Large Foreign Body Research Articles

S2805 Light at the End of the Tunnel: Successful Retrieval of a Large Rectal Foreign Body

S2805 Light at the End of the Tunnel: Successful Retrieval of a Large Rectal Foreign Body

Wrong site but intact sight

Orbital foreign bodies are common. A large metallic foreign body involving ipsilateral orbit into the maxillary sinus is potentially vision-threatening. This case report describes a potentially serious incident involving a 49-year-old man who presented with an injury to his right eye with an iron nail while working in a factory. An iron nail penetrating the infraorbital margin of the right eye extended into the maxillary sinus associated with periorbital edema. X-ray showed a metallic foreign body extending from the right eye infraorbital margin into the maxillary sinus. Under local anesthesia, under all aseptic precautions, a linear iron nail measuring 4.5 cm in length was removed from the right orbit without any evidence of damage to vital structures. This case represents one of the largest reported infraorbital metallic (iron nail) foreign bodies, highlighting its rarity and potential danger to vision and overall health.

Exotic Keratin Pearl Degradation Mechanism by Giant Cells in Oral Squamous Cell Carcinoma and its Plausible Hypothesis.

Oral squamous cell carcinoma (OSCC) is a formidable malignancy in the Indian subcontinent, characterized by high morbidity and mortality, with a dismal 5-year survival rate of 40-50%. The tumor's histopathological heterogeneity is well documented, particularly in its differentiation status, which ranges from well-differentiated lesions with prominent keratin pearls to poorly differentiated forms lacking such structures. Existing literature has elucidated the role of neutrophils and macrophages in the degradation of keratin pearls, the involvement of multinucleated giant cells (MNGCs) in this process remains cryptic. This study reports a novel case of a 49-year-old male with moderately differentiated OSCC, characterized by ulcerative growth in the left buccal mucosa. Histopathological analysis revealed neoplastic cell infiltration, keratinization, and abnormal mitoses, alongside the degradation of keratin pearls by large foreign body and Langhans MNGCs. This intricate keratin pearl degradation by MNGCs in OSCC highlights tumor heterogeneity and aggressiveness, offering profound insights into surgical, radiotherapy, and chemotherapy strategies. Surgeons must meticulously consider this process as a marker of aggressive behavior, warranting precise surgical planning and a multidisciplinary approach for optimal outcomes. This case emphasizes the critical role of foreign body and Langhans MNGCs in the degradation of keratin pearls within OSCC, revealing a hitherto unrecognized facet of tumor biology. This discovery holds profound implications for understanding OSCC progression, prognosis, and therapeutic responsiveness, warranting further investigation into the molecular mechanisms underpinning this process.

RETRACTABLE UROLOGY THREE-PRONGED GRASPING FORCEPS FOR REMOVAL OF LARGE, NONMAGNETIC INTRAOCULAR FOREIGN BODIES.

To demonstrate the use of urology retractable three-pronged grasping forceps in the removal of a large, round, and nonmagnetic intraocular foreign body (IOFB) that was difficult to remove with other surgical instruments. Extraction of a 3.0 mm lead shot pellet embedded in vitreous hemorrhage was attempted with multiple surgical instruments including an intraocular magnet, IOFB forceps, and two tools designed for urology stone removal: a three-pronged grasping forceps and a nitinol basket extractor. Owing to the round and smooth surface, large size, and nonmagnetic nature of the IOFB, extraction was challenging and failed with multiple other surgical instruments. The wide and secure grasp of the grasping forceps allowed for swift IOFB extraction without iatrogenic injury to the retina. The grasping forceps offer an effective and safe method for removal of large, round, and nonmagnetic IOFBs.

