Long-standing Foreign Body Research Articles

Prepubertal vaginal discharge: Vaginoscopy to rule out foreign body.

Medical records of all prepubertal patients who underwent vaginoscopy to rule out vaginal foreign body between 2004 and 2013 were reviewed retrospectively. All patients were evaluated by pediatricians prior to surgical consultation. Vaginoscopy is performed in the operating room under general anesthesia. During the study period, 20 girls with persistent vaginal discharge with a mean age of 6.8 years (1-13 years) underwent vaginoscopy to rule out vaginal foreign body. Six patients had bloody vaginal discharge and 4 had recurrent vaginal bleeding lasting for more than one month. Ten patients had purulent vaginal discharge lasting for 1-7 months. None of vaginal cultures revealed pathological bacteria or candida species. Preoperative imaging techniques revealed vaginal foreign body in one patient only. Vaginoscopy demonstrated vaginal foreign bodies in four patients. Foreign bodies were grass inflorescence, safety pin and undefined brownish particles (n=2), which may be pieces of toilet paper or feces. There was no complication related to vaginoscopy and removal of foreign body. Hymen integrity was preserved in all patients. Persistent or recurrent vaginal discharge in prepubertal girls should raise the suspect of vaginal foreign body. Continuous flow vaginoscopy is mandatory to detect and remove any vaginal foreign body. Early diagnosis would prevent complications secondary to long-standing foreign bodies.

Isolated primary amyloidosis of the epiglottis presenting as a long-standing foreign body sensation in throat: A case report

Abstract Primary amyloidosis of the larynx is a rare benign disease of unknown aetiology. Isolated epiglottic involvement with amyloidosis is an extremely uncommon benign laryngeal pathology and can present with a foreign body sensation in the throat. This lesion should be kept in mind in cases with a long-standing foreign body sensation in the throat. Observation and endoscopic carbon dioxide laser excision are the main methods of treatment. Long-term follow-up is also required because of the slow progressive nature of this disease.

Longstanding Multiple Pellets in Head and Neck Following Blast Injury

All kinds of foreign bodies have been described in most part of the body. Head injury after explosion of bomb can result in devastating functional and neurological consequences for patients. There is no consensus in the terms of removing or retaining longstanding foreign bodies such as pellets. We report a case of 55-year old male who suffered from blast injury 35-year ago. Although most of the pellets in the head and neck were still present after secondary blast injury, but there were no symptoms such as lead poisoning, foreign body reaction, recurrent infections to date except feeling of nasal blockade, cold and headache during the winter season.

Complications of Long-Standing Foreign Body in the Airway and Their Outcomes After Endoscopic Management: An Experience of 20 Cases

To study the outcomes after endoscopic treatment of chronic foreign bodies (FBs) in the airway. A retrospective study (2008-2013) of 20 cases with chronic airway FBs (>2 weeks) was done with emphasis on endoscopic management. All cases were initially evaluated by the pediatric pulmonologist. Flexible and rigid bronchoscopy was done for diagnosis and retrieval, respectively. The techniques of FB retrieval, problems encountered, and their solutions were analyzed. Follow-up flexible bronchoscopy was done in symptomatic cases. Outcomes were assessed in terms of successful removal of the FB, clinical recovery, lung expansion, and need for further procedures. Twenty cases (16 boys, 4 girls) with a mean age of 7 years had a chronic airway FB diagnosed on chest X-ray (n=6) and flexible bronchoscopy (n=14). Six cases had computed tomography evaluation. On rigid bronchoscopy, the FB was successfully retrieved in 16 cases. Two cases required open surgery for FB-induced tracheoesophageal fistula. One case required pneumonectomy because of a battery eroding into the lung parenchyma. One patient died. Of the 16 who had successful retrieval, 11 recovered with full lung expansion. Four recovered after additional bronchoscopic procedures (cauterization of granulation [n=2] and balloon dilatation of bronchial stenoses [n=2]). One case required pneumonectomy for persistent collapse despite multiple dilatations. An airway FB producing chronic respiratory symptoms may be missed because of lack of definite history of an inhaled FB. Clinical suspicion and flexible bronchoscopy are instrumental in diagnosis. Treatment is challenging because of chronicity-related complications and requires innovative ideas to make best use of the available urologic and bronchoscopic equipment. Addition of tracheotomy provides safety in difficult cases. Bronchoscopic removal leads to clinical and radiological recovery in most cases.

