Foreign Bodies In Adults Research Articles

Emergency admissions due to swallowed foreign bodies in adults

To study a retrospective analysis of patients who presented to the emergency departments (ED) with complaints related to foreign body ingestions. Patients older than 16 years of age who presented to the ED between January 1(st) and December 31(st) of 2010 with complaints related to swallowed foreign bodies were identified from electronic health records and patient charts. A total of 100 patients presented with a complaint of foreign body ingestion during the study period. Overall, an X-ray was performed on 75 patients, and a fiberoptic evaluation was performed on 45 patients. A foreign body was detected in 46 (46%) patients. The diagnostic yield of the X-ray was 27 (36%) out of 75 patients, while the diagnostic yield of the fiberoptic evaluations was 21 (47%) out of 45 patients. The detected foreign bodies were mostly located in the esophagus (17 out of 46 foreign bodies detected). When the types of ingested foreign bodies were evaluated, 52 (52%) patients reported ingesting food, and 19 (19%) patients reported swallowing pins. An X-ray was performed on 33 patients with accidental food ingestions but yielded a positive result in only two cases. In 12 out of 21 patients with accidental food ingestion who underwent fiberoptic evaluation, the foreign material was detected and removed. Plain radiography is helpful in the localization of radiopaque swollen foreign bodies, while fiberoptic methods are useful as both diagnostic and therapeutic tools, regardless of radiopacity.

Pulmonary Lobectomy on Delayed Inhaled Foreign Body in Adult: A Case Report

We present the case of a 51 years old female who experienced foreign body aspiration 3 years before. The foreign body, which should be removed by bronchoscopy before, was lodged at the bifurcation of the right inferior bronchus and could only be removed via right lower lobectomy. The patient experienced a swift recovery and was well at follow-up 8 months later.

Swallowed Foreign Bodies in Adults

Foreign-body ingestion is a common event most often seen in children from 6 months to 6 years of age. In adults, foreign bodies are usually ingested accidentally together with food. This happens more commonly in persons with certain pathological changes of the gastrointestinal tract. We present a selective review of pertinent literature retrieved by a search in the PubMed database. The foreign bodies most commonly ingested by adults are fish bones and chicken bones. The clinical approach to the problem depends on the type of material ingested and on the patient's symptoms and physical findings. In about 80% of cases, the ingested material passes uneventfully through the gastrointestinal tract; endoscopy is performed in about 20% of cases, and surgery in less than 1%. Emergency esophagogastroduodenoscopy (EGD) is recommended when the esophagus is completely occluded (because of the risk of aspiration and/or pressure necrosis), when the ingested object has a sharp point or edge (because of the risk of perforation, with ensuing mediastinitis or peritonitis), and when a battery has been ingested (because of the risk of necrosis and fistula formation). For non-occluding esophageal foreign bodies, including magnets, an urgent but non-emergency EGD within 12 to 24 hours is recommended. Most patients can be treated conservatively by observation alone, but there should be a low threshold for deciding to proceed to endoscopic retrieval. Surgery is reserved for complicated cases.

Subcutaneous emphysema: An unusual presentation of an unsuspected foreign body bronchus in an adult patient

Foreign body in airway is common in children but extremely rare in adults. Here, we are presenting a case report of an adult patient with an unsuspected foreign body in the airway who presented unusually as widespread subcutaneous emphysema in neck. We did an extensive review of literature on this topic but could find only few cases with similar clinical presentation of asymptomatic inhaled foreign body in adults. This case underlines the fact that airway foreign bodies can have extremely unusual presentations and only a high degree of clinical suspicion can clinch the diagnosis. This case is being reported for its unusual presentation and its rarity.

Impaction of Durian Seed in the Larynx

Common foreign bodies in adults include fish bones and improperly chewed meat A 72-year-old Malay gentleman was brought in by his son to the emergency department after he was seen gasping at home. The patient has an underlying history of stroke with neurological deficit include his gag reflex. According to family members, the patient had the symptom a day after he had allegedly consumed a piece of durian without removing its seed. Patient was then admitted to Intensive care Unit (ICU) for monitoring. His blood gas normalized and was extubated after 2 days in ICU before discharged home the next day.

