Metallic Foreign Body Research Articles

Penetrating neck trauma” - Enigma to surgeons: A case report with review of literature

: We report for the first time a case of penetrating injury to carotid artery by a stone piece during welding using hammer.: A 26, year old male labourer presented with a penetrating neck injury by a stone piece. As the patient was stable, NCCT neck was done which revealed a metallic foreign body obliterating the right carotid space. CT Angiography was also done to rule out any vascular injury. The patient underwent neck exploration during which foreign body was removed and right carotid artery repair was done with 4-0 prolene. : The patient had no complications and showed no sequalae from this injury during follow up.: CT angiography should be done in all patients who are stable to rule out injury to great vessels before neck exploration .

Performing magnetic resonance imaging in patients with gunshot wounds: a guide for radiologists

INTRODUCTION: The safety of magnetic resonance imaging (MRI) in patients with metallic foreign bodies is an important aspect that has been the subject of many scientific papers and guidelines. The issue of MRI in patients with implanted medical devices is well researched. However, for gunshot wounds, there are no clear guidelines for practitioners, and most recommendations are to refuse to perform the study if there is the slightest doubt about its safety.OBJECTIVE: To systematize information on the safety and quality of MRI in patients with gunshot wounds and to develop practical guidelines for radiologists.MATERIALS AND METHODS: We have analyzed and summarized the main domestic and foreign recommendations for ensuring safety during MRI, generally accepted classifications and mechanisms of gunshot wounds.RESULTS: A review of physical risk factors in MRI, their causes, and recommendations for their minimization is presented. The influence of metallic objects on the appearance of artefacts on MRI images is considered. The algorithm of decision making on the safety of MRI in a patient with a bullet or shotgun wound is given. Two clinical observations are presented to illustrate the application of this algorithm.CONCLUSION: Performing MRI in gunshot wounds is feasible but requires careful analysis of the risks and the importance of diagnostic information. Interviewing the patient in these situations is often uninformative, so radiography or CT are the methods of choice for detection of metallic foreign bodies. To minimize the risks of MRI, a scan protocol should be prepared in advance and the patient should be monitored after each pulse sequence.

Foreign Body Trapped in the Oropharynx Requiring Emergency Tonsillectomy in a Case at Nianankoro Fomba Hospital in Ségou

Introduction: Pharyngeal foreign bodies, particularly in oropharyngeal locations, should raise concerns about the presence of an associated wound. They constitute a common pathology. Their diagnosis is most often easy, but difficult in the case of an unknown foreign body. We report a foreign body embedded in the lateral wall of the oropharynx which required emergency tonsillectomy. Observation: This is a 6-year-old child received urgently at the Nianankoro Fomba Hospital in Ségou 6 hours after the introduction of the foreign body (wheel spoke) into the tonsillar compartment. On admission to the ENT and head and neck surgery department, the child's general condition was poor, consciousness remained and the conjunctivas were normal-colored. On oropharyngeal examination, we note a sharp metallic foreign body measuring 30 cm and 2 mm in diameter located at the level of the posterior fold of the right amygdala. Furthermore, there is hypersialorrhea with blood streaking. Faced with the failure of an extraction attempt; we decided to take him to the operating room after a minimum assessment. The immediate postoperative course was unremarkable. The evolution was very favorable on the 10th day of the intervention. Conclusion: Pharyngeal foreign bodies constitute a vital emergency due to their appearance or location. Their management requires rapid intervention with suitable equipment. Prevention remains the best solution.

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.

Fragmented acupuncture needle as a linear metallic foreign body near the proximal interphalangeal joint of a horse.