Diagnostic difficulties in chronic obstructive pulmonary disease exacerbations: A case report

Exacerbations of COPD (chronic obstructive pulmonary disease) influence, by their frequency and severity, the life prognosis of patients with COPD. Most exacerbations are caused by respiratory infections with negative impact on patient quality of life. The impact of frequent exacerbation in COPD is manifested by the rapid decline of lung function, decreased quality of life increased airway inflamation and high mortality. Bronchial obstruction by foreign bodies meets frequently during childhood but can occur in adults under certain conditions of loss of consciousness (sleep, administration of tranquilizers, after anesthesia, intoxicated). The longstanding intrabronchial foreign body presents problems of diagnosis and treatment which are very different from those associated with the recently inhaled foreign body. We herein report a 77-year-old male, smoker (40 pack-year) presented to the clinic with severe dyspnoea, fever and cough with purulent sputum for about 6 months. Persistent symptoms require repeated hospitalizations for receiving different regimens of antibiotics, but they have not helped. Chest radiography showed extensive consolidation of the right lower lobe, intensity rib, heterogeneous and Chest CT scan showed metallic foreign body in right lower lobar bronchus with secondary pneumonic process in the lower right lobe. Emergency was performed bronchoscopy and extracted dental crown consists of three teeth and then the patient received combined antibiotic therapy for 14 days, in association with anti-inflammatory, mucolytics and bronchodilators. After 2 weeks he was overall in very good condition and all other complaints disappeared and Chest X-ray control showed full resorption of pneumonia opacity, without disabling signs. In this particular case, only minor symptoms are seen at the beginning and the aspirated foreign body was forgotten until later symptoms (inflammation, infection) were developed and developing clinically manifest. The diagnosis was delayed due to lack of radiographic view which may be aspirated foreign body embedded in granulation tissue formed around.

Long‐standing iron‐containing intraocular foreign body without siderosis

Long‐standing iron‐containing intraocular foreign body without siderosis

An unusual cure for a foreign body in the airway: A case report

Foreign body in the tracheobronchial tree represents a true emergency. The condition may be difficult to diagnose in children especially when there is no history to suggest aspiration and when the foreign body is not visualized on x-rays. If diagnosed, however, the definitive management is removal of the foreign body. We report a case of a long-standing foreign body (pencil eraser with a metal rim) in the left main bronchus of a child which had remained undiagnosed until after five weeks but coincidentally expelled following hard coughing triggered by passage of a nasogastric tube meant for investigative purposes. This was followed by dramatic resolution of the respiratory distress and a normalization of radiographic features five days later. Keywords : Foreign body; nasogastric tube passage; hard coughing; outcome

Large foreign body removed from the nasal cavity after 28 years

Foreign bodies of the nasal cavity are relatively frequent in pediatric patients, while in the adults, they are usually seen in disturbed persons or at the emergency room. Here we report a case of an unusual long-standing foreign body that passed misdiagnosed for 28 years in a 47 year-old man. The main complain of the patient were a continuous bad breath and presence of drainage of secretions in the posterior right maxilla. The patient related that he suffered a trauma in the face 28 years ago. Panoramic radiography exam showed a triangular radiopaque mass, superimposed on the right maxillary sinus and presence of the root of tooth 17, with a bucosinusal communication. A piece of glass of large dimensions was removed by the nasal cavity by general anesthesia. The patient developed well without any complaints after the surgery, showing total remission of earlier symptoms. This case shows the significance of medical history and clinical and radiographic detailed assessment of the nasal cavity and maxillary sinus in any adult patient with unilateral nasal symptoms, especially in cases without improvement after drug treatment.