Displaced Nasal Dilator Caused Severe Pain: Case Report and Literature Review

Internal nasal dilators are widely used but have not been reported to cause severe symptoms. We describe a case in which a male adult had accidentally, during sleep, inhaled a nasal dilator into his right nasal cavity, and we review the relevant literature. A PubMed search was performed of nasal dilators, especially of the internal types, including “Nasaline Snooze'” (ENTPro, Stockholm, Sweden). A foreign body in adults may be an inhaled nasal dilator. It may be overlooked on computed tomography scans, and thorough inspection of the nose is diagnostic.

Removal of Tracheobronchial Foreign Bodies in Adults Using a Flexible Bronchoscope: Experience with 200 Cases in China

Tracheobronchial foreign bodies (FBs) are frequently present in adults. This study reports our experience with the managements of FB and FB-related complications using flexible bronchoscopy. We retrospectively reviewed the adult patients with FBs treated between 2001 and 2011 in China. The demographic and endoscopic data were collected and analyzed. A total of 200 adult patients (136 men and 64 women) with an average age of 51 years were analyzed. The most common FBs included bones (51.0%), nut shells (15.0%), food boluses (7.0%), plastic toys or pen caps (6.5%). After FB aspiration occurred, only 11.0% were diagnosed within three days, while more than half of the patients (58.0%) delayed the diagnosis by more than one month. The incidence of FB-related complications was 79.5%, including granulation formation (76.5%), obstructive pneumonia (22.0%), hemorrhage (14.5%), atelectasis (10.0%) and endobronchial stenotic scarring (8.0%). In 96.5% of the patients, the FBs were successfully removed under flexible bronchoscopy. A total of 53 out of the 153 patients with granulation (34.6%) were managed by argon plasma coagulation (APC) or cryotherapy; two out of the sixteen patients with endobronchial stenotic scars were treated by balloon dilation under flexible bronchoscopy. A high incidence of FB-related complications occurs, likely as a result of the long delay between aspiration and diagnosis, a proportion of which require endoscopic intervention. The removal of FBs under flexible bronchoscopy has a high success rate and therefore should be recommended for adults.

Endoscopic management of suspected esophageal foreign body in adults

Foreign bodies should not be allowed to remain in the esophagus beyond 24 hours after presentation. However, some patients with esophageal foreign body ingestion do not come to the hospital immediately and may delay medical intervention from the time of ingestion. The aim of this study was to investigate the outcomes of adults with suspected esophageal foreign body ingestion according to the time of ingestion and types of foreign bodies. A total of 326 adult patients (151 men and 175 women) were analyzed, and divided into two groups according to the time period: within or beyond 24 hours from ingestion to endoscopic intervention. A total of 172 patients (52.7%) were found to have ingested foreign bodies; 73.5% were removed smoothly, 10.3% were treated by push technique and 16.0% with failed retrieval received alternative treatments. A higher proportion of patients in the beyond-24 hours group suffered from odynophagia (25.9 vs. 12.9%, P < 0.05). Negative identification of esophageal foreign bodies was more frequent in the beyond-24 hours group (67 vs. 40.2%, P < 0.05), but these patients showed higher proportions of esophageal ulcers (21.1 vs. 7.2%, P < 0.05). The beyond-24 hours group also showed a significantly higher rate of foreign bodies in the lower esophagus (40.0 vs. 15.3%, P < 0.05). Patients with esophageal food bolus impaction had significant delayed endoscopic intervention, longer therapeutic endoscopic time, higher proportions of esophageal cancer, stricture and fewer complications. Endoscopic intervention within 24 hours from the time of ingestion should be considered early in adults, because delaying intervention may produce more symptomatic esophageal ulcerations with odynophagia.

