Foreign Body Impaction Research Articles

Cap-assisted endoscopic treatment of esophageal food bolus impaction and/or foreign body ingestion: a systematic review and meta-analysis.

Esophageal food bolus and/or foreign body (FB) impaction is a common gastrointestinal emergency. This meta-analysis reports on the pooled outcomes of cap-assisted endoscopic removal of esophageal FB. We conducted a comprehensive search of several databases (inception to February 2022) to identify studies reporting on the use of a cap in the endoscopic treatment of esophageal FB ingestion. A random effects model was used to calculate the pooled odds ratio (OR) and mean difference (MD), and I2 values were used to assess the heterogeneity. Six studies were analyzed that included 677 patients treated with cap-assisted and 694 with conventional endoscopy. The cap-assisted method demonstrated statistically significant superiority regarding technical success (pooled OR 7.1, 95% confidence interval [CI] 1.9-26.9; P=0.004), en bloc removal (pooled OR 26.6, 95%CI 17.6-40.2; P<0.001), as well as a significantly shorter procedure time (4.6 min, 95%CI -6.5 to -2.8; P<0.001), compared to conventional methods. Better technical success was achieved with the cap-assisted method performed under anesthesia (OR 8.7, 95%CI 1.6-47.7; P=0.01); however, a shorter procedure time was noted for the cap-assisted method without anesthesia (MD -1.5, 95%CI -2.7 to -0.4; P=0.01). Pooled adverse events were comparable. Pooled OR for mucosal tear was significantly lower with cap in food bolus impaction (OR 0.07, 95%CI 0.01-0.38; P=0.02). Cap-assisted endoscopic removal of esophageal FB is associated with better technical success and en bloc removal, and a shorter procedure time compared to conventional methods, with comparable adverse events.

A RARE CASE OF HYDROPNEUMOPERICARDIUM

Hydro-pneumopericardium is an uncommon life threatening clinical/ radiological nding, constitutes an acute emergency that requires immediate (3) surgical intervention . Here, we report a rare case of hydropneumopericardium secondary to foreign body impaction in oesophagus.

Impacted dentures in the pharynx and esophagus - Implication for advocacy.

Impaction of dentures has potentially significant morbidity and management challenges. This study sought to leverage on the occurrence of swallowed dentures to advance discussions on its management and prevention. A 5-year retrospective review of patients seen on account of impacted dentures at the Ear, Nose, and Throat Department of the Korle-Bu Teaching Hospital was done. Variables obtained included age, sex, location of impacted denture, treatment done, denture type, number of teeth, and complications. Variables were analyzed, and descriptive summaries were reported. There was a record of 898 cases of impacted foreign bodies which presented to the department. Fifty-five (6.1%) records were on account of impacted dentures. These consisted of 25 (45%) males and 30 (55%) females. Ranging from 23 to 98 years, the mean and median ages were 55.7 (±18.1) years and 56.5 years respectively. There were no complications, and no identifiable predisposing patient conditions. All prostheses were removable acrylic dentures, and some observations included worn-out and loose dentures, while several had their prostheses dislodging in the process of swallowing tablet medications with water. Swallowed dentures are not rare occurrences in Ghana. Denture wearers should, therefore, be encouraged to get professional reviews, especially when prostheses get unretentive, while dental professionals are urged to incorporate measures in their fabrication to reduce the occurrence of swallowed dentures.

FOREIGN BODY ON RIGHT LATERAL BORDER OF TONGUE THAT MIMICKS VARIX: A CASE REPORT

Foreign body impaction in the oral cavity either due to traumatic injury or iatrogenically is not uncommon. Most commonly encountered iatrogenic foreign bodies is restorative materials such as amalgam, obturation materials, broken instruments and needles. Majority of foreign bodies are impacted in tonsils, base of tongue, maxillary sinus and vallecula. However, foreign bodies impaction in the mobile tongue is rare. We present a case of unusual foreign body impaction on the right lateral border of tongue appeared as bluish mass. A 40-year-old female military personnel came to Oral and Maxillofacial Surgery Department of 94 Armed Forces Hospital Terendak Camp complaining of bluish, painless mass on the right side of her tongue for 4 years. Excisional biopsy has been done and histopathological examination reveals foreign body impaction, likely amalgam tattoo. Amalgam tattoo can sometimes be confused with other foreign body pigmentations, being then biopsied. Once amalgam tattoos have been established, the removal of lesions is not necessary, except for esthetic reasons.