Letters to the Editor

16 November 2008 Dear Editor, AN OESOPHAGEAL FOREIGN BODY An 11-month-old baby presented to the emergency room (ER) at a local hospital with sudden onset of food refusal and irritability. There was no history of fever, vomiting or diarrhoea. On examination, the baby was afebrile, well perfused and looked well with no signs of infection. The baby had some preliminary investigations in the form of complete blood picture, electrolytes and a urine sample, which was sent for microbiology. All investigations came back normal. The baby was discharged home and was thought to have a non-specific viral infection. As the baby continued to refuse solid foods and was not able to finish her bottles, her mother brought her to the ER twice over the next few days. Repeat blood and urine investigations with inflammatory markers remained normal. As a part of partial septic screen a chest X-ray was requested. The chest X-ray showed a radio-opaque foreign body (FB) sitting in the cervical oesophagus. Interestingly, the baby remained generally well with no respiratory symptoms or drooling and was transferred to our Tertiary Hospital to have the FB removed. At endoscopy a coin was found in the cervical oesophagus and extracted using a coin grasper. The baby recovered well and tolerated feeds with no health problems. FB ingestion is relatively a common problem and frequently asymptomatic. About 40% of FB ingestion may not be witnessed.1 A chest X-ray is helpful if the FB is radio-opaque. Nevertheless, with a high index of suspicion and a negative chest X-ray, a radio-lucent FB should be thought of and diagnosis can be made through oesophagogram or endoscopy.2 Oesophageal FBs must be removed without delay even in the absence of acute symptoms. Long-standing FB in the oesophagus may lead to recurrent aspiration pneumonia, failure to thrive and/or oesophageal perforation with serious complications.2

Letters to the Editor

16 November 2008 Dear Editor, AN OESOPHAGEAL FOREIGN BODY An 11-month-old baby presented to the emergency room (ER) at a local hospital with sudden onset of food refusal and irritability. There was no history of fever, vomiting or diarrhoea. On examination, the baby was afebrile, well perfused and looked well with no signs of infection. The baby had some preliminary investigations in the form of complete blood picture, electrolytes and a urine sample, which was sent for microbiology. All investigations came back normal. The baby was discharged home and was thought to have a non-specific viral infection. As the baby continued to refuse solid foods and was not able to finish her bottles, her mother brought her to the ER twice over the next few days. Repeat blood and urine investigations with inflammatory markers remained normal. As a part of partial septic screen a chest X-ray was requested. The chest X-ray showed a radio-opaque foreign body (FB) sitting in the cervical oesophagus. Interestingly, the baby remained generally well with no respiratory symptoms or drooling and was transferred to our Tertiary Hospital to have the FB removed. At endoscopy a coin was found in the cervical oesophagus and extracted using a coin grasper. The baby recovered well and tolerated feeds with no health problems. FB ingestion is relatively a common problem and frequently asymptomatic. About 40% of FB ingestion may not be witnessed.1 A chest X-ray is helpful if the FB is radio-opaque. Nevertheless, with a high index of suspicion and a negative chest X-ray, a radio-lucent FB should be thought of and diagnosis can be made through oesophagogram or endoscopy.2 Oesophageal FBs must be removed without delay even in the absence of acute symptoms. Long-standing FB in the oesophagus may lead to recurrent aspiration pneumonia, failure to thrive and/or oesophageal perforation with serious complications.2

Removal of long-standing laryngopharyngeal foreign bodies from three children

Removal of long-standing laryngopharyngeal foreign bodies from three children

Removal of longstanding laryngopharyngeal foreign bodies from three children

Summary Impaction of a foreign body in the laryngopharynx is a rare but serious event, due to the potential for complete laryngeal obstruction and associated high mortality. Children with positive aspiration histories and typical symptoms are generally admitted to an ear, nose and throat department, where the foreign body can be promptly extracted. However, those children with atypical symptoms and/or with no history of foreign body aspiration noted by their caregivers are often misdiagnosed, and treatment is therefore delayed, leading to the development of complications. The presence of longstanding foreign bodies may cause tissue hypertrophy and the development of granulation tissue, making diagnosis and treatment more difficult. There have been few reports of longstanding laryngopharyngeal foreign bodies in the literature. In this report, we present our experience in dealing with longstanding laryngopharyngeal foreign bodies in three children.

Unusual presentation of foreign body in the hypopharynx

A mentally retarded and deaf-mute boy presented with a discharging sinus on the anterior part of the neck. The patient was diagnosed to have a long-standing hypopharyngeal metallic foreign body which has resulted in unusual presentation of the cutaneous sinus. The sinus healed upon removal of the foreign body.

Overlooked foreign body: 18 years inside the bronchus

A long-standing undiagnosed foreign body in the bronchus of an adult is very rare. We report an extremely rare case of overlooked foreign body in the bronchus. A 38-old man presented with complaints of chronic cough with expectoration and wheezing for the past 18 years. CT of the chest revealed a foreign body in the right lower lobar bronchus. Detailed history revealed that the patient had aspirated a whistle 18 years back, which was overlooked by the treating clinicians. It remained undiagnosed in chest radiographs. It was extracted using a rigid bronchoscope. We emphasize the need to constantly remain alert of such a possibility.