Colorectal and Anorectal Foreign Bodies

Foreign bodies (FBs) in the colon, rectum and anal canal are not unusual. Colorectal Foreign Bodies (CRFBs), whether administered per-anally or swallowed orally, intentionally or unintentionally, bring management challenges to the attending physicians and surgeons. CRFBs are usually seen in the adult patients with perverted sexual or erotic or psychosis, or mental retardation, or in drug smugglers or prisoners, and anorectal FBs (ARFBs) are sometimes seen on accidental or careless swallowing with or without food, or per-anal administration in all age groups. Careless elderly patients with or without visual problems, with or without using artificial dentures are also not unusual victims. Self-administration per-anally to attempt relief from constipation has also been described, especially in adults and elderly people. Many of these FBs can pass with intestinal contents and may be thus removed with stool without complications. The sharp FBs can penetrate the bowel wall leading to serious consequences, and a relatively large FB can get impacted causing bowel obstruction. The presentation may be straightforward and sometimes may be exquisitely concealing. The objective of this review article is to understand and share the management strategies which would be very much helpful to all concerned. KYAMC Journal Volume: 14, No: 04, January 2024: 240-245.

T-shaped pars plana scleral incision to remove large intraocular foreign body.

To investigate the efficacy and safety profile of T-shaped pars plana scleral incision technique in removing large intraocular foreign bodies, during 23-gauge pars plana vitrectomy. Retrospective interventional case series that included patients diagnosed with a large intraocular foreign body (IOFB). Possible postoperative complications were recorded 24 h, 1 month, 3 and 6 months postoperatively. Thirty eyes of 30 patients (48 ± 5 years old) were enrolled. All IOFBs were successfully removed: mean diameters of 7.8 ± 2.0 mm and 2.6 ± 0.3 mm. Silicone oil and sulfur hexafluoride were used in 27 and 3 eyes, respectively. Lensectomy was performed in 27 eyes. Intraocular lens was implanted at first attempt in 12 eyes; during a second operation in 12 eyes and 6 eyes remained aphakic. At any follow-up, no signs of postoperative complications were observed. Secondary retinal detachment occurred in 12 eyes. Mean preoperative corrected distance visual acuity was 0.04, on the Snellen scale; it increased to 0.07, at last follow-up. Mean intraocular pressure was 17.97 mmHg. All eyes were preserved. T-shaped scleral incision could be an effective, safe and easy-to-perform standard procedure to remove large IOFBs during pars plana vitrectomy, without increasing the risk of surgical complications and additional damage to the ocular tissues.

Management of a Large and Strange Intraocular Foreign Body: Case Report

Introduction: Intraocular foreign bodies (IOFBs) are unusual and can cause serious eye damage. Case Presentation: We present a case report of a 62-year-old male patient who presented to our ophthalmic emergency department with an intraocular foreign body following a domestic accident.Imaging evaluation with facial CT scan confirmed the presence of a foreign body, made of glass, without any associated bone fractures. Conclusion: Previous studies have emphasized the potential complications and visual consequences associated with these injuries.This case report contributes to the existing literature on intraocular foreign bodies and reinforces the importance of prompt diagnosis and appropriate management.

Orbitocranial penetrating injury with a lawnmower blade: case report

The aim of this study is to present the management of a patient with orbitocranial penetrating injury by a large foreign body. The case described in the article was taken from the work of the Regional Specialist Hospital No. 5 in Sosnowiec. The patient was hit by a fragment broken off a lawnmower blade. The patient was transported to a district Hospital in Raciborz by the emergency medical team . After performing basic imaging diagnostics and temporary surgical management at another unit, the patient was transported to a multispecialty center for further treatment, where the surgical treatment was applied. A foreign body embedded in the craniofacial region penetrating the orbit and bordering the anterior cranial fossa constitutes a challenging case requiring the cooperation of a team composed of neurosurgeons, otolaryngologists, ophthalmologists, maxillofacial surgeons. The treatment of the patient should be preceded by a thorough analysis of imaging studies.