To describe the clinical presentation, diagnosis, and treatment of a fragmented, migrating acupuncture needle near the palmar proximal interphalangeal joint (PIPJ) of a horse. A 9-year-old Warmblood cross mare. The mare presented for evaluation of a linear metallic foreign body on the palmar lateral aspect of the PIPJ following acupuncture treatment. The mare had a pinpoint puncture wound and sensitivity to palpation over the lateral aspect of the PIPJ region. The referring veterinarian performed radiographs and found a linear metallic foreign body near the lateral palmar PIPJ. Ultrasonographic examination demonstrated a hyperechoic lesion consistent with a metallic object in the soft tissues of the palmar lateral aspect of the PIPJ. The horse was anesthetized, and the linear metallic foreign body was removed. The use of intraoperative ultrasound and digital radiographs assisted in determining the location of and surgical approach to remove the foreign body. The linear metallic foreign body was the fragmented segment (body) of an acupuncture needle. The mare recovered from surgery uneventfully and returned to the previous level of activity. This report demonstrates the potential risks of prolonged retention and or delayed removal of acupuncture needles in the form of needle fragmentation and migration. It also demonstrates the use of imaging in determining the location and position of small, thin metallic foreign bodies to aid in surgical approach and removal.

Surgical techniques for optimal lens management of posterior segment metallic intraocular foreign body removal: a case series.

We describe three different approaches for lens management in cases of metallic IOFBs involving the posterior segment. All consecutive posterior segment metallic IOFB cases from 2012 to 2023 at a single institution were included in this retrospective case series. Surgical outcomes and surgical videos are presented. A total of 25 metallic IOFB cases were included. In 9 cases, there was no significant lens involvement, therefore not requiring lens extraction at the time of IOFB removal. In 8 cases with traumatic cataract, lens extraction sparing the anterior lens capsule was performed with IOFB removal. In 8 cases, both lens extraction and lens capsule removal were required at the time of IOFB removal. We demonstrate our algorithm to capsular management in patients who present with IOFB with good visual outcomes in follow-up.

A case of prolonged corneal sulfur foreign bodies and review of literature

BackgroundThis case mainly describes a relatively rare case of an old mineral-like corneal foreign body that existed for up to 20 years, and did not significantly affect the visual quality of the patient.Case presentationA 56-year-old male miner complained of right eye vision loss for 3 years, swollen and painful for 4 months. Admission examination: Best corrected visual acuity was no light perception in the right eye and 20/20 in the left eye. Anterior segment examination: A large number of spot-like grayish-brown mineral foreign bodies in the conjunctiva of the nasal conjunctiva, emulsified silicone oil floating in the anterior chamber, Corneal foreign bodies in the right eye were widely distributed in the upper cortex and the proelastic layer. There were fewer foreign bodies in the left cornea. Previous medical history, 20 years ago due to forging and burning sulphur mine explosion, resulting in a large number of ore foreign bodies in the conjunctiva of both eyes. As these corneal foreign bodies did not affect the visual quality of the patient, we adopted a conservative treatment plan, did not remove these foreign bodies, and only carried out symptomatic treatment for the patient’s secondary ocular hypertension. The patient was followed up normally in the outpatient department, and no cornea-related complications occurred up to now.ConclusionsFirst of all, it is necessary to understand the source and nature of the foreign body in patients with corneal and conjunctival foreign body injuries. In the second, for the old corneal metal foreign body, when the patient’s visual acuity is stable and there are no symptoms of corneal irritation and inflammatory reaction, it can be Conservative treatment or outpatient follow-up observation. In the end, corneal Optical coherence tomography imaging should not be ignored, which is very important for determining the depth of embedding and the location of the corneal foreign body.

A STUDY TO EVALUATE THE DEMOGRAPHIC PATTERN OF THE INJURY CAUSED BY METALLIC CORNEAL FOREIGN BODY AND ITS OUTCOME AFTER TREATMENT