Unusual Presentation of an Aural Foreign Body in an Adult

Aural foreign body is a common entity in the ENT practice. An astonishing variety of materials have been reported as offending foreign bodies. The commonest articles found in the adults include cockroaches, cotton tips and ear plugs. Often, particularly in adults, the inaccessibility of the deep-seated foreign body inside the ear canal makes the self removal impossible and patient seeks medical advice. In the present article, an unusual case of aural foreign body has been reported where a gauze-piece got anchored to the handle of malleus through a pre-existing central perforation of the ear-drum and the successful removal was possible only by operative procedure under microscope. INTRODUCTION Studies on foreign body insertion were done mainly in children. Available literature on adult aural foreign bodies are mostly unusual case reports. In available studies on adult aural foreign body, the object is mostly cotton wool of cotton buds, flying insects or silicone ear plugs. In some studies, cockroaches have been found as a common foreign body both in adults and children. CASE REPORT A 30 year old male presented in the ENT out patient department with a part of cotton thread hanging outside his left ear for 2 days. On careful history taking it was noted that he had history of profuse, intermittent discharge from left ear for past many years. He had the habit of inserting rolled cotton gauge pieces in his ear to clean the discharge. Two days back, after cleaning his ear, he couldn’t pull out the cotton piece and on traction, it caused pain. It was hanging outside his ear since then. [Fig-1] Figure 1 Figure. 1 The white cotton thread can be seen hanging from the left ear in this photograph. Otoscopy revealed a moderately large central perforation of the tympanic membrane and cotton threads of the gauge piece were found to be entangled to the malleus handle. The thread could not be removed in out patient department. He was taken to the operation theatre and was examined under microscope. It was found that the cotton threads got entangled forming a knot around the handle of malleus [Fig-2]. Unusual Presentation of an Aural Foreign Body in an Adult 2 of 3 Figure 2 Figure. 2 This is a microscopic view showing the left external auditory canal (with hairs). The tympanic membrane perforation can be seen. The whitish cotton thread is seen entangled with the malleus handle. Under local anesthesia, the knots were untied carefully and the gauze-piece was removed. [Fig-3] Figure 3 Figure. 3 Photograph of the cotton thread after removal. The blood soaked end was tied to the malleus. The patient was counseled to undergo proper treatment for his existing ear ailment. DISCUSSION Most of the case reports of adult aural foreign bodies, found in literature, are about unusual objects either accidentally entering the ear-canal or in cases where mentally diseased patient, inserting the foreign body in the ear and subsequently forgetting about it. In the available studies, the adult foreign bodies commonly found in ear are cotton wool of cotton buds, flying insects, silicone ear plugs or cockroaches. 3 In self-inserted foreign bodies, done accidentally e.g. cotton wool, the deep-seated foreign body becomes inaccessible for self-removal forcing the patient to seek medical help. Adults generally present late, usually after all self removal methods fail. The novelty of the present case lies in the fact that – (1) The foreign body got access to the middle ear ossicles due to the pre-existing central perforation and(2) It got anchored to the handle of malleus due to the maneuvering by the patient himself. In fact, part of it was dangling outside the ear and the threads of the gauge-piece were entangled around the handle of malleus and any attempt to remove it by traction proved to be painful. It proves that, even when a part of any foreign body is visible outside the ear, it becomes imperative to perform an otoscopic examination to be sure of its attachments inside before planning a successful retrieval.

