Foreign Body Research Articles

Laryngotracheal Foreign Body Spontaneously Expelled in Children: An Unusual Observation

Laryngotracheal foreign bodies are a life-threatening emergency. The diagnosis is suspected by the onset of laryngeal dysphonia and confirmed by cervico-thoracic radiography. Suspension laryngoscopy under general anaesthetic enables the foreign body to be located and extracted. However, spontaneous expulsion of a laryngotracheal foreign body, considered an unusual situation, may be observed during coughing fits or vomiting. In this case report, we describe a laryngeal foreign body that was expelled spontaneously on the 11th day of hospitalisation at Brazzaville University Hospital.

Rescuing the knee: arthroscopic extraction of a long-neglected glass fragment: a case report

The knee joint frequently encounters penetrating injuries and has ample space to harbor foreign objects. While foreign bodies in the knee joint are unusual, especially those not originating from surgical procedures, extensive literature exists on the extraction of loose bodies and metallic objects from this articulation. However, documentation on uncommon intruders remains scarce. This case study delves into the experience of a 22-year-old male who suffered persistent pain due to a neglected foreign object in his knee joint. After its removal, a complete resolution of symptoms was achieved. It highlights the importance of prompt arthroscopic intervention for optimal outcomes. Here we present a unique case involving a 22-year-old male who underwent arthroscopic retrieval of a neglected glass fragment from his knee joint. The patient sought medical attention five months after the initial injury due to sudden and severe pain onset. Arthroscopy stands as the favored minimally invasive method for extracting foreign bodies from the knee joint, especially from its deeper and less accessible regions. Utilizing pre-operative radiological imaging enhances understanding of the anatomical placement, facilitates surgical orientation, and reduces operation time. A keen sense of suspicion and thorough history-taking are crucial in achieving an accurate diagnosis.

Flexible bronchoscopy-assisted removal of aspirated scarf pins from the tracheobronchial tree: the experience of 146 subjects.

Aspiration of scarf pins is a common problem in specific geographical locations where the Muslim population is high, especially in countries like Egypt, Bangladesh, Middle Eastern countries, and certain regions in India. This condition is also referred to as hijab-pin syndrome. We discuss the largest experience of flexible bronchoscopic extraction of aspirated scarf pins from the tracheobronchial tree. A multicenter retrospective observational study was conducted on 146 patients from 4 different centers in Egypt, Bangladesh, India, and Germany. Flexible bronchoscopy was successful in the extraction of aspirated scarf pins in all 146/146 patients with a 100% success rate. 136/146 (93.15%) patients were females, with the most common age group between 12 and 18 years (34.24%). 132/146 (90.4%) remembered the aspiration event before coming to the hospital. Cough was the predominant presenting symptom. (71.22%). In all 146 cases, the foreign body was identified on a standard chest X-ray. The left main bronchus was the most common site of aspiration, 67/146 (45.89%), followed by the right main bronchus, 56/146 (38.35%). 14 patients (9.58%) had a history of unsuccessful attempts to remove by rigid bronchoscopy, and flexible bronchoscopy was successful in these 14 (100%) patients who had a prior unsuccessful attempt to remove. The current series is the largest in literature and demonstrated an excellent success rate in the removal of the aspirated scarf pin.

Outcomes of Elongated Styloid Process Syndrome Treated with Minimally Invasive Cervical Styloidectomy (MICS)-A Single-Center Retrospective Study.

Background: Stylohyoid syndrome, also known as classical Eagle syndrome (ES), is a rare condition characterized by elongation of the styloid process (SP) or calcification of the stylohyoid chain, presenting numerous non-specific symptoms. Most papers concerning this rare condition are case reports, case studies, or retrospective studies. This retrospective study delves into the intricacies of Eagle syndrome and evaluates surgical outcomes in patients treated with minimally invasive cervical styloidectomy (MICS). Methods: We conducted a retrospective study of patients treated due to ES between September 2021 and August 2023. Ninety-seven patients were qualified for MICS. Evaluation before and after surgical treatment was conducted during follow-up visits and by a questionnaire that included various data, such as symptoms, pain intensity, evaluation of healing period, and overall patient satisfaction. The minimum follow-up period was six months. Results: After applying inclusion and exclusion criteria, eighty-four patients were qualified for further assessment. The most common symptoms that subsided completely after treatment were pharyngeal foreign body sensation and pain with dysphagia or odynophagia. The MICS procedure proved to be highly effective, with 94.2% of patients experiencing a significant reduction in pain intensity and 97.1% reporting overall success. All patients were satisfied with the aesthetic outcome of the scar. The length of SP and time onset from the first symptoms to treatment positively correlated with the number, intensity, and time required for symptoms to subside. Conclusions: Eagle syndrome should be considered in diagnosing patients with orofacial and cervical pain symptoms, as the time from occurrence of the first symptoms to treatment is crucial. MICS is highly effective and has a low rate of complications in treating ES. Potential scar formation should not be a significant factor when deciding between the intraoral and external approaches.