Incidence and evolution of foreign body impaction in the upper gastrointestinal tract and its relationship with eosionophilic oesophagitis

BackgroundForeign body impaction is a frequent indication of urgent endoscopy. One of the reasons for impaction is eosinophilic oesophagitis (EE). To analyze characteristics of oesophageal foreign body impactions and their relationship with eosinophilic oesophagitis. MethodsIn this retrospective study, urgent endoscopies in a tertiary care centre were analyzed. We included all urgent endoscopies due to bolus and foreign body impactions performed between September 1st 2018 and September 1st 2020. We reviewed clinical data of all patients who were diagnosed with EE and compared it to impactions that were due to other motives. The mean follow-up time was 18.7 months. Results693 urgent endoscopy procedures were performed. 239 (34%) of these were due to foreign body ingestion. Mean age of the patients was 63 years old and 135 (63%) were men. EE was diagnosed in 36 (17%) patients. The factors associated with EE were age, to be younger than 50 years (OR, 7.3; 95% CI, 1.1–48.4; p=0.04), asthma/rhinitis/atopic dermatitis (OR, 8.9; 95% CI, 2.3–35.3; p=0.002), findings in the endoscopy as trachealization (OR, 9.7; 95% CI, 1.3–70.9; p=0.03) and psychotropic/calcium channel blocker drugs (OR, 0.09; 95% CI, 0.009–0.9; p=0.04). 15 (7%) patients died. In 6 of them death was impaction-related. None patients with EE died. ConclusionsForeign body impaction in the upper gastrointestinal tract due to EE is a frequent cause of urgent endoscopy. Being under 50 years of age, having asthma/rhinitis/atopic dermatitis, trachealization on the oesophagus and not taking psychotropic/calcium channel blocker drugs are factors associated with the diagnosis of EE. Mortality in the follow-up of patients without EE is important.

Robie V. Zantua, MD (1951-2021)

Robie V. Zantua, MD (1951-2021)

ESOPHAGEAL IMPACTION OF FERTILIZED DUCK EGG ALBUMEN (HARDENED BALUT WHITE) IN A TERTIARY GOVERNMENT HOSPITAL IN THE PHILIPPINES: A CASE SERIES

Background: This study described the clinical profile of patients who developed esophageal impaction after ingesting the hardened white portion (albumen) of a fertilized duck egg (colloquially termed balut).&#x0D; Methods: A review of patients with foreign body impaction of hardened balut egg white was performed. These patients were admitted in the emergency room from November 2013 to November 2018. Clinical features analyzed included age, sex, clinical signs and symptoms, imaging performed, operative findings and complications.&#x0D; Results: In all, 18 patients were included in the review. Seventeen were male with a majority in the 20- to 40-year-old age range. Dysphagia and neck tenderness were the most commonly presented symptoms and physical examination finding, respectively. Twelve cases were successfully extracted via rigid esophagoscopy under general anesthesia, while one case was resolved through spontaneous ejection. The most common site of impaction was at the cervical esophagus. One third of patients undergoing extraction had minor noncircumferential esophageal abrasions.&#x0D; Conclusion: Ingestion of the entire hardened balut white can lead to esophageal impaction, necessitating admission and operative management. Young males are commonly affected. Due to its intrinsic characteristics as a foreign body, its removal can prove challenging. Push technique and extraction (both via piecemeal and wholly) were found to be effective, and when performed correctly, minimized complications. Nevertheless, this condition may be prevented with health education.

The practice of foreign body removal from the ear, nose, and upper esophageal in children in Ethiopia: A retrospective descriptive study.

BackgroundEar, nose, and upper esophageal foreign body (FB) impaction in children is a common emergency in‐hospital service. There are no clear guidelines regarding the management of ingested FBs. This study aimed to determine the FB in terms of type, anatomic site, management outcome, and associated complications.MethodsRetrospective study of children with ear, nose, and upper esophageal FB managed under general anesthesia (GA) at operating room of Wolkite Hospital in the southern part of Ethiopia between January 2019 and February 2021. Data were collected from the medical chart of the patients using a prepared checklist. The parameters included were age, sex, FB anatomic site, type, management outcome, and associated complications related to FB or procedure modalities.ResultsA total of 169 (31.4%) study subjects were required GA for the removal of FBs. The mean age was 4.45 ± 3.20 years. Under 5 years old children comprises 61.5% of total cases. The most common anatomic site of FB impaction was in the ear 97 (57.4%). The most commonly found type of FB was cereals or seeds, which constituted 102 (60.35%). The complication rate was 18.35%. Epistaxis was the commonest complication (6.51%) from the nose while canal abrasion (5.92%) was common from the ear.ConclusionEar, nose, and upper esophageal FBs were found more frequently in younger children. The ear was the most common anatomic site of FB impaction followed by the nose and upper esophageal. The most common type of FB was cereals or seeds.Level of Evidence4.