Erişkinlerde Trakeobronşiyal Yabancı Cisimler

Yabanci cisim aspirasyonu, acil girisim gerektiren ve yasami tehdit edici bir durum olusturabilir. Ulkemizde, ozellikle eriskinlerde yabanci cisim aspirasyonu oldukca siktir. Bu calismada amac, eriskinlerdeki trakeobronsiyal yabanci cisim aspirasyonlarinin etiyolojisi, klinigi, bronkoskopik tedavinin onemini belirterek tedavi sonuclarini degerlendirmektir. Ocak 1998 - Aralik 2003 arasinda Ondokuz Mayis Universitesi Tip Fakultesi Gogus Cerrahisi Anabilim Dali'nda trakeobronsiyal yabanci cisim aspirasyonu tanisiyla bronkoskopi uygulanan 53 hasta retrospektif olarak degerlendirildi. Tani hikaye, fizik muayene, radyolojik bulgular ve bronkoskopi ile konuldu. Hastalarin yas araligi 14-58 olup yas ortalamasi 24±1.6 yil idi. Hastalarin 44'u (%83) kadin, 9'u (%17) erkekti. Basvuru aninda 18 (%34) hasta semptomatikti ve en sik semptom oksuruktu (%17). En sik rastlanan radyografik anormallik radyo-opak yabanci cisim gorulmesi idi (%81). Bronkoskopi uygulanan hastalarin 50'sinde (%94) yabanci cisim tespit edildi, uc hastada yabanci cisime rastlanmadi. Uc hastaya rijid + fleksibl bronkoskopi uygulandi ve yabanci cisim cikarilmadi. Bu olgulara (%5.6) torakotomi + pnomotomi uygulandi. Yabanci cisimlerin; 24'u (%48) sag bronsiyal sistemde, 18'i (%36) sol bronsiyal sistemde ve 8'i (%16) trakeada tespit edildi. Yabanci cisimlerin buyuk cogunlugunun (%80) turban ignesi oldugu goruldu. Trakeobronsiyal yabanci cisim aspirasyonunda erken tani ve tedavi onemlidir. Trakeobronsiyal yabanci cisimler bronkoskopi ile basariyla cikarilabilir. Bolgelere ve ulkelere gore aspire edilen yabanci cisimler cesitlilik gostermektedir. Tracheobronchial Foreign Bodies in Adults Foreign body aspiration can be a life-threatening emergency requiring immediate intervention. In our country and especially in adults, the prevalence of foreign bodies aspiration is high. In this study, the aim is to evaluate results of the treatment, as well as pointing the importance of bronchoscopic treatment, and etyology and clinics of tracheobronchial foreign bodies in adults. Between January 1998 and December 2003, at Ondokuz Mayis University Medical School, Department of Thoracic Surgery, 53 patients were examined with a suspicion of tracheobronchial foreign body aspirations, retrospectively. The diagnosis was made on history, physical examination, radiological methods and bronchoscopy. The age interval of the patients was 14 to 58 and the mean age was 24±1.6 years. Nine (17%) of them were male and 44 (83%) of them were female. Eighteen (34%) patients were symptomatic on admission and the most frequent symptom was cough (17%). The most common radiographic abnormality found in 81% of the cases was a radiopaque foreign body. All 53 patients had bronchoscopic evaluation, and at 50 (94%) of them foreign bodies were identified. Only in three cases a foreign body was not found during the bronchoscopy. In 3 (5.6%) cases, in which rigid + flexible bronchoscopy were unsuccessful, thoracotomy + pneumotomy was applied. Foreign bodies were localized in the right bronchial tree in 24 (48%) cases, in the left bronchial tree in 18 (36%) cases and in the trachea in 8 (16%) cases. The majority of the foreign bodies were turban pins, in 40 (80%) cases. Early diagnosis and treatment is important in tracheobronchial foreign body aspiration. Tracheobronchial foreign bodies can be successfully removed with bronchoscopy. Aspired foreign bodies vary from region to region and country to country.

A bitter pill to swallow

Foreign body aspiration can be a life-threatening emergency requiring immediate intervention. However, unlike in children, clinical presentation of foreign bodies in adults often varies with regard to symptoms and signs and occurs without asphyxia. We here describe the case of a 65-year-old man on maintenance hemodialysis who developed dyspnea and left chest aspiration pneumonia after swallowing one tablet of the phosphate binder sevelamer. This case illustrates that elderly patients with swallowing complaints should be taken serious when they complain about their subsequent frustration of ingestion of their pills.