Longer preoperative fluid resuscitation decreased anesthetic fluid interventions in 297 dogs undergoing surgery for gastrointestinal foreign body obstruction.

The objectives were to (1) compare the impact of preoperative fluid resuscitation on anesthetic parameters and interventions and (2) assess the impact of preoperative resuscitation duration on the integrity of intestinal tissue and postoperative complications in dogs with gastrointestinal foreign body obstruction. Medical records from 1 academic hospital were reviewed for 297 client-owned dogs that underwent gastrointestinal foreign body obstruction surgery between May 2017 and August 2022. Data collected included the following: signalment, preoperative fluid resuscitation, surgical findings, anesthetic parameters and interventions, postoperative complications, and timing of the first meal. Variables for preoperative length of fluid resuscitation (hours), total preoperative fluid bolus (mL/kg), and preoperative fluid rate (mL/kg/d) were changed to categorical variables. Associations between anesthetic interventions, postoperative outcomes, preoperative fluid resuscitation length, and total fluid bolus were assessed with ordered logistic regression. Shorter preoperative fluid resuscitation length was associated with higher anesthetic fluid rates (P = .033) and fluid boluses performed (P = .023). Increased total volume of preoperative fluid boluses was associated with anesthetic synthetic colloid use (P = .028). There was insufficient evidence to claim an association between the impact of preoperative fluid resuscitation length and intestinal wall compromise (perforation, P = .912; enterectomy performed, P = .711). Shorter preoperative fluid resuscitation was associated with increased anesthetic fluid interventions but not the need for more complex surgeries. Longer fluid resuscitation periods are associated with fewer anesthetic interventions in dogs.

Clinical Features and Complications of External Auditory Canal Foreign Bodies in the ENT Emergency Unit.

Objective: To determine the risk factor for developing complications in patients undergoing removal procedures for foreign bodies (FBs) in the external auditory canal (EAC) in the otolaryngology (ENT) emergency unit. Methods: Cases involving patients with EAC FBs treated at the ENT emergency unit of a tertiary medical center were retrospectively recruited. Patients were classified into the age < 10 years and ≥10 years groups. Univariate analyses of the complication rates were performed in all patients and the two age groups. Results: The mean age of the 457 patients was 29.9 ± 19.9 (range, 1.0-89.0) years; 42.7% (n = 195) were under 10 years of age, and 57.1% (n = 261) were male. Complications following FB removal occurred in 40 cases (8.8%), with EAC laceration being the most common (4.4%). Patients under 10 years of age had a higher risk of developing complications than those over 10 years (13.8% vs 5.0%, P = .001), with the younger group also showing an increased risk of EAC laceration (6.7% vs 2.7%, P = .039). Conclusion: Patients under 10 years of age had a significantly-higher rate of complications after EAC FB removal in the ENT emergency unit. Sedation or surgical removal under general anesthesia should be considered to minimize the risk of complications after a failed removal under direct vision in this patient group. Further studies are warranted to verify this implication for clinical practice.