Missed foreign body inhalation for 15-years

&#x0D; Background:&#x0D; Foreign body inhalation is a life threating event in children and it is common in our country ,which is a daily practice of Thoracic .It can lead to morbidity even mortality in the hands of untrained or not well- trained doctors.&#x0D; Aim:&#x0D; Is to report a case of missed foreign body inhaled 15-years back, which is uncommonly reported in the literatures and to compare it with other studies reporting similar cases.&#x0D; Methods:&#x0D; The details, presentation, clinical findings, radiological appearance and the successful removal by a rigid bronchoscope under general anesthesia will be presented.&#x0D; Results:&#x0D; The successful removal of this long standing impacted foreign body (plastic whistle) using the rigid bronchoscope and the eventful outcome of patient’s clinical symptoms is elucidated.&#x0D; Conclusion:&#x0D; Refractory respiratory symptoms of long duration without improvement justify the need for diagnostic bronchoscopy which will offers the best chance of cure in missed foreign body inhalation.&#x0D;

Trends and predictors of 30-day readmissions in subjects with eosinophilic esophagitis: results from a national cohort.

Eosinophilic esophagitis (EoE) is a chronic allergic inflammatory condition causing recurrent dysphagia and may predispose patients to repeated hospitalizations. We assessed temporal trends and factors affecting readmissions in patients with EoE. Patients with primary diagnosis of EoE and/or a complication (dysphagia, weight loss, and esophageal perforation) from EoE between 2010 and 2017 were identified from the National Readmissions Database using the International Classification of Diseases codes. The primary outcome was incidence of EoE related 30-day readmission. Independent risk factors for readmissions were evaluated using multivariable logistic regression analysis. Secondary outcomes were temporal trends of readmissions and healthcare costs. Of the 2,676 (mean age 45 ± 17.8 years, 1,667 males) index adult admissions, 2,103 (79%) patients underwent an upper endoscopy during the admission. The mean length of stay (LOS) was 3 ± 3.7days. The 30-day readmission rate was steady at 6.8% from 2010 to 2017 and majority of the readmissions occurred by day 10 of index discharge. Age > 70years was associated with a higher trend in 30-day readmission (P < 0.001). Longer LOS, history of smoking and the presence of eosinophilic gastroenteritis predicted readmission. Conversely, a history of foreign body impaction and upper endoscopy (including esophageal dilation) at index admission were negatively associated with readmission. Mean hospital charges significantly increased from $24,783 in 2010 to $40,922 in 2017. Readmissions due to EoE are more likely to occur in the first 10days of discharge and at a lesser rate when upper endoscopies are performed at the index admission.

Impacted Foreign Bodies in Primary and Permanent Teeth: A Report of Two Cases

Impacted Foreign Bodies in Primary and Permanent Teeth: A Report of Two Cases

Delayed Endoscopic Management of Esophageal Sharp-Pointed Food Impaction: An Analysis of 829 Cases in China.

Esophageal foreign body impaction is the most common cause of endoscopic emergency. However, there are limited available data on delayed endoscopic management of esophageal sharp-pointed food impaction. To investigate cases of esophageal sharp-pointed food impaction with endoscopic removal findings. This single-center retrospective study collected medical records to identify patients with esophageal sharp-pointed food impaction who underwent endoscopic removal between April 2018 and April 2020. The patients were divided into the early (endoscopic removal <12h) and delayed intervention (>12h) cohorts. Overall, 133 and 696 patients received early and delayed intervention, respectively. The success rate of endoscopic foreign body removal was 96.45%. The most common foreign body was fish bone (66.90%), and the most common shape was "I" (56.26%). Patients from the delayed intervention cohort received general anesthesia with a higher risk for perforation, and no foreign body was identified. The duration of endoscopy, distance between the foreign body/wound and the incisor, and longest diameter of the foreign body were not different between the groups. In multivariate analysis, male sex (odds ratio = 1.792 [1.159, 2.771]; P = 0.009), longer duration of impaction (odds ratio = 2.212 [1.121, 4.365]; P = 0.022) and endoscopy (odds ratio = 1.502 [1.253, 1.800]; P < 0.001), and longest diameter of the foreign body (odds ratio = 1.632 [1.329, 2.003]; P < 0.001) were associated with a higher incidence of perforation in patients with foreign body impaction. Endoscopic removal is a safe and effective treatment method for sharp-pointed food impaction. Delayed endoscopic removal can increase the risk of esophageal perforation.