EPIDEMIOLOGY OF OPEN-GLOBE INJURIES IN IRAN

To review characteristics of open-globe injuries presented to Farabi Eye Hospital, a large referral center for serious ocular injury in the capital city of Iran. A retrospective review of 2,340 open-globe injury patients during a 5-year period was performed. Data about any patient that was diagnosed as open-globe injury were collected from medical records. Of 2,340 patients, 1,904 (81.4%) were men. Mean age was 22.44 +/- 16.65 years (range, 4 months to 90 years). Seventy-five percent of cases were younger than 30 years, with a peak of 5 years. There were 561 patients who had an intraocular foreign body (24.7%). In patients younger than 16 years, a knife was the most prevalent cause (22%); in patients younger than 7 years, knives accounted for 33.6% of trauma etiology; and in patients more than 16 years, a projectile metallic foreign body was the most common cause, accounting for 27% of open-globe injuries. Endophthalmitis developed in 5.1% (117 cases). Factors that had a positive association with severity of ocular injury were visual acuity lower than 20/200 at admission, endophthalmitis, double perforation, and laceration length. According to Ocular Trauma Scoring, there was better visual prognosis in younger age groups, male sex, and intraocular foreign body groups. The rate of enucleation or evisceration was 5.3% (126 cases). We had a low sympathetic ophthalmia rate of 0.08%. The most prevalent trauma etiology is a projectile metallic foreign body in adults and a knife injury in children. Compared with other previous epidemiologic studies, we had younger patients, lower enucleations, and sympathetic ophthalmia.

Thoracoscopic removal of a transesophageal ingested mediastinal foreign body☆

Transesophageal migration of a foreign body into the mediastinum in human adults is rare. This event can result in life-threatening situations and is associated with a high mortality rate. Only a few case reports of thoracoscopic removal of a foreign body in adults have been published so far. The authors describe the case of a successfully performed thoracoscopic approach to remove an ingested needle from the mediastinum posterior of a 69-year-old patient. The authors are discussing why, in similar cases, removal of the foreign body should be performed and they describe the preliminary conditions for this method. A video file is attached.

Extraction of airway foreign bodies in adults: experience from 1987–2008☆

To determine the incidence and the clinical, radiographic, and endoscopic characteristics of adult patients in our area diagnosed with tracheobronchial foreign bodies (FBs), we have performed a descriptive retrospective study analysing rigid and flexible bronchoscopies practised at our department between 1987 and 2008 in patients older than 14 years. Of the 9781 bronchoscopies performed, 32 involved cases of bronchoaspiration of FBs. The mean age of the patients was 43.81 years (S.D. 21.43); 65.6% were male and 34.4% were female. Acute or recurrent infection was the most frequent clinical presentation. Chest radiographs provided data for diagnosis in 68% of the cases. The most common FB aspirated were inorganic (pins and plastic devices 21.4%, respectively). In conclusion, we can state that in our area tracheobronchial aspiration of FBs by adults is not common. The clinical symptoms are highly variable and the FBs are usually lodged in the right bronchial tree.

Esophageal Food Impaction: A Homemade Suction Tube Attached to Esophagogastroduodenoscopy for Food Bolus Removal

The most common esophageal foreign body in adults is impacted food bolus. Polypectomy snares, Dormia baskets, retrieval nets, rat-tooth forceps, alligator forceps or polyp graspers are usually used to remove it. Here, we report the case of a 78-year-old woman whose esophagogastroduodenoscopy (EGD) showed a firm goose liver impacted tightly in the lower esophagus; all of the above-mentioned retrieval instruments could not remove it. We used a homemade device by attaching a modified nasogastric tube to an EGD and successfully removed the goose liver by suction under endoscopic visualization. The method is very effective to remove firm and tightly impacted materials in a narrow lumen. When the usual retrieval instruments fail, a homemade suction tube attached to an EGD is an alternative.