Objective: This study aims to investigate the demographic characteristics, occupational background, and injury management of patients presenting with ocular trauma involving metallic corneal foreign bodies (FBs). Methods: A cross-sectional study was conducted at the outpatient clinic of Ophthalmology at Pt JLNGMC, Chamba. Data were collected from consecutive patients over three months. Demographic data, including age, gender, and education level, were analyzed alongside occupational background, injury context, and protective measures. Statistical analysis was performed using SPSS version 17.0, with descriptive statistics utilized to present the results. Results: The study revealed a predominance of young males (66%) in the 14-29 age group, with the metalwork industry (47%) being the primary sector where injuries occurred, mainly during metal grinding activities (53%). Lack of protective measures, such as temporary removal of eyewear (39%), contributed to the injuries. Notably, 54% of patients did not attempt self-removal of FBs. Superficial corneal FBs accounted for 45% of cases, indicating significant potential for severe injury. Conclusion: The findings underscore the urgent need for enhanced safety education, rigorous enforcement of protective eyewear usage, and targeted interventions in high-risk occupational sectors to mitigate the prevalence and severity of corneal FB injuries. Addressing these challenges is crucial for preserving vision, reducing healthcare costs, and improving occupational health and safety standards.

Stab wounds of the neck in children

BACKGROUND: Stab wounds in children are very rare and are described as isolated cases. Sharp metal foreign bodies in the neck pose a real threat to trachea, esophagus, large vessels and nerves. The risk of damage is still present when specialists try to remove foreign bodies, especially if they are fixed. CLINICAL CASES DESCRIPTION: The aim of the study is to demonstrate outcomes after treating patients with neck injuries. We have two observations of stab wounds in the neck (with a knitting needle and a sewing needle) in children. To put diagnosis, we used clinical, laboratory, radiation and endoscopic methods. Surgery was done under general anesthesia, and the knitting needle and the sewing needle were removed from deep structures of the neck. Patients were discharged from the hospital in satisfactory state. CONCLUSION: The described observations may be of interest to specialists because we could remove foreign bodies penetrated into the neck without damage to internal organs, vessels and nerves. To prevent complications, foreign bodies in the neck have to be removed by experienced specialists in an operating room under general anesthesia with artificial ventilation. In case of complications, radical surgery is indicated.

Oesophageal squamous cell carcinoma in a blue‐fronted Amazon parrot (Amazona aestiva)

AbstractA 14‐year‐old, female, blue‐fronted Amazon parrot was referred for episodes of regurgitation. The differential diagnosis mainly included bornavirus infection, infectious or traumatic ingluvitis, gastro‐oesophageal reflux, gastritis/enteritis, heavy metal poisoning, metabolic disease (severe hepatic or renal disease), coelomitis, digestive neoplasia, extra‐digestive masses, organomegaly or foreign body. No improvement was noted with symptomatic treatment. Radiographs, avian bornavirus polymerase chain reaction and serology, biochemistry, haematology, crop cytology and ultrasonography failed to provide a definitive diagnosis. Lethargy, weight loss and crop stasis after 1 month motivated computed tomography, which revealed focal thickening of the oesophageal wall. Fine‐needle aspiration under computed tomography guidance of the mass was non‐diagnostic, and the bird died during recovery from anaesthesia. Oesophageal squamous cell carcinoma was confirmed by histopathology. This case illustrates the benefit of advanced diagnostic imaging to investigate chronic refractory regurgitations and describes the use of computed tomography‐guided fine‐needle aspiration in an avian patient.

Investigation of metal non-opaque foreign bodies of firearm origin by radiation methods