Flexible endoscopy versus direct laryngoscopy for localising impacted pharyngeal foreign bodies in emergency department: A randomised cross-over manikin pilot study

Background: Direct laryngoscopy is often poorly tolerated in patients with foreign body ingestion. The use of flexible endoscopes, which are reported to be better tolerated, was described. However, studies on endoscopy usage by emergency physicians are lacking. Objective: This study evaluates whether using a bronchoscope is as effective as the direct laryngoscopy for localising pharyngeal foreign bodies by emergency physicians. Methods: This was a randomised cross-over manikin study conducted on 32 emergency physicians. Four foreign bodies were placed at the oropharynx, vallecula, arytenoid and post-cricoid area of a manikin. Participants, being randomised into two groups, examined the pharynx with a bronchoscope and a direct laryngoscope in designated orders. The primary outcome was the complete visualisation rate defined as visualising all the four foreign bodies within the time limit. Secondary outcomes included participants-rated difficulty scores, device preferences, the time needed for complete visualisation and cumulative success rates. Results: Complete visualisation rate was significantly higher using the bronchoscope (93.8%) than the direct laryngoscope (62.5%) p = 0.02. The overall difficulty score was lower using the bronchoscope (median 4, interquartile range: 3–5) than the direct laryngoscope (median 6, interquartile range: 5–8), p &lt; 0.001. The bronchoscope was the preferred method for overall examination (71.9%) over the direct laryngoscope (28.1%), p = 0.001. There were no significant differences in times needed for complete examination for the bronchoscope (median 73.6 s, interquartile range: 54.7–97.7 s) and the direct laryngoscope (median 82.2 s, interquartile range: 40.1–120 s), p = 0.9, and cumulative success rates, p = 0.081. Conclusion: The bronchoscope was associated with an increased complete visualisation rate and was the easier and preferred method for pharyngeal examination.

Unusual esophageal foreign body in neonates: A case report

Introduction and importanceEsophageal foreign body mostly occurs in children aged 6 months to 5 years old. In neonates (babies less than 28 days old), such report is extremely rare. In this case, we report the first esophageal foreign body in neonates without any symptoms.Case presentationA 28-day-old baby boy, with normal body weight, from a low socio-economic status family, came to us with a history of ingested foreign body. No sign of unconsciousness, excessive saliva, dysphagia, and respiratory distress. The chest X-ray revealed a radiopaque foreign body in the upper third of the esophagus. The patient underwent extraction of the foreign body using a flexible endoscope under general anesthesia. We found a 1.9 cm in diameter pendant with no sign of bleeding nor inflammation in the esophageal lumen. After the foreign body removal, the patient is in good condition and recovered uneventfully.Clinical discussionForeign body in children under 6 months old is very rare. A high index of suspicion for foreign body ingestion must be considered in unattended children from lower socio-economic status, primarily if witness statements are present and confirmed with radiological examination. Most common impaction site is at the level of the cricopharyngeus muscle. Currently, flexible endoscopy is the standard for foreign body removal in children.ConclusionHigh index suspiciousness, witness statements and radiological examination are the important points in diagnosing ingested foreign body in neonates. Clinicians are required to provide education to parents to supervise their children when playing together.

How we do it: impacted oesophageal foreign body removal using a dilatation balloon.

Ingested foreign bodies are a common presentation to paediatric ENT services. Depending on the site, these are usually managed with flexible or rigid oesophagoscopy and retrieval. This paper presents a novel technique for removing a hollow foreign body that could not be removed using conventional means. After rigid and flexible approaches failed, a guidewire was passed through the foreign body under fluoroscopic guidance and a dilatation balloon passed through the lumen of the object. Inflating the balloon allowed dilatation of the inflamed mucosa above and below the object, facilitating straightforward removal under traction. This is a novel and reproducible technique that uses equipment readily available in tertiary referral centres. Employed in this context, the technique enabled removal of an impacted object surrounded by granulation tissue, and would be appropriate for other objects with a lumen.

Management of impacted corneal foreign bodies: A review

Corneal foreign bodies are commonly seen in an ophthalmology emergency. The most common cause of this condition is a workplace-related injury. In these situations, the management differs from patient to patient and depends on a wide range of variables. In this article, we aim to review the literature on corneal foreign bodies in the past 50 years and classify them based on their level of impaction and elaborately discuss all the management options described for each.

