of endoscopic intervention in large and unusual foreign bodies of the stomach by an experienced endoscopist. This avoids more invasive interventions like surgery, leading to less complications and shorter length of stay in the hospital.Figure 1Figure 2

Tracheobronchial Foreign Bodies Aspirations in Adults: A 25-Years Experience

Objective:The incidence of tracheobronchial aspirations of foreign bodies in adults is lower than in children. In this article, we aimed to present our experience in tracheobronchial aspiration of foreign bodies in adults during 25-years.Methods:From January 1990 to January 2015, 122 patients older than 16 years with suspected tracheobronchial aspiration of foreign body were included in this study. Patients’ data cards were retrospectively assessed according to age, gender, clinical symptoms and physical examination findings, localization and type of foreign body, radiologic findings and therapeutic options.Results:Ninety-six of the patients were female (78.7%) and 26 were male (21.3%). The age range was 17-70 years and mean age was 30.3 years. Rigid bronchoscopy was performed in all patients. Foreign bodies were seen in 112 patients (91.8%). Foreign bodies were extracted by rigid bronchoscopy in 109 patients. Thoracotomy and pneumotomy were performed in the remaining 3 patients. The most common foreign body was pin (83%). The chief symptom was cough (100%). The most common anatomic location of foreign bodies was right bronchial system (60.7%). The main radiologic finding was radiopaque image of the related foreign body (88.4%). Right lower lobectomy was performed in two patients because of bronchiectasis.Conclusion:If tracheobronchial aspirations of foreign bodies are not treated in early period, irreversible and suppurative lung diseases may occur as results of aspirations in later years. The education of societies about this subject is principal precaution in reducing the frequency of tracheobronchial aspirations of foreign bodies.

Adult foreign body aspirations treated for many years with the diagnosis of asthma: report of two cases

While foreign body aspirations are mostly seen in children, they are also observed in adulthood, but in a rare frequency. As it can be asymptomatic for a long time, it can also be confused with many clinical conditions, such as asthma, which can cause chronic cough. Various complications, such as bronchiectasis and pneumonia, can develop in the presence of long-standing aspirated foreign body. In this study, we present two cases one of whom diagnosed with asthma and treated for 30 years, and the other diagnosed with asthma and treated for 10 years. Although no pulmonary complications developed in our first case, bronchiectasis in the right middle lobe developed in our second case.

Extraction of a Large Central Airway Foreign Body Using Flexible Bronchoscopy Combined with an Endobronchial Blocker.

Adult foreign body (FB) aspiration is an uncommon but potentially fatal event. Options for extraction include flexible bronchoscopy (FLXB), rigid bronchoscopy (RB), and surgical extraction. We report the case of a large, smooth aspirated rock causing airway obstruction in an elderly male. RB is generally the preferred approach for extraction of a large complex FB; however, due to its size, the FB had to be removed using FLXB combined with an endobronchial blocker. In this report, we describe the anesthetic and surgical considerations and the novel technique used to extract the FB.

Anaesthestic Management of Removal of Aspirated Hypodermic Needle in Trachea: A Case Report.

Aspiration of foreign body is a very common emergency in paediatric age group. It is very rare in adult population. Moreover common foreign body in adults are food materials. Aspiration of hypodermic needle is very rarely reported. But this can happen accidentally during use of hypodermic needle for dental block. We hereby report such a case of aspiration of hypodermic needle accidentally aspirated during performing a dental block. Aspiration of sharp foreign body and its bronscopic removal can lead to injury to airway. We report successful management of such a case where needle was removed under general anaesthesia successfully using rigid bronchoscope.

Foreign Body Inhalation in the Adult Population: Experience of 25,998 Bronchoscopies and Systematic Review of the Literature.