Removal of tracheobronchial foreign bodies in adults using flexible bronchoscopy: experience 1995–2006

Tracheobronchial foreign body (TFB) removal in adult patients using the combined technique of flexible bronchoscopy (FBSC) through the endotracheal tube as well as using the simple FBSC has not often been described. This study reports our experience with FBSC for removal of TFBs and describes diagnosis, techniques of removal, and types of TFBs. We retrospectively examined bronchoscopic records of adult patients performed between 1995 and 2006 and collection of foreign bodies in Clinical Department for Respiratory Diseases, University Hospital Split, Croatia. TFBs were found in 86 (0.33%) out of 26,124 patients who were submitted to bronchoscopy. The majority of the patients (90%) had some risk factor for aspiration, among which stroke (30%) was the most frequent. Patients with different neurologic and neuromuscular diseases together accounted for 58% of all patients with TFB aspiration. Medical history was suggestive of foreign body aspiration in 38.4% of the patients, while chest X-ray was indicative in 7% of the patients. TFBs were most often found in the right bronchial tree (75.6%). The most common TFBs were animal and fish bones (39.5%). In 90.7% of the patients they were successfully removed under FBSC, whereas in 8.1% of the patients a TFB was extracted with flexible bronchoscope through endotracheal tube. Surgery was needed in only one case. Although foreign bodies in the tracheobronchial tree are rare in adults, the clinician must be aware of their likelihood. Foreign body aspiration should be considered especially in the etiology of recurrent lung diseases and in the presence of risk factors for aspiration, in particular with different neurologic and neuromuscular diseases. They can be successfully and safely removed in the majority of patients under local anesthesia by using FBSC. In cases when repeated procedure is needed, endotracheal tube is recommended.

Clinical Features of Tracheobronchial Foreign Bodies in Adults according to the Risk of Aspiration

연구배경: 국내에서 굴곡성 기관지경에 의해 기도 내 이물이 확인된 성인 환자에서 흡인의 위험도에 따른 임상적 특징 및 이물 제거 방법 및 결과에 대한 보고가 없어 본 연구를 계획하였다. 방법: 1994년 12월부터 2004년 12월까지 경희대학교 부속병원에서 굴곡성 기관지경을 시행하여 기도 내 이물이 확인되었던 29명의 성인 환자를 대상으로 면밀한 의무 기록을 바탕으로 후향적 분석을 시행하였다. 결과: 14명은 흡인의 위험인자가 없었던 반면 15명은 흡인의 위험도가 높은 중추신경계 질환을 가지고 있었다. 전체 환자 중, 7명(24.1%)은 흡인에 대한 과거력이 없었다. 22명의 환자가 호흡기 증상이 확인되었는데, 기침(62.0%), 호흡곤란(44.8%), 발열(20.7%), 천명(13.8%), 흉통(10.3%) 및 객혈(0.4%) 순이었다. 흡인의 위험인자가 없는 환자의 92.8%가 증상이 발생한 반면 흡인 위험도가 높은 환자에서는 60%에서만 증상이 발생하였다(p=0.005). 또한 진단이 되기까지 증상 발생 기간이 각각 4일과 2일로 흡인 위험도가 높은 환자들에서 더 길었고(p=0.007), 3일 이내의 급성 호흡기 증상이 발생한 경우가 더 적었다(p=0.048). 6명(20.9%)의 환자가 단순 흉부 방사선에서 이상 소견이 없었던 반면 23명에서는 이물의 음영(11명), 폐렴(8명), air trapping(5명) 및 무기폐(3명) 등의 소견이 관찰되었다. 흡인의 위험도에 따른 기도 내 이물에 의한 방사선학적 특징에는 차이가 없었다. 흡인 위치로는 우측 기관지가 16예로 가장 많은 빈도를 보였고 우측 하엽 기관지가 가장 흔한 위치였다. 흡인 이물의 종류로는 치아가 11예로 가장 많은 빈도를 보였다. 흡인의 위험도가 높은 환자들에서 의학적 처기가 기도 내 이물 흡인이 발생하는 가장 흔한 경우였다. 모든 대상 환자의 기도 내 이물은 큰 부작용 없이 성공적으로 모두 제거되었으며 alligator jaw biopsy forceps이 이물 제거를 위해 가장 많이 사용되었다. 결론: 본 연구는 흡인의 위험도가 높은 환자에서는 이물 흡인의 과거력이 명확하지 않고 비전형적인 호흡기 증상을 보이는 경우가 많아 진단이 지연되거나 간과될 가능성이 높고 특히 의학적 처치 시 가장 많이 발생한다는 것을 보여주었다. 따라서 흡인의 위험성이 높은 환자에서 이물 흡인에 대한 적극적인 검사와 주의가 필요할 것으로 사료된다.