Bone mineral density affects tumor growth by shaping microenvironmental heterogeneity

Breast cancer bone metastasis is a major cause of mortality in patients with advanced breast cancer. Although decreased mineral density is a known risk factor for bone metastasis, the underlying mechanisms remain poorly understood because studying the isolated effect of bone mineral density on tumor heterogeneity is challenging with conventional approaches. Moreover, mineralized biomaterials are commonly utilized for clinical bone defect repair, but how mineralized biomaterials affect the foreign body response and wound healing is unclear. Here, we investigate how bone mineral affects tumor growth and microenvironmental complexity in vivo by combining single-cell RNA-sequencing with mineral-containing or mineral-free decellularized bone matrices. We discover that the absence of bone mineral significantly influences fibroblast and immune cell heterogeneity, promoting phenotypes that increase tumor growth and alter the response to injury or disease. Importantly, we observe that the stromal response to bone mineral content depends on the murine tumor model used. While lack of bone mineral induces tumor-promoting microenvironments in both immunocompromised and immunocompetent animals, these changes are mediated by altered fibroblast phenotype in immunocompromised mice and macrophage polarization in immunocompetent mice. Collectively, our findings suggest that bone mineral density affects tumor growth by impacting microenvironmental complexity in an organism-dependent manner.

Is There a Role for Bronchoscopy in Aspiration Pneumonia?

Aspiration represents the passage of oropharyngeal content to the lower respiratory tract. The interplay between the host and the aspirate proprieties determines the subsequent aspiration syndrome. A low pH, typical of gastric aspirate, favors chemical pneumonitis, whereas an increased bacterial inoculum causes aspiration pneumonia. About a quarter of patients with aspiration pneumonitis will develop a bacterial superinfection during the course of recovery. While antibiotic therapy is indicated for aspiration pneumonia, supportive care remains the cornerstone of treatment in aspiration pneumonitis. However, the overlapping clinical features of these syndromes lead to initiation of antimicrobial therapy in most cases of aspiration. Bronchoscopy can aid in clinical decision-making by direct airway visualization and also by providing access to a series of emerging biomarkers. Invasive microbiological studies increase diagnostic yield and enable a tailored antibiotic treatment. In conjunction with stewardship programs, invasive sampling and novel molecular diagnostics can decrease the amount of inappropriate antibiotic therapy. In the context of foreign body aspiration, bronchoscopy represents both diagnostic and treatment gold standard.

Gossypiboma with enterocutaneous fistula after cesarean section: a case report and review of the literature

IntroductionAlthough precautions taken for surgical procedures are strict and effective in most operative theaters, the incidence of retained foreign bodies following surgery has a reported rate of 0.01–0.001%, of which gossypibomas make up 80% of cases.Case presentationA 42-year-old woman who was Oromo in ethnicity came to the hospital with symptoms of infection, including pus drainage from her lower abdominal incision, fever, chills, and weight loss. Tests indicated an intraabdominal mass consistent with a foreign body from a previous surgery. An exploratory laparotomy revealed a surgical pack causing intestinal perforations. The foreign body was removed, and the patient recovered well postoperatively.ConclusionRetained surgical items are serious problems of surgical operations that can result in morbidity and mortality. Therefore, it should be among the differential diagnoses of any abdominal pain in patients having a history of prior surgery.

Enterotomia para remoção de corpo estranho no jejuno

In the small animal clinic, dogs that ingest non-digestible objects are frequently seen, which end up causing obstruction in the animal's digestive system. Young canines are the most affected, when playing or/and eating indiscriminately with inedible objects. The diagnosis of intestinal obstruction is essential, as it can cause clinical repercussions such as erosions and ulcers. Therefore, it is based on anamnesis and clinical signs such as emesis, anorexia and apathy, in addition, when necessary, the professional may request imaging tests and exploratory laparotomy to confirm the diagnostic hypothesis. From this perspective, a Shih Tzu dog, approximately two years old, weighing 4 kg, was seen at the clinic. In the anamnesis, the guardian reports that the patient was apathetic and had recurrent vomiting. On clinical examination, only moderate dehydration was evident. The treatment was carried out surgically using the laparotomy technique followed by enterotomy, which is the most recommended treatment in cases of intestinal obstruction caused by a foreign body. The animal had a positive prognosis and a good recovery. Therefore, the aim of this work is to report a case of obstruction of the intestinal tract by a foreign body in a dog and the surgical techniques used to treat it.