Foreign body aspiration is an uncommon entity in adults. Herein, we describe our experience with flexible bronchoscopy in the removal of tracheobronchial foreign bodies in adults. We also conducted a systematic review of the literature on the topic of foreign body inhalation in adults managed with flexible bronchoscopy. The bronchoscopy database (from 1979 to 2014) was reviewed for subjects > 12 y of age with a history of foreign body aspiration managed with flexible bronchoscopy. Demographic, clinical, and bronchoscopy data were collected and analyzed. PubMed was reviewed for studies describing the use of flexible bronchoscopy for foreign body extraction in adults. During the study period, a total of 25,998 flexible bronchoscopies were performed. Of these, 65 subjects (mean age of 32.8 y, 49 males) were identified who had undergone bronchoscopy for foreign body aspiration. Nonresolving pneumonia (30.6%), direct foreign body visualization (24.6%), and segmental collapse (18.4%) were the most common radiological abnormalities. Foreign bodies were identified in 49 cases during bronchoscopy and successfully removed in 45 (91.8%) subjects with no major complications. Metallic (41%) and organic (25.6%) foreign bodies were the most common. Shark-tooth (44.9%) and alligator (32.6%) were the most commonly used forceps in retrieving the foreign bodies. The systematic review yielded 18 studies (1,554 subjects with foreign body inhalation). In adults, the proportion of flexible bronchoscopy (6 studies, 354/159,074 procedures) performed for the indication of foreign bodies among the total flexible bronchoscopies was 0.24% (95% CI 0.18-0.31). The overall success of flexible bronchoscopy (18 studies, 1,185 subjects) for foreign body extraction was 89.6% (95% CI 86.1-93.2). Foreign body aspiration is a rare indication for flexible bronchoscopy in adults. Flexible bronchoscopy has a high success rate in removal of inhaled foreign body and can be considered the preferred initial procedure for management of airway foreign bodies in adults.

A comparative study of small intestinal perforation secondary to foreign body and other non-traumatic causes.

Little was known about gastrointestinal perforation secondary to foreign body in adults, which was only documented by several case series reports. The aim of this study was to characterize it with comparative methods. A retrospective study was conducted on twenty patients with the diagnosis of gastrointestinal perforation secondary to foreign body between January 2003 and October 2013. The perforations were all located in the small intestine and compared to eighty-seven patients with non-traumatic small intestinal perforation. 35% of the patients in the foreign body group were over 65 years of age, which is much higher than the local elderly population ratio (p=0.002). In the foreign body group, more patients presented without diffuse abdominal physical signs (p=0.008) and preoperational CT scans had higher accuracy (p=0.027). Perforation repair was performed more often (p=0.024). Mean MPI was 19.9 and the morbidity rate was 35%, significantly lower than in the cases of other causes (p=0.001, 0.041). Mean duration of hospitalization was 11.5 days and was shorter compared to other causes (p=0.038). Clinical performance of small intestinal perforation secondary to foreign body is atypical, and preoperative diagnosis relies on CT scans. Primary perforation closure is safe and effective, and relatively better outcomes can be achieved.

Foreign bodies in the ear, nose and throat: an experience in a tertiary care hospital in central Nepal.

Introduction A foreign body (FB) is an object or substance foreign to the location where it is found. FBs in the ear, nose, and throat are a common problem frequently encountered in both children and adults. Objective To analyze FBs in terms of type, site, age, and gender distribution and method of removal. Methods A retrospective study was performed in a tertiary care hospital in the central part of Nepal. The study period was from June 2013 to May 2014. The information was obtained from hospital record books. Results A total of 134 patients had FBs in the ear, nose, or throat; 94 were males and 40 were females. Of the 134 patients, 70 (52.23%) had FB in the ear, 28 (20.89%) in the nose, and 36 (26.86%) in the throat. The FB was animate (living) in 28 (40%) patients with FB in the ear and 1 (3.5%) patient with FB in the nose, but the FB was inanimate (nonliving) in any patient with FB in the throat, in 42 (60%) patients with FB in the ear FB, and in 27 (96.4%) patients with FB of the nose. The FB was removed with or without local anaesthesia (LA) in 98 (73.13%) patients, and only 36 patients (26.86%) required general anaesthesia (GA). The most common age group affected was <10 years. Conclusion FBs in the ear and nose were found more frequently in children, and the throat was the most common site of FB in adults and elderly people. Most of the FBs can be easily removed in emergency room or outpatient department.

