Foreign Body Insertion Research Articles

312 Foreign Bodies in the Urinary Tract - Can We Learn Something from the Pandemic?

Abstract Aim We aim to quantify the morbidity and resource utilisation from patients presenting with foreign bodies in the urinary tract and analyse the effect of the coronavirus pandemic on the numbers. Often these patients have co-existing mental health issues, which necessitates coordinated multi-disciplinary care. It is important that patient care is assessed holistically, with assessment of whether changes in mental health care impact urological morbidity. Method We performed a 2-year, retrospective, single-institution study of patients requiring removal of foreign bodies from their urinary tract. Results There were 49 episodes of patients needing removal of foreign body; all were inpatients at the regional mental health hospital.8% of patient episodes presented with urinary sepsis. All patients had successful general anaesthetic, endoscopic removal of the foreign body from their urinary tract. There was significantly more episode’s pre-pandemic (38 episodes, mean 2.7 per month) than during the pandemic (11 episodes, mean 1.1 per month). During the pandemic, staffing levels within the mental health hospital have been increased to enable isolation procedures to be conducted when necessary. It was felt that the reduction in foreign body insertion episodes was a consequence of this. The resultant reduction in acute hospital admissions and procedures is estimated to have saved £400,256 per annum. Conclusions Patients presenting with a foreign body in the urinary tract utilize a considerable number of resources and are a source of morbidity. Urosepsis and retention are common sequelae. Reduced episodes during the pandemic have shown that increased staffing levels have a positive effect and could be cost-effective. It is imperative that this data is used to appropriately allocate resources to reduce patient morbidity.

Polyembolokoilamania in Child Sexual Abuse: Physical Examination Findings After Abusive Foreign Body Insertion and Literature Summary.

To characterize the physical examination findings in children and adolescents who disclosed insertion of an object into their bodies as part of their sexual abuse history and to identify how this population compares to similar cases described in the published literature. This is a 15-year retrospective review of children younger than 18 years seen at a large urban children's assessment center. In addition, we reviewed and summarized the last two decades of literature characterizing pediatric anogenital foreign bodies to better understand previously described findings in similar populations. Sixty-eight children whose abuse histories included anal or genital insertion of a foreign body still presented with normal examination findings in the vast majority (89.7%) of cases, despite the diversity of items described. The literature on anogenital foreign bodies was sparse, offered a variety of approaches to the overall evaluation of such cases, and demonstrated inconsistent consideration of child sexual abuse in response to the diagnosis. This article further supports the literature reflecting the overall rarity of abnormal anogenital findings in the clinical assessment for sexual abuse.

Dual-Energy Computed Tomography for the Diagnosis of Urethral Foreign Body: A Case Study

Foreign body insertion in the urethra and bladder is not uncommon and has been reported in many studies to date. However, since foreign bodies are often accidentally introduced into the urethra and bladder during masturbation, they take a variety of shapes and sizes. Furthermore, patient self-reports are typically unreliable as many patients feel ashamed; thus, appropriate preoperative diagnosis is critical. Diagnosis of foreign body insertion in the urethra and bladder is performed using imaging modalities such as abdominal X-ray and computed tomography (CT). However, single-energy CT (SECT) is not sufficient in detecting foreign bodies in some cases. In the present study, we report a successful preoperative identification of urethral foreign body in a patient using dual-energy CT (DECT).

Neglected Nasal Foreign body discovered by Nasal Deformity: A Case Report and Review of the Literature

Foreign bodies of the nose are mostly common in paediatric population. In teenagers and adults, they are predominately seen in patients with mental disturbances. Usually with acute presentation, they also can remain in place for a long time. The main clinical presentation is unilateral purulent rhinorrhea possibly associated, in chronic cases, to nasal deformities, nasomaxillary abnormalities or rhinolithes. The removal can require a surgical procedure under general anaesthesia specifically in front of neglected foreign bodies covered by mucosa or previous multiple failed attempts. We report the case of a 14-years-old girl, with mental retardation, who consulted in our structure for a swelling in the left nasal alar base evolving progressively since 4 months, with intermittent purulent rhinorrhea not improved after medical treatment. No incident of nasal foreign body insertion was reported or witnessed by the patient and its family. The facial CT scan confirmed the diagnosis and the removal required surgical procedure. The diagnosis of neglected nasal foreign body should always be considered in front of unilateral nasal obstruction and discharge specifically in children and mentally disabled patients. Its removal should be rapid in order to avoid the constitution of rhinolithes and nasal deformities.