Utility of Flexible Bronchoscopy as an Interventional Tool in Children: A Single-Center Cross-Sectional Study

AbstractThe aim of this study was to study the utility of pediatric flexible bronchoscopy as an interventional tool. This is a prospective study conducted in a tertiary care hospital. The studied patients underwent flexible bronchoscopy for various diagnostic and therapeutic reasons. The endpoint was to document the type of therapeutic procedure done in a patient, success rate, and any procedural complications encountered. During the 7-year period, a total of 824 different bronchoscopic procedures were conducted. The majority of procedures were for diagnostic reasons. A total of 68 therapeutic procedures were performed successfully, which included foreign body retrieval in 46 patients, bronchoscopic intubation in 5 patients, transbronchial needle aspiration (TBNA) in 4 patients, dilatation of tracheal stenosis in 4 patients, mucus plug removal in 3 patients for lung collapse, postoperative hydatid membrane removal in 3 patients, whole lung lavage in 2 patients, and transbronchial needle biopsy (TBNB) for suspected fibrosing mediastinitis in 1 patient. The 7-year audit of therapeutic role of flexible bronchoscopy (FB) in children revealed that the procedure is safe and can be utilized for many therapeutic procedures in children, including removal of aspirated foreign bodies, bronchoscopic intubation, dilatation of tracheal stenosis, treatment of atelectasis, and collection of biopsy specimens from the mediastinum. The procedure is safe and carried no major complication rate.

Fishbone Foreign Body Ingestion With Gastric Impaction and Intestinal Micro-perforation in an Adult Female: A Case Report

Fishbone Foreign Body Ingestion With Gastric Impaction and Intestinal Micro-perforation in an Adult Female: A Case Report

Mechanical Viability and Functionality Assessment of a New Sutureless Endoluminal Microvascular Device: A Preliminary In Vivo Rabbit Study.

Our group has developed a new nitinol endoluminal self-expandable device for microvascular anastomosis. It attaches to each vessel ending with opposite directed microspikes and reaches complete expansion at body temperature, using the nitinol shape memory capacity. The main purpose of this first in vivo trial is to evaluate the mechanical viability of the device and its immediate and early functionality. A recuperation study with seven New Zealand White rabbits was designed. A 1.96 mm outer diameter prototype of the new device was placed on the right femoral artery of each rabbit. Each anastomosis was reassessed on the seventh postoperative day to reevaluate the device function. The average anastomosis time with the new device was 18 min and 45 seg (±0.3 seg). It could be easily placed in all the cases with an average of 1.14 (1) complementary stitches needed to achieve a sealed anastomosis. Patency test was positive for all the cases on the immediate assessment. On the 1 week revision surgery, patency test was negative for the seven rabbits due to blood clot formation inside the device. The new device that we have developed is simple to use and shows correct immediate functionality. On the early assessment, the presence of a foreign body in the endoluminal space caused blood clot formation. We speculate that a heparin eluting version of the device could avoid thrombosis formation. We consider that the results obtained can be valuable for other endoluminal sutureless devices.

Use of Cohesive Viscoelastic Agents to Facilitate Safe Removal of Posterior Segment Intraocular Foreign Bodies.

Purpose: To assess the ability of viscoelastic agents and perfluoro-N-octane (PFO) to safely remove an intraocular foreign body (IOFB). Methods: A 23-gauge pars plana vitrectomy and lensectomy were performed in a porcine eye. A 5.0 mm metallic IOFB was inserted through a corneal paracentesis and dropped into the vitreous cavity. The posterior segment was filled completely with a balanced salt solution, cohesive viscoelastic, or dispersive viscoelastic or partially filled with PFO under a balanced salt solution. The IOFB was then brought anteriorly and released. Each test was repeated multiple times and videorecorded. Results: The IOFB fell with high velocity through the balanced salt solution-filled vitreous cavity. When the eye was filled with either of the 2 viscoelastic agents, the IOFB did not move or moved posteriorly extremely slowly. A vitreous cavity filled partially with PFO led to deflection of the object's path, with the peripheral retina being struck, or the IOFB dropping straight down and striking the macula. PFO and the cohesive viscoelastic were easily removed from the eye with the vitrectomy instrument. The dispersive viscoelastic could not be completely removed and repeatedly clogged the vitreous cutter. Conclusions: Filling the posterior segment with a cohesive viscoelastic agent may significantly increase the safety and ease of IOFB removal.