Background. The purpose is to investigate metal non-opaque foreign bodies of firearm origin. Materials and methods. Five cases of removing soft tissue foreign bodies of gunshot origin were investigated, when radiography of the limb soft tissues didn’t detect foreign bodies, but they were removed during the primary surgical wound debridement. X-ray of soft tissue gunshot wounds found no foreign bodies. To study radiographic density, foreign bodies were placed in a foam model with subsequent multislice computed tomography. For spectral analysis of metal foreign bodies, we used wavelengths unconventional for X-ray, which allowed to conduct X-ray fluorescence and X-ray structural studies. Results. Radiographic density of metal foreign bodies ranged from 989 to 2123 HU. Given the different thickness of foreign bodies, from 0.4 to 3.2 mm, the average was 1700 ± 189 HU. The foam had radiographic density of –969 HU with model dimensions of 200 × 100 × 50 mm. When examining samples of foreign bodies, it was found that they are deformed, have different thicknesses. One of the samples is light and smooth on one side, and dark and rough on the other. X-ray fluorescence results: composition on the light side (% by mass): Al — base, Mn — 0.8, Fe — 0.3, Zn — 0.1, Cr — 0.05, Ti — 0.2, corresponding to Al-Mn alloy. The dark side is an oxidized Al-Mn alloy. In the spectrum of the dark side of the sample, the Br-Kα line was detected, which indicates the participation of bromine compounds in the oxidation process. From the smooth side of the sample, the spectrum of this line is not determined. Conclusions. Non-opaque metal foreign bodies of gunshot origin are a rare phenomenon. Metal foreign bodies with low radiographic density are non-ferromagnetic, the use of modern magnetic surgical instruments will not be effective. Visualization of metal foreign bodies, which are not determined by radiography, is possible with the help of multislice computed tomography. The use of the wavelength of primary radiation, which is unconventional for X-ray spectral analysis, and original X-ray optical schemes allows for quantitative determination of the composition and structure of any metal foreign bodies.

Longstanding iris foreign body to treat or not to treat!

A 61 year female presented with whitish discolouration of left eye noticed few days ago with a forgotten history of trauma 28 years ago for which a consultation was made and was asked for review with orbital x-ray, which was not done as she was asymptomatic. On examination, her best corrected visual acuity was 6/6 both eyes. Examination of right eye was unremarkable except for early lens changes, while left eye showed a nebular corneal opacity, suggesting entry wound. A brown coloured foreign body was seen stuck to iris surface temporally, measuring 4*3mm with degenerative changes over it and exposing underlying pigment epithelium with focal cataract. Rest of anterior segment, gonioscopy and fundus examination were normal. A thorough search for other intraocular foreign bodies (IOFBs) was made, revealing no other IOFBs. Anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM) demonstrated foreign body limited to iris surface, while orbital x-ray showed no evidence of metallic foreign body and electroretinogram (ERG) showed mildly decreased amplitude of b-wave. Plan for foreign body removal with cataract surgery was made as per patient’s request for cosmesis, and was retrieved through viscoexpression after a failed attempt to remove it through magnetic forceps thereby confirming its non-metallic nature. Special care was taken during capsulorhexis to not damage the intact capsule. Rest of cataract surgery was performed as usual and anterior chamber wash was done to flush all the debris. Post operative picture shows an area of partial and full thickness iris defect while maintaining a good visual acuity. The debate for removal of longstanding, well encapsulated, inert foreign body over iris without functional impairment depends on multiple factors.[1,2] Which in our case was due to the patient’s demand for cosmesis. Video link: https://youtu.be/pC3ZRoqxB8o

Letter to the editor on 'Combined Phacovitrectomy with Metallic Intraocular Foreign Body Removal through Corneal Incision Using A Novel "Magnetic Conduction" Technique'.

Letter to the editor on 'Combined Phacovitrectomy with Metallic Intraocular Foreign Body Removal through Corneal Incision Using A Novel "Magnetic Conduction" Technique'.

Management of thoracoabdominal gunshot injuries by using minimally invasive surgery at role 2 deployed field hospitals in Ukraine