Overlooked Foreign Body

A long-standing undiagnosed foreign body bronchus in an adult is very rare. We report a rare case of an overlooked foreign body in the bronchus. A 38-year-old man presented with the complaints of chronic cough with expectoration and wheezing for the last 18 years. Computed tomography of the chest detected a foreign body in the right lower lobar bronchus. Detailed history revealed that the patient had aspirated a whistle 18 years earlier that was overlooked by the treating clinicians. It remained undiagnosed in chest radiographs. It was extracted using a rigid bronchoscope. We emphasize the need to remain vigilant for endobronchial foreign bodies in patients with persistent cough and wheeze.

A cholesterol-containing foreign body granuloma presenting as an inter-metatarsal bursa

A 68-year-old man presented with progressive forefoot swelling which coincided with the onset of type 2 diabetes mellitus. Imaging revealed a cystic inter-metatarsal mass containing two foreign bodies, which had been present for many years. Following aspiration of the mass, cholesterol crystals were observed on polarised microscopy. It is postulated that the development of diabetes triggered the shedding of cholesterol crystals around a long-standing quiescent foreign body granuloma.

胸腔鏡下肺切除術を施行した長期介在気管支異物の一例

胸腔鏡下手術にて切除し得た長期介在気管支異物の一例を経験した.症例は54歳男性で, 咳嗽を主訴に来院した.胸部X線写真, 胸部CT検査にて, 右B10末梢の金属製と思われる異物影と右下葉の浸潤影を伴う気管支拡張像を認めた.問診により14歳頃, 鉛製の空気銃の弾を誤嚥した既往が判明したため, 右肺野末梢に存在する40年来の長期介在気管支異物と診断した.気管支鏡による異物への到達が困難であること, 周囲に二次性変化を認めることから胸腔鏡下肺部分切除術を施行し, 異物と二次性変化部位を切除した.気管支鏡による到達が困難な気管支異物に対し, 胸腔鏡手術は有用であると考えられた.

長期かん在した咽頭腔外魚骨異物例

A case of a long-standing foreign body in extrapharyngeal space is reported. A 61-year-old male experienced pharyngalgia after eating a sea bream. The pharyngalgia disappeared after 3 days. Six months later, he visited our hospital complaining of hoarseness, pharyngalgia and dyspnea. On laryngeal fiberscopy, we observed paralysis of the left vocal cord and edema of the left arytenoid and the left side of the epiglottis, but we found no foreign body. A cervical soft X-ray film revealed the foreign body in extrapharyngeal space. After we mitigated inflammation by using methylpredonisolone and antibiotics and identified the position of the foreign body by CT scan, we removed it by laryngomicro surgery. It was a fish-bone measuring 20mm in length. Vocal cord paralysis disappeaed several days later.

Foreign body in the tracheobronchial tree.

A 20-year experience with the treatment of 74 patients (83.8% children) for foreign body aspiration is reviewed. The object of this review is to show the clinical manifestations, the radiological findings, the nature and distribution in the bronchial tree, and complications due to longstanding (months or years) foreign bodies in the bronchial tree. The most common foreign bodies found were peanuts (13.5%), corn (13.5%), and beans (13.5%). The most frequent clinical manifestation was choking (67.5%), and the most frequent radiological finding was atelectasis (41.8%). The most serious complication was bronchiectasis needing resection in six patients who had the foreign body retained for years in the bronchial tree. In conclusion, in spite of an obvious foreign body in the tracheobronchial tree many cases are not diagnosed, and a longstanding foreign body in the airway may be responsible for irreversible complications.

Foreign body in the trachea: Fragmentation and migration

For many centuries, foreign bodies in the aerodigestive tract have provoked interesting conversation among otolaryngologists. Foreign bodies in the larynx or respiratory passage are almost always caused by accidental inhalation. Children, especially between 1 to 3 years, appear to be more vulnerab1e.r Children’s natural propensity of gaining knowledge by putting things into the mouth, their inability to masticate well, and their inadequate control of deglutition, beside a habit of crying, shouting, playing, or laughing during meals, constitute some predisposing factors.‘z3 The aim of this article is to report the unusual course of a long-standing foreign body in the trachea.