Three different surgical methods of the special tracheobronchial foreign body (pen cap) in children: Case series

We present three novel cases of tracheobronchial foreign bodies (TFBs) in children caused by pen caps. One was removed by the rigid bronchoscopy successfully, the second was removed by rigid bronchoscopy combined with tracheotomy, and the last one was treated by bronchotomy from an external thoracic approach. Rigid bronchoscopy is the most widely used for treating TFBs in clinics, especially treating large and special foreign bodies, because rigid bronchoscopy can provide a good view for observation and operation. Successful removal of a foreign body under rigid bronchoscopy (an experienced doctor, suitable instruments, etc.) can obviate tracheotomy/tracheostomy or thoracotomy/bronchotomy.

A homemade snare device for removing large foreign bodies.

A homemade snare device for removing large foreign bodies.

Unusual presentation and management of a penetrating foreign body in the pyriform fossa: a case report

Foreign body impaction in the upper aerodigestive tract is considered an emergency that necessitates extraction within 24 hours to prevent adverse events. Rigid oesophagoscopy is crucial in managing sharp, penetrating, and large foreign bodies lodged in the pharynx or at the cricopharyngeus muscle level. In this case report, a 15-year-old male patient presented with throat pain after consuming a chicken meal. He experienced dysphagia and odynophagia but no vomiting, drooling, or hematemesis. Initial video direct laryngoscopy did not reveal any foreign body, and subsequent rigid oesophagoscopy under general anaesthesia was inconclusive. However, a post-operative X-ray of the neck confirmed the presence of a foreign body. A contrast-enhanced computed tomography scan showed the foreign body penetrating the right pyriform fossa. With the assistance of a medical gastroenterologist, a flexible upper gastrointestinal endoscopy was performed, and the foreign body was successfully removed from the right pyriform fossa. Prompt endoscopic removal under conditions of minimal trauma and maximum safety is the preferred treatment approach for foreign bodies in the upper aerodigestive tract, necessitating a multidisciplinary team involving radiologists, otorhinolaryngologists, medical gastroenterologists, and anesthesiologists to develop tailored treatment plans for each patient.

Bullet in the orbital apex: Explosive situation!

A healthy thirty-seven-year-old male presented with a gunshot injury to the eye. The bullet was lodged in the orbital apex and had caused rupture of the left globe and extensive damage to the orbital soft tissues including the optic nerve, as well as the bones at the apex. This large metallic foreign body needed to be removed as it was causing continuous bleeding and cellulitis; also, its location was precarious. The surgery for tracking and removal of the bullet presented several interesting pointers which are described in this case report.

Difficulties of diagnosis and the need for a comprehensive approach to treatment of patients with X-ray non-contrast orbital foreign bodies

Introduction. An orbital foreign body, especially of an organic nature, is often difficult to diagnose during the initial examination. A thorough history taking, clinical examination, and the use of additional imaging techniques are of great importance. Due to the risk of purulent-inflammatory complications, foreign bodies must be surgically removed.The aim of the work was to demonstrate the importance of timely diagnosis and complex approach to treatment of patients with X-ray non-contrast foreign bodies of the orbit using the example of clinical observation.Materials and methods. Patient R. came in with complaints of redness, pain, lacrimation and lack of vision in the left eye after falling and hitting the left side of his face on a metal corner. Left eye visual acuity = 1/∞PrLinc, IOP = T−3 (palpatory).Results. Control X-ray computed tomography (CT) of the orbits and paranasal sinuses (PNS) suspected the presence of a radiopaque foreign body. A rhinoendoscopic examination was performed by an otorhinolaryngologist and a fragment of a large wooden foreign body was found in the nasopharyngeal arch. Surgeons of the ophthalmologic and otorhinolaryngologic departments performed surgery: removal of the foreign body, endonasal endoscopic opening of the labyrinth on the left, endoscopic endonasal maxillary sinus maxillary sinus maxillotomy on the left, left microcoidectomy, resection of trauma-exposed tissue. During his stay in the 2nd Ophthalmologic Department of the Regional Clinical Hospital named after N.A. Semashko. N.A. Semashko Regional Clinical Hospital, the patient’s condition improved, infection was eliminated, prevention of possible complications was carried out. The patient was referred to the Pirogov National Medical-Surgical Center, where the following surgery was performed: microinvasive vitrectomy + FEC + PFOS + retinotomy + endotamponade with silicone oil 1300 of the left eye, and a consultation with a laser surgeon was recommended for laser iridectomy.Discussion The clinical case considers a comprehensive approach to the treatment of intraorbital foreign bodies, the participation of a multidisciplinary team of specialists, while the patient still has a long road to rehabilitation.Conclusion In orbital trauma with penetration of a foreign body, an accurate history, timely diagnosis, and rational surgical and conservative treatment are important. This will help to avoid serious complications and prevent visual and oculomotor disorders of the visual organ.