Sewing Needle as Foreign Body in Urethra of an Adolescent Boy

Self-insertion of a foreign body in the urethra is an uncommon presentation clinically. The cases usually arise due to fulfillment of sexual desire, for recreation, play, or exploration, or the foreign body insertion may take place accidentally. We present a case of an adolescent boy with a foreign body urethra presenting to the emergency room with urinary retention, pain, and dysuria. Attending urologist suspected urethral stricture and ordered ultrasonography to investigate which turned out to be a sewing needle in his urethra. The patient was then enquired about the foreign body. He tried to self-dilate his urethra as he was experiencing lower urinary tract symptoms. The sewing needle was removed by endoscopy and he was administered with antibiotics and painkillers. The urethral foreign bodies may present with pain, dysuria, or urinary incontinence and these foreign bodies are mostly seen in the male population in the adolescent age group.

Epistaxis Secondary to Rhinolith: A Forgotten and Scarce Entity

Rhinolith is a calcareous concretion resulting from mineralization and encrustation of an endogenous or exogenous nidus in the nose. This rare clinical entity could be the result of a previous introduction of a foreign body into the nasal cavity. Rhinolith is rarely seen by the clinical practitioner. We report a case of rhinolith in a young healthy lady who presented with epistaxis and highlight the clinical presentation and management of this case. The history of foreign body insertion may be overlooked in such cases. Presence of grittiness on endoscopic probing aid in establishing the diagnosis. Early referral from primary care centre to ENT can avoid misdiagnosis and further complications as removal of the rhinolith is the ultimate treatment.

To X-Ray or Not to X-Ray? Discussing Unknown Nasal Foreign Bodies and Button Batteries.

The emergency of esophageal button batteries is recognized. Foreign bodies in the ear or nose are treated as comparatively nonemergent. We present the case of a child who presented with suspected pen-nib in the nostril to highlight the importance of investigation and intervention in unwitnessed nasal foreign body and review the literature regarding X-rays in these cases. Fifteen papers were identified as per search parameters; 3 papers recommend the use of plain radiographs for nasal foreign bodies. We propose that in unwitnessed pediatric nasal foreign body insertion, a facial X-ray should be considered, especially if suspecting a metallic foreign body.

76 What got where? a population-based analysis of pelvic foreign bodies in women

Pelvic foreign body insertion can present in female patients across multiple age groups and in a variety of healthcare settings. Complaints may be vague and non-specific, such as pain, bleeding, or discharge, which lead to a broad differential diagnosis. If undiagnosed, retained foreign bodies pose major risks to a woman’s health. The purpose of this retrospective review is to describe the nationwide incidence of emergency department (ED) visits for females with pelvic foreign body occurring in the bladder, vagina, or rectum.

Unusual self-inflicted foreign bodies in the urethra

Self-inflicted urethral foreign body insertion in men is very rare and an important condition which urologists encounter in their clinical practice. Urologists should be familiar with the different techniques for the removal of these foreign bodies. Most cases are associated with psychiatric disorders. Hence, they should be referred for complete psychiatric evaluation. The emotional condition of the patient and the circumstances under which this act was committed should be investigated at the same time. Many cases of self-inflicted foreign body in the urethra have been reported in the literature such as fishhooks and bullets. However, metallic tongue cleaner in urethra has not yet been reported. Here, we are reporting the case of a 28-year-old male who presented with dysuria for 1 day following insertion of metallic tongue cleaner in the penile urethra, for sexual gratification which, he was unable to remove. The foreign bodies were found in the anterior urethra on X-ray and were successfully removed endoscopically without any complication. The patient was advised to take psychiatric consultation and counseling to prevent future episodes.

Presentation and management of nasal foreign bodies in a Chinese metro area.

Nasal foreign bodies in children are common complaints encountered by pediatric otolaryngologists. We investigated clinical features, diagnosis, and treatment of nasal foreign bodies in children in a Chinese metro area.Six hundred sixty eight children with nasal foreign bodies presented to Shenzhen Children's Hospital, diagnosed and treated by the authors were enrolled from January 2016 to October 2019, causes for medical consultation, age, sex, duration, types, locations, removal, and complications were recorded and analyzed.Nasal foreign bodies were common in children between 1 and 5 years of ages (96.8%). The right nasal cavity (61.4%) was the most common site for foreign body insertion (61.4%). Most of the children (89.4%) presented for a complaint of nasal discomfort or foreign body insertion themselves, or for foreign body impaction discovered by the caregivers. Most of the foreign bodies (85.0%) were discovered within 1 day. The most nasal foreign bodies were the whole toys and toy parts (34.1%). The majority of nasal foreign bodies (99.1%) located in the antero-inferior portion of the nasal cavities and could be removed with simple instruments. The occurrence of complications in nasal foreign bodies (10.2%) was not common.The present study objectively exhibited clinical features, diagnosis, and treatment of nasal foreign bodies in a Chinese metro area.

Evaluation and management of urethral foreign bodies and description of a novel ultrasound-guided catheter-based extraction technique.