Delayed and Unusual Presentation of Impacted Laryngeal Foreign Body in Adult

Laryngeal foreign body is very rare in sane adults. Diagnosis is mostly achieved by high index of suspicion and clinico-radiological examinations. Delayed presentation pose a high risk of complications and also presents a challenge to both otolaryngologists and anaesthiologists. Prompt intervention is all that is needed to avoid morbidity and/or mortality. We report a case of delayed and unusual presentation of impacted laryngeal foreign body in a 35 year old man presenting with unremitting hoarseness for 3 months.

Value of helical computed tomography in the early diagnosis of esophageal foreign bodies in adults

PurposeTo investigate the relationship between early use of computed tomography (CT) and complications associated with esophageal foreign body impaction in adults. Material and MethodsA retrospective study was performed on 120 patients (63 females, 57 males, median age 50 years) with a history of foreign bodies. All had negative findings on clinical examination. All cases underwent unenhanced helical CT, and patients with positive findings underwent esophagoscopy within 6 hours. All patients were followed up postoperatively. ResultsCT demonstrated 100% sensitivity, 92.6% specificity, 100% negative predictive value, and 97.9% positive predictive value. Esophageal foreign bodies were associated with a high incidence of complications in adults, and there was a significant difference in the incidence of complications between different durations of impaction (P < .01). In total, 37 patients presented with complications: 32 patients with grade I, 3 with grade II, 2 with grade III, and 0 with grade IV. ConclusionsEsophageal foreign bodies were associated with a high incidence of complications in adults. CT could detect foreign bodies accurately in the early stages, and then FBs could be removed as early as possible, which may reduce the incidence of complications. Moreover, the great majority of complications were of lower grades. Thus, CT may be a useful first-line radiological tool for the early diagnosis of esophageal foreign bodies in adults.

Non-Ionizing Diagnostic Evaluation of Ingested Foreign Bodies

The interesting article by Ambe et al. on the diagnostic and therapeutic approach to swallowed foreign bodies in adults indicates, among other issues, the all-too scarce use of sonography in the diagnostic evaluation of ingested foreign bodies (1). In our opinion, using non-ionizing imaging modalities are a welcome alternative in children and adolescents—the groups in which ingestion of foreign bodies occurs most commonly—but also in pregnant women. Magnetic resonance imaging (MRI) is ruled out, on the one hand, because of the unknown size of the bodies and the fact that it is not known whether the bodies contain metal. On the other hand, bodies consisting of stone, metal, ceramic, or glass do not display well on MRI. For this reason we immersed several metallic and non-metallic items into a solution containing water or jelly and conducted sonography using a commercially available ultrasound device with different probes (linear, convex) (2). We were able to clearly sound out, measure, and unequivocally identify all items (among others, a key, a shell, a plastic Smurf, a spring from a ballpoint pen, and a 2-Euro coin). We believe that this method could easily be used in vivo, in spite of possible masking effects, and would therefore encourage colleagues to conduct sonography before radiography or as an add-on, in order to obtain more data on the specificity and sensitivity of this method in this particular indication.

Factors associated with development of complications after endoscopic foreign body removal

Background/Aims:We analyzed the clinical characteristics of patients who underwent endoscopic foreign body removal and the risk factors of complications.Patients and Methods:The medical records of 415 patients treated from January 2000 to August 2011 for suspected foreign bodies were retrospectively reviewed. Patient characteristics, endoscopic findings, clinical outcomes, and risk factors of complications were analyzed.Results:Foreign bodies were detected endoscopically in 315 patients. Fish bone fragment (36.9%) and coins (15.3%) were the most common type of foreign bodies in adults and children, respectively. Complications associated with endoscopic procedure occurred in 26 patients (8.3%); 20 of the patients were treated conservatively and the other six patients underwent surgical treatment. Perforation (14%) was the most common complication. By univariate and multivariate analysis, the risk factors associated with complication after endoscopic foreign body removal were long duration from ingestion to endoscopy (P = 0.009) and existence of initial mucosal injury (P = 0.018).Conclusions:Most foreign bodies were successfully removed by endoscopy without complication, but long duration from ingestion to endoscopy and mucosal injury were risk factors of complications of endoscopic foreign body removal. Patients with these risk factors could require more careful treatment.