Rectal Foreign Body Causing Perforation: A Case Report

The rectal foreign body is a rare presentation with rising incidence. We present a case of a 26-year-old heterosexual male with an alleged history of sexual assault with insertion of a large foreign body through the anus two days prior with peritonitis. After investigations, the patient underwent an exploratory laparotomy, foreign body removal, primary repair of perforation with a diverting colostomy. Diversion must be considered in cases where the extent of anal sphincter mechanism injury is in question. The patient had a good outcome. Assessment of the shape, size, nature, and location of the object through appropriate imaging is necessary. Exploratory laparotomy is inevitable in cases of perforation.

Balloon-assisted technique for endoscopic en bloc retrieval of a large gastric gastrointestinal stromal tumor specimen.

A 64-year-old woman underwent gastroscopy and abdominal computed tomography, which revealed a 4.0 × 3.5 cm gastric gastrointestinal stromal tumor (GIST) in the anterior wall of the stomach ([Fig. 1 a]). After full evaluation, an endoscopic full-thickness resection technique was used to achieve complete resection ([Fig. 1 b]). It is very important to retrieve the complete specimen to allow for subsequent pathological evaluation; however, retrieval is difficult for specimen larger than 3.5 cm. Wu et al. successfully applied a balloon-assisted technique for removal of large esophageal foreign bodies [1]. Therefore, we applied this technique for endoscopic en bloc retrieval of a large gastric GIST specimen ([Video 1]).

Commentary on the article by A. A. Gumerov et al. «Large foreign bodies of the esophagus and stomach in children»

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Foreign Body Ingestion in an Adult not Associated with Mental Disorder: An Unusual Clinical Case Report

Introduction and objective: Esophagus is a muscular and mucosal tubular organ with 4 physiological narrowing’s that are preferred sites for the retention of foreign bodies accidentally or deliberately ingested. The latter form is frequent in people with mental disorders and prisoners. The aim of this study is to describe a rare clinical case of foreign body ingestion.Case Report: This case describes an incident in which a young man deliberately swallowed a key to hide evidence of theft. This is a unique case in the literature of deliberate ingestion in mentally healthy people and not part of the prison population. Discussion: Foreign bodies are a public health problem, related with huge ENT doctor's activities. It represents the first cause of ENT emergency services care. Although large foreign body ingestion is rare. The worldwide literature is full of articles related with little accidental foreign bodies ingestion, especially in children, such as coins, toys, fish bones and bones Conclusions: In the presence of intentionally and/or accidental foreign bodies ingested in adults, it is necessary to discard mental disorders or social factors.

A Rare Case of a Lisfranc Ligament Transection.

Ligamentous Lisfranc injuries, which mimic a surgical transection are rare. Left untreated or missed, these injuries may result in severe complications including long-term disability. The present case describes a unique mechanism of injury via a sharp object puncture through the plantar surface of the midfoot. It highlights the utility of planning staged procedures to remove a large foreign body object, reports notable intraoperative techniques, and provides a decision management guide for treating this type of injury. Extensive surgical planning may be required when encountering similar cases and knowledge of this may be useful to providers.

Retained large intraorbital metallic foreign body with delayed presentation: An unusual case report

Penetrating orbital trauma necessitates a multidisciplinary approach because complex orbital injuries often encompass damage to the brain, the eyes, and the disfigurement of the face.

Large intraorbital transnasal wooden foreign body sparing vital structures

Large intraorbital transnasal wooden foreign body sparing vital structures