There are numerous reports in the medical literature documenting urethral foreign bodies with nearly all cases found in men and often associated with underlying psychiatric disorders, autoerotic stimulation, and/or intoxication. Patients most commonly presented with localized penile pain, hematuria, dysuria, and occasionally obstruction. Although endoscopic removal by a urologist is often the first‐line treatment, this report describes evaluation and management considerations and presents a novel extraction technique that may allow emergency physicians in consultation with urology to perform removal of some unusual urethral foreign bodies in the emergency department.We report a novel extraction technique using a pediatric foley catheter under ultrasound guidance that has been applied during multiple encounters with 2 individuals who have each presented multiple times at a single emergency department (ED) for evaluation because of urethral foreign body insertion. The foreign body materials have ranged from small pieces of rubber to cellophane to styrofoam and most commonly plastic utensils. Urologic extraction may be required in some cases, but ED removal can be considered. A final discussion of the creation of a multidisciplinary care plan to address resource use concerns also is described.

Management of severe iatrogenic perineal injury

Perineal injuries are uncommon. More uncommon are severe perineal injuries. This is attributed to the relative protection of the perineum by the bony pelvis. Common causes of perineal injury include injuries from motor vehicular accidents, fall from height, foreign body insertion into the perineum, injuries from rape, and penetrating external trauma. The management of severe perineal injury entails addressing any life-threatening condition in the patient first and, subsequently, the perineal injury. The perineal injury can be repaired primarily with or without colostomy or colostomy carried out alone without primary repair. We present four cases of severe perineal injury managed by colostomy alone without primary repair of perineal soft tissue or anal sphincters. The anal sphincters and perineal soft tissues healed secondarily and sealed without any need for repair with good outcome.

Unexpected nasal foreign body

Foreign body in the nose is a common complaint in the paediatric age group and the most prevalent site of foreign body insertion compared to the ear and throat. Typical presentation involves foul-smelling unilateral nasal discharge. However, some cases are asymptomatic with no witnesses, and only discovered by medical practitioners during routine examinations. The diagnosis in this scenario becomes more challenging when another nasal pathology is present. We describe the case of a 6-year-old girl with underlying extensive infantile haemangioma of the face, tongue, neck and chest, who came for a routine follow-up, without any nasal complaints. However, the examination revealed right nasal crusting with bluish discoloration and hypertrophy of the right inferior turbinate, which was initially thought of as extension of the patient’s haemangioma. A foreign body in the right nasal cavity was noted by the girl’s parent on the next day after nasal douching, and was successfully removed in the clinical setting.

Amulet in penile tract- A case study

We do get strange cases of self insertion of foreign bodies in the penile urethra. It is very difficult to know the reason for inserting variety of objects. Here this case needs discussion due to extreme rarity and strangeness of getting a metal amulet with the attached hanging thread inserted inside the penile urethra. Keywords: Amulet, Foreign body self inserted in penile urethra, Psychiatric selferotism

Chronic Infectious Complications of Recreational Urethral Sounding With Retained Foreign Body

The practice of recreational urethral sounding involves insertion of foreign body in the urethra usually for sexual gratification. We present a case of a 62-year-old male with longstanding recurrent urinary tract infections complicated with Staphylococcus epidermidis bacteremia, discitis, and osteomyelitis at T12-L1 vertebral level associated with left psoas abscess secondary to a retained foreign body inserted into his urethra and urinary bladder. He had extraction of foreign body, cystoscopy, and open cystolithotripsy. He received long-term antibiotics and back surgery resulting in residual chronic back pain. This case illustrates important chronic infectious complications associated with the high-risk sexual practice of urethral sounding.

Unusual case of vaginal stenosis in an adolescent girl

Foreign body insertion into the vagina has been described across all ages. The presenting symptoms may be persistent vaginal discharge, chronic pelvic pain, post menopausal bleeding. Foreign body as a differential diagnosis is rarely thought of with the above presentations and remains a diagnostic challenge.An unusual case of a foreign body causing vagina l stenosis, haematocolpos and inflammatory adnexal masses leading to diagnostic confusion and difficult surgery is presented.An eighteen year old unmarried woman with chronic pelvic pain of 3 years duration was diagnosed to have bilateral adnexal masses on pelvic USG. On suspicion of genital tuberculosis she received a course of anti tuberculosis treatment with no symptomatic relief or decrease in size of the adnexal mass. A second sonogram four months later suggested presence of vaginal /cervical foreign body surrounded by fluid (haematocolpos?) and she was referred to a gynaecologist. An MRI confirmed the findings. As examination showed what was presumed to be a transverse vaginal septum the patient was posted for examination under anaesthesia. There were dense vaginal adhesions and as the haematocolpos could not be accessed from below a laparotomy was performed, the vagina opened from above and after draining 300ml of chocolate colored fluid a bottle cap was retrieved. The stenosed vagina was successfully opened by vaginal dissection by abdomino-vaginal approach. This case is an unusual presentation of a foreign body causing vaginal stenosis and causing much diagnostic dilemma and difficult surgery.