The Russia-Ukraine war is associated with critical and severe thoracoabdominal injuries. A more specific approach to treating patients with thoracoabdominal injury should also include minimally invasive technologies. It remains unclear about the utility of using video-assisted thoracoscopic surgery (VATS) and laparoscopy in patients with thoracoabdominal injury. The aim of this study was to investigate and evaluate the utility of video-assisted thoracoscopic surgery, laparoscopy as well as magnetic tool applications for the management of severe thoracoabdominal injury in combat patients injured in the ongoing war in Ukraine and treated in the Role 2 deployed hospital. Patients and methods 36 male combat patients thoracoabdominal injury were identified for the study during the first 100 days from February, 24 2022. These individuals were diagnosed with thoracoabdominal GSW in the Role 2 hospital (i.e. deployed military hospital) of the Armed Forces of Ukraine. Video-assisted thoracoscopy surgery (VATS) and laparoscopy with application of surgical magnetic tools were applied with regards to the damage control resuscitation and damage control surgery. Results In 10 (28%) patients, VATS was applied to remove the metal foreign body fragments. Both thoracotomy and laparotomy were performed in 20 (56%) hemodynamically unstable patients. Of these 20 patients, the suturing of the liver was performed in 8 (22%) patients, whereas peri-hepatic gauze packing in 12 (33%) patients. Massive injury to the liver and PI 2.0–3.0 were diagnosed in 2 (6%) patients. Lethal outcome was in 1 (2.8%) patient. Conclusions Thoracoabdominal gunshot injuries might be managed at Role 2 hospitals by using video-assisted thoracoscopy (VATS) and laparoscopy accompanied by surgical magnetic tools. Damage control surgery and damage control resuscitation must be applied for patients in critical and severe conditions.

Migrated tubal sterilisation clip presenting as a subcutaneous gluteal foreign body 24 years later: a case report and literature review

BackgroundThe incidence of sterilisation clip migration is reportedly 25%. However, less than 1% of those who experience clip migration will present with pain, an abscess, or spontaneous extrusion. Here we present a rare case of sterilisation clip migration through the entire pelvic floor.Case presentationA 66-year-old female was referred from community to the Surgical Emergency Unit with a possible metallic foreign body under the skin following an attempted routine gluteal cyst excision. The patient first noticed a lump under the skin 2 years ago which gradually became more apparent and tender over the previous 2 months. The patient denied recent trauma, had no co-morbidities and had a sterilisation procedure 24 years prior. Examination revealed a non-mobile solid structure just beneath the skin 5 cm laterally from the anal verge. Inflammatory markers were normal and an ultrasound confirmed a 15 × 7 mm foreign body in the subcutaneous tissues. The foreign body was excised easily under local anaesthesia, revealing a closed Filshie sterilisation clip. The wound was closed primarily, and recovery was uncomplicated.ConclusionsThis was a case of sterilisation clip migration to the subcutaneous gluteal region. A literature review revealed 34 case reports of sterilisation clip migration, mostly to the bladder. Patients with a previous sterilisation procedure and suspected subcutaneous foreign body without trauma should elicit a high index of suspicion for migrated sterilisation clips. These clips can migrate through multiple layers of muscle and fascia, including the pelvic floor.

Right Middle Lobectomy on Metallic Foreign Body Using the Uniportal Video Assisted Thoracoscopic Surgery: A First Experience in the Democratic Republic of Congo

The removal of metallic foreign bodies in the lower airways, a source of recurrent pneumonia, is not currently performed in the Congolese population using video-assisted thoracoscopy surgery (VATS) under unipulmonary ventilation. Multiple failures of rigid and/or flexible bronchoscopy are likely to be a cause of morbidity and mortality. To the best of our knowledge, we report a first experience in DRC, of right middle lobectomy on metallic foreign body by VATS in a 14-year-old girl after two years of accidental inhalation of a metallic key, in the face of two bronchoscopy failures. A partial transverse bronchotomy successfully performed under VATS allowed extraction of the foreign body followed by bronchial reconstruction with resection of the right middle lung lobe. The aim of the multidisciplinary team was to determine whether lobectomy by VATS would result in shorter hospital stays, fewer complications and faster recovery than lobectomy by thoracotomy, to review the key stages of case management using an unusual approach in the region, and to draw a conclusion based on this first experience.