Adult Foreign Body Airway Obstruction in the Prehospital Setting

Background. Although the treatment of foreign body airway obstruction in adults has been well studied, few data exist on the characterization of prehospital experiences. Objectives. To describe the frequency, etiologies, andtreatments of foreign body airway obstruction in adults in the prehospital setting andto discuss the relative efficacies of treatments andpresenting factors that predict overall patient outcome. Methods. A San Diego County prehospital database was retrospectively reviewed for all adult patients over a 17-month period with data extracted on demographic characteristics, incident outcome, patient disposition, item involved in obstruction, location of episode, initial vital signs, initial level of consciousness, pertinent medical history, treatments initiated by bystanders andparamedics, andresponse to those treatments. Results. During the study period, there were 513 cases of foreign body airway obstruction in adults. Of these, 17 (3.3%) died. The mean age was 65.0 years, with increasing age correlating with worse outcome. The item causing obstruction varied widely, with medications andmeat being the most common items. The Heimlich maneuver was the most commonly used intervention, with an 86.5% rate of patient improvement. Magill forceps proved useful for three cases refractory to the Heimlich maneuver. Presenting vital sign aberrations, particularly with respiratory rate, correlated with poorer patient outcome. Conclusions. Foreign body airway obstruction represents a true emergency in adults, with a 3.3% mortality rate in the current study. The Heimlich maneuver was used frequently andwith good success. Key words: paramedic; choking; adult; foreign body.

어류골편이물에 의한 설기저부 농양 1예

Foreign bodies in the oral cavity and pharyngolarynx are one of the most frequently encountered accidental cases in the out patients departments and the emergency room in the otolaryngological fields. Fish bone is the most common foreign body in adults. They are simply removed with a endoscope, but sometimes surgical removal is needed. These foreign bodies occasionally become impacted necessitating general anesthesia for extraction. We experienced a case of fish bone which caused tongue base abscess. It was removed under ultrasonographic guidance with minimal morbidity. (J Clinical Otolaryngol 2006;17:270-272)

Inhaled foreign bodies in adolescents and adults

Accidental foreign body inhalation is not uncommon. The incidence is high in children, especially the very young ones. We evaluated the management of inhaled foreign bodies in an adult respiratory medical unit, highlighting circumstances leading to inhalation, associated complications and difficulties encountered at bronchoscopic retrieval. We reviewed all cases of inhaled foreign bodies presenting over a period of 12 years (1991-2003). 5 of 8 cases were teenagers whereas 3 were aged over 55 years. The older patients had co-morbidities and had aspirated food particles. In 2 cases, a bronchoscopy was performed primarily to exclude lung cancer, and the discovery of a foreign body was a surprise. Pulmonary complications related to foreign body inhalation were common among this group. All 5 teenage patients presented after inhalation of small objects. 4 patients from the teenage group had general anaesthesia; in 2 of them a laryngeal mask airway was employed, whilst 2 had endotracheal intubation. Only one patient was given a rigid bronchoscopy following failure of the fiberoptic instrument. Difficulties at retrieval of foreign body were frequently encountered. In the adolescent and adult patients, most inhaled foreign bodies are retrievable by flexible bronchoscopy. However, facilities for rigid bronchoscopy should be available as a back-up. Pulmonary complications are common after foreign body inhalation especially in the older patients. Difficulties at bronchoscopic removal may occur due to late presentation or to the site and/or position of the foreign body within the tracheobronchial tree.