Foreign Bodies in the Urinary Bladder and its Management: a Single Centre Experience from North India

This study was done to assess the nature, clinical presentation, mode of insertion and management of intravesical foreign bodies treated at our hospital. Between January 2008 and December 2014, 49 patients had been treated for intravesical foreign bodies at King George Medical University, Lucknow. All records of these patients were retrospectively analysed for the nature of foreign body, clinical presentation, mode of insertion and its management. A total of 49 foreign bodies were retrieved from the urinary bladders during study period. The age of patients ranged from 11 to 68 years. Thirty-three presented with complaints of haematuria (67.3%), 29 complained of frequency of urination and dysuria (59.1%) and 5 patients had pelvic pain (10.2%) The circumstances of insertion were as follows: iatrogenic in 20 (40.8%) cases, self-insertion in 17 (34.6%), sexual abuse in 4 (8.1%), migration form other organ in 4 (8.1%) and assault in four (8.1%). Thirty-three (67.3%) foreign bodies were retrieved by cystoscopy, and transurethral cystolitholapaxy was required in 10 (20.4%) patients, percutaneous suprapubic cystolitholapaxy in 4 (8.1%) and holmium laser lithotripsy in 2 patients (4.08%). Foreign bodies should always be kept in the differential when accessing a patient presenting with chronic lower urinary tract symptoms. A large percentage of foreign bodies can be retrieved using endoscopic techniques. Open surgical removal is done in cases where endoscopic techniques are unsuitable or have failed.

Management of Foreign Bodies in the Ear: A Retrospective Review of 123 Cases in Nigeria.

Foreign bodies in the ear are relatively common in emergency medicine. However, attempts at removal made outside the healthcare setting by untrained persons can result in complications of varying degrees. We conducted a 3-year retrospective review of 123 cases of aural foreign bodies at our hospital in Nigeria. Our patient population was made up of 80 males and 43 females, aged 2 to 67 years (mean: 13.2); almost three-fourths of these patients were aged 15 years or younger. Only 40 of them (32.5%) presented to an otolaryngologist within 12 hours of foreign-body insertion. A total of 30 patients (24.4%) had initially undergone removal attempts by a non-otolaryngologist prior to receiving trained ENT care, and 23 of them experienced a total of 41 complications: 17 cases of canal abrasion, laceration, and/or bleeding, 8 cases of otitis externa, 6 cases of tympanic membrane perforation, 5 cases of impaired hearing, 3 cases of chronic suppurative otitis media, and 2 cases of middle ear involvement. Of the 93 patients who were seen by an otolaryngologist initially, only 6 (6.5%) developed a complication: 4 cases of canal abrasion, laceration, and/or bleeding and 2 cases of otitis externa. The difference in overall complication rates between patients treated by otolaryngologists and non-otolaryngologists was statistically significant (p < 0.001). We conclude that attempts at removal by non-otolaryngologists can result in a high incidence of preventable complications.

Partners in crime: two prisoners with foreign body insertion.

Two prisoners, a 35-year-old and a 42-year-old man, were admitted to the Emergency Department (ED), following court order. Upon clinical evaluation, their vital signs were normal, while digital rectal examination was suspicious for foreign bodies. Abdominal radiographs were performed and revealed that the first beared rectally two smartphone chargers with their cables (A) and the second a smartphone (B) for communication purposes. Penis pearling is also incidentaly noted (B) not unusual among prisoners to increase intercourse stimulation. Following mild sedation, all rectal foreign bodies were manually extracted and both were discharged in good health after 2-hour monitoring. It is common for prisoners to present with foreign body ingestion or insertion which may be associated with escape or self-destruction attempts, drug-dealing, acts of physical stimulation/assault. Admission may be involuntary and essential history information may be concealed. The emergency physician needs to be vigilant and familiar with the radiographic appearances of commonly encountered foreign bodies.

Superglue self-insertion into the male urethra - A rare case report.

Background:Foreign body insertion in the urethra and bladder are relatively rare. These patients usually insert foreign body in urethra for eroticism, inquisitiveness, or as a consequence of disinhibited or disturbed behavior.Case presentation:Herein, we report a case of 41-year-old man presented with weak stream and suprapubic pain. Due to incontinence, he instilled superglue into his urethra. On perineal examination, a foreign body was palpable in the penile urethra. A 10 cm dried superglue block got out with incision at glance.Conclusion:Urethral foreign bodies are mostly found on physical examination and clinical history. Although imaging modalities are commonly used for FBs detection, the necessity of imaging modalities are still a controversy.