Design of a system for detection of non-ferromagnetic metallic foreign bodies based in eddy currents and GMI magnetometer

A portable magnetic mapping system was designed to determine the three-dimensional location of non-ferromagnetic metallic foreign bodies to ensure fast and successful surgical procedures for their removal. The system is based on the induction of eddy currents in the foreign body by an excitation stage and the measurement of the magnetic field generated by these currents employing a commercially available high-resolution magnetometer based on the Giant Magneto-Impedance effect. The instrument topology is based on decoupling the excitation and measurement stages with a configuration that produces a high primary magnetic field in the foreign body region and a weak one in the GMI sensor region. This feature allows increasing the primary excitation magnetic field without saturating the GMI magnetometer, making it feasible to overcome relevant limitations evidenced in a previously developed instrument proposal. Computational simulations were built considering four possible configurations, with two models of excitation and two options for the magnetometer GMI sensitivity axis orientations. International guidelines for exposure limits to non-ionizing radiation and the principles of biometrology, besides constructive and electrical aspects, were also considered in the system design. The performance analysis of the most promising settings confirmed the viability of the proposed measuring instrument, optimizing the linear operation of the magnetometer during the measurement procedure and contributing to the construction of a complete measurement system prototype, with performance and safety characteristics ensured for the intended biomedical application.

Incidental Quiescent Metallic Foreign Body in a Case of Penetrating Neck Injury

Incidental Quiescent Metallic Foreign Body in a Case of Penetrating Neck Injury

Occupational Nerve Injuries due to Metallic Foreign Bodies: A Case Series of Eighteen Patients.

Peripheral nerve injuries (PNIs) remain an important health problem. PNIs mostly affect young men as this age group is mostly involved in road traffic accidents and other injuries at workplace. PNI can occur from foreign bodies like metal chips while working in industries using lathe machines. Among PNI's, injuries to the ulnar nerve, the brachial plexus and the median nerve are the most frequent lesions encountered. This presentation is on a series of 18 cases of nerve injuries among industrial workers located from finger level up to the arm excluding the brachial plexus due to metallic foreign bodies entering while operating lathe machines over a period of two years with patients being followed-up over a one year period. Mean age in this series was 31.3 years with age range 16-40 years and all were males. Two patients had more than one nerve involvement and one patient had associated vascular injury. All the patients showed functional improvement. Most common nerve injured was median nerve. Most common site for nerve injury was forearm. Combined lesions most commonly involved the ulnar and median nerves. Social cost of traumatic peripheral nerve injuries is significant since it has a higher incidence in young, previously healthy, and economically active people.

Comparing forceps and self-assembled intraocular rare earth magnet in removing metallic intraocular foreign bodies in 25-guage vitrectomy

PurposeTo compare the efficacy and efficiency of self-assembled intraocular rare earth magnet and forceps in removing intraocular foreign bodies(IOFBs) undergoing 25-gauge(G) pars plana vitrectomy.MethodsA total of 30 patients with metallic IOFB underwent 25-G PPV were enrolled into this study. Self-assembled intraocular rare earth magnet were used in 15 patients(bar group), and forceps were used in 15 patients(forceps group). Success rate of removing IOFB, time taken to remove IOFB, incidence of IOFB slippage and fall, iatrogenic retinal damages were compared between the two groups.ResultsThere was no significant difference in success rate of removing IOFBs between the groups(93.3% and 100%, P > 0.99). The median time taken of removing FB was significantly shorter in bar group than in forceps group(112 and 295 s, P = 0.001). None of the patients in bar group had IOFB slippage and fall, or related iatrogenic retinal damage in the process of removal. In forceps group, IOFB slippage and fall during removal were observed in 7 of 15(47.6%) patients, related iatrogenic retinal injuries were recorded in 6 of 15(40.0%) patients, both were significantly higher than bar group(P = 0.003 and P = 0.017, respectively).ConclusionsCompared with forceps, the assembled intraocular magnet can greatly reduce the possibility of IOFB slippage and fall, prevent related iatrogenic retinal damage, and shorten the time taken to remove IOFB. The assembled intraocular magnet can be an useful tool in removing metallic IOFBs in PPV.