Bacterial Cellulose Membrane Experimentally Implanted in the Peritoneum of Wistar Rats—Inflammatory Immunoreactivity and Oxidative Stress

Bacterial cellulose (BC) has been used for various applications; however, studies investigating the immunohistochemical characteristics of the inflammatory and scarring component in BC implanted in the peritoneum in vivo have not yet been fully described. This study aimed to evaluate the systemic and organic safety of BC through oxidative stress, blood, and serum biochemical markers, as well as the late inflammatory response in rats, using histopathology and immunohistochemistry. Forty-three rats (26 males; 17 females) received BC in the peritoneal cavity (implanted group—IG), while twenty-seven rats (12 males; 15 females) served as the control (sham group—SG). Sixty days after surgery, oxidative stress in tissues, blood biochemical markers, and histopathological and immunohistochemical analyses for lymphocytes, macrophages, collagen, and vascular response around the BC were assessed. Only one oxidative stress marker, glutathione peroxidase, was elevated in the liver of IG rats. Creatine kinase MB and lactate dehydrogenase levels were significantly lower in IG animals. Histopathological analysis showed granulomatous inflammation in 93% of IG rats, with 74% of mild intensity. Immunohistochemistry revealed a significant macrophage presence (F4/80), with CD3, CD20, and F4/80 markers indicating differences favoring macrophages. In conclusion, BC implantation in the peritoneum induces a foreign body granulomatous response with prominent macrophage presence (F4/80). Type I and III collagen were observed around the membrane, and vascularization was intense 60 days post-implantation. From a biochemical and oxidative stress perspective, BC seems to be a safe material to be used in the peritoneal cavity.

Viscoelastic Hydrogel Modulates Phenotype of Macrophage-Derived Multinucleated Cells and Macrophage Differentiation in Foreign Body Reactions.

Biomaterial-induced macrophage-derived multinucleated cells (MNCs) are often observed at or near material implantation sites, yet their subtypes and roles in tissue repair and wound healing remain unclear. This study compares material-induced MNCs to cytokine-induced MNCs using both in vitro and in vivo models. 3D-embedded Raw264.7 cells and rat bone marrow-derived monocytes (BMDMs), with or without cytokines such as IL-4 and RANKL, were characterized for their MNC morphologies and subtypes via in situ immunocytochemistry and flow cytometry. Macrophage polarization and osteoclastic differentiation were assessed through NO production, arginase activity, and tartrate-resistant acid phosphatase levels. 3D matrix-induced MNCs expressed the same phenotypic heterogeneity as the IL-4 and RANK-treated ones. 3D matrix-induced MNCs displayed the same phenotypic heterogeneity as those treated with IL-4 and RANKL. A high viscoelastic matrix (1006.48 ± 92.29 Pa) induced larger populations of proinflammatory and osteoclast-like MNCs, whereas a low viscoelastic matrix (38.61 ± 7.56 Pa) supported active differentiation and gene expression across pro-, anti-inflammatory, and osteoclast-like macrophages. Matrix viscoelasticity also influenced the effects of IL-4 and RANKL on macrophage-derived MNC polarization. In an in vivo subcutaneous implantation model, medium to high viscoelastic matrices exhibited higher populations of CD86+ and RANK+ MNCs, while low viscoelastic matrices showed higher populations of CD206+ MNCs. These findings suggest that matrix viscoelasticity modulates macrophage differentiation and MNC phenotype, with low viscoelastic matrices potentially favoring anti-inflammatory MNCs and macrophage differentiation suitable for subcutaneous implantation.

Intraoperative navigation in craniofacial surgery.