Successful Endoscopic Management of Suspected Foreign Bodies in Upper Gastrointestinal Tract among Patients Undergoing Upper Gastrointestinal Endoscopy in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

Most ingested foreign bodies pass through the gastrointestinal tract spontaneously. However, some foreign bodies may get impacted in the upper gastrointestinal tract. A variety of endoscopic techniques and instruments are indicated for the removal of such impacted foreign bodies. This study was conducted to find out the prevalence of successful endoscopic removal of foreign bodies. This descriptive cross-sectional study was conducted among patients who presented at the Department of Gastroenterology with complaints of upper gastrointestinal foreign body ingestion from 2/11/2008 to 23/07/2020 after taking ethical approval of the research proposal was taken from Institutional Review Board (Reference no 13). Convenient sampling was done. The data were entered into Microsoft Excel and analyzed in Statistical Package of Social Sciences version 22. A total of 119 cases were identified with foreign bodies ingestion. In hundred patients, foreign bodies 100 (84 %) (77.41-90.58 at 95% Confidence Interval) were extracted completely. Complete extraction failed in 19 (16%) patients. Six (5%) patients were treated by push technique and 10 (8.4%) patients with failed retrieval, received surgical intervention for foreign body removal. Endoscopic removal technique of foreign bodies in the upper gastrointestinal tract was successful in most of the cases and is associated with few complications.

Durian seed an uncommon foreign body impaction: a case report

&lt;p class="abstract"&gt;Durian is known as the king of fruits. Its seed is an uncommon foreign body impaction on the larynx. A 23-year-old male alleged that durian seed stuck in the throat while eating. He was having difficulty breathing with bouts of coughing. He had a failed Heimlich manoeuvre and rushed to emergency department and subsequently the seed expelled after bouts of violent coughing. Flexible nasopharyngolaryngoscopy was done and showed the arytenoids was swollen, erythematous laryngeal surface of the epiglottis, inflamed inner surface of right anterior and left true chords, ventricles and the false chords. Close observation with intravenous dexamethasone and intravenous antibiotic is paramount in managing the patient. Durian seed impaction on the larynx is rare. This case report showed the function of the larynx as the protective or the watch dog for any foreign body. The endoscopic findings highly suggestive the lodgement of the foreign body on the laryngeal inlet and the appropriate treatment is important in managing such cases.&lt;/p&gt;

Foreign Body Ingestion

Foreign-body ingestion and food bolus impaction are common causes of esophageal obstruction, with an annual incidence of 13 cases per 100,000, and represent approximately 4% of all emergency endoscopies. Although the majority of foreign bodies that travel to the gastrointestinal (GI) tract will pass spontaneously, 10 to 20% must be removed endoscopically, and 1 to 5% will require surgery. Key diagnostic and therapeutic decisions are based on common factors, including the type of ingested object, number of objects, timing between ingestion and presentation, anatomic location of the object, and presence or absence of symptoms. Complications relating to foreign-body ingestion are typically uncommon; however, the associated morbidity may be severe and occasionally life threatening, and despite the fact that overall mortality has been extremely low, it has been estimated that up to 1,500 deaths occur annually in the United States as a result of foreign-body ingestion. The initial and follow-up management strategies are crucial to preventing morbidity. This review details the epidemiology, etiology and pathophysiology, diagnosis, management, and complications of foreign-body ingestion. Figures show examples of foreign bodies in the esophagus and stomach, three esophageal areas where a foreign body is likely to be impacted, examples of a meat bolus in the esophagus, radiograph of a patient who swallowed one nail and three batteries, and examples of linear erosions of the esophagus and stomach. Tables list the most common GI pathology predisposing individuals to esophageal foreign-body impaction, timing and management of food bolus impaction and foreign-body ingestion, endoscopic management strategies for food bolus impaction and ingested foreign bodies, and radiographic and surgical management strategies for monitoring progress of foreign-body passage through the GI tract. This review contains 5 highly rendered figures, 4 tables, and 78 references.

Colossal Rhinolith

Introduction Rhinolith is a calcic deposition formed by mineralization of salts in an impacted nasal foreign body. It is a benign condition that can be troublesome owing to its size and extent of impact. Case Report A 35-year-old man with a history of right nasal obstruction with occasional foul-smelling discharge and right eye pain since ten years was diagnosed with rhinolith. During its removal, it was three times bigger than what could be visualized in nasal endoscopy. Conclusion Proper history, examination, and a high suspicion can clinch the diagnosis in almost all cases. A rigid diagnostic nasendoscopy is an important tool in the diagnosis. The treatment of choice is endoscopic removal under local or general anaesthesia.