Craniofacial surgery requires comprehensive anatomical knowledge of the head and neck to ensure patient safety and surgical precision. Over recent decades, there have been significant advancements in imaging techniques and the development of real-time surgical navigation systems. Intraoperative navigation technology aligns surgical instruments with imaging-derived information on patient anatomy, enabling surgeons to closely follow preoperative plans. This system functions as a radiologic map, improving the accuracy of instrument placement and minimizing surgical complications. The introduction of first-generation navigation systems in the early 1990s revolutionized surgical procedures by enabling real-time tracking of instruments using preoperative imaging. Initially utilized in neurosurgery, intraoperative navigation has since become standard practice in otolaryngology, cranio-maxillofacial surgery, and orthopedics. Since the 2000s, second-generation navigation systems have been developed to meet the growing demand for precision across various surgical specialties. The adoption of these systems in craniofacial surgery has been slower, but their use is increasing, particularly in procedures such as foreign body removal, facial bone fracture reconstruction, tumor resection, and craniofacial reconstruction and implantation. In Korea, insurance coverage for navigation in craniofacial surgery began in 2021, and new medical technologies for orbital wall fracture treatment were approved in August 2022. These technologies have only recently become clinically available, but are expected to play an increasingly important role in craniofacial surgery. Intraoperative navigation enhances operative insight, improves target localization, and increases surgical safety. Although these systems have a steep learning curve and initially prolong surgery, efficiency improves with experience. Calibration issues, registration errors, and soft tissue deformation can introduce inaccuracies. Nonetheless, navigation technology is evolving, and the integration of intraoperative computed tomography data holds promise for further enhancements of surgical accuracy. This paper discusses the various types and applications of navigation employed in craniofacial surgery, highlighting their benefits and limitations.

CONCEPTUAL APPROACHES TO THE DIAGNOSIS AND TREATMENT OF PENETRATING GUNSHOT WOUNDS OF THE ABDOMEN WITH DAMAGE TO THE PANCREAS

Summary. The goal is to determine the main directions of the concept of diagnosis and treatment of penetrating gunshot wounds of the abdomen with damage to the pancreas. Materials and methods. A retrospective analysis of the medical records of inpatient patients treated in the VMC of the Northern region, who received combat trauma of the pancreas during the war in Ukraine, was conducted. All the wounded were examined, complaints, medical history were studied, general clinical blood and urine tests were performed, biochemical analysis of blood and abdominal secretions, ultrasound examination of the abdomen and pleural cavity, radiographic examinations of the chest and abdomen, multispiral computed tomography of the chest and abdomen with contrast and without, video endoscopic methods, X-ray spectral and X-ray structural analysis of secretions from the abdomen and pancreatic tissues, electron microscopy, world microscopy, immunohistochemistry, mathematical and statistical methods. The results. The diagnostic component of the concept is implemented through the study of complaint data, anamnesis, local examination, laboratory, instrumental, hardware, histological and immunohistochemical studies. The therapeutic component, which combines conservative and operative measures depending on the patient’s geodynamic stability, is aimed at correcting hemodynamic disorders and influencing the four directions of the conceptual model of treatment of penetrating gunshot wounds to the abdomen with pancreatic damage. It is mandatory to study the foreign bodies of firearm origin that injured the pancreas and the possibilities of modern magnetic surgical instruments for the removal of ferromagnetic foreign bodies. The examination and control of treatment carried out covers research at the atomic and molecular level, at the subcellular level, at the cellular and tissue level, at the organ and clinical levels. All these studies are implemented within the framework of clinical and experimental research design with data analysis using mathematical and statistical methods. Conclusions. Conceptual approaches to the diagnosis and treatment of penetrating gunshot wounds to the abdomen with damage to the pancreas are based on a systematic analysis. The conceptual model is based on the following areas: localization of pancreatic injury, presence or absence of pancreatic duct injury, severity of pancreatic injury according to AAST, presence of combined injuries to other organs.

Preventing Foreign Body Aspiration and Ingestion with a Damp Gauze in Clinics

Implantable medical devices and prostheses are inherently recognized as foreign bodies by the human body [...]

Has the cat got your tongue, or is something obstructing your throat? A review of imaging of ingested and aspirated foreign bodies in the paediatric population.

Children frequently swallow or inhale foreign objects, a situation that can be life-threatening. Radiographic imaging plays a lead role in the early identification and location of inhaled or swallowed objects is essential. Promptly identifying and locating inhaled or swallowed objects are essential, as some items require immediate removal. For example, button batteries in the throat can cause grave harm; magnets can attract each other through the gut and cause perforations; and other objects can obstruct the airway or intestinal tract. Radiologists must understand how these objects appear in images to assist doctors in treating patients effectively. Recognising signs of inhaled objects on radiographs is also crucial, as symptoms may not always be clear, and many inhaled objects are not visible on radiographs. Radiographs are the primary means of checking for swallowed or inhaled objects, although other tests like fluoroscopy and computed tomography may be used in complex cases. Doctors working with children should be acquainted with the appearance of these common objects on images and their clinical importance.