Removal Of Sharp Foreign Bodies Research Articles

EP.TH.691Necrotic Liver Abscess secondary to Duodenal Perforation caused by ingestion of a Fish Bone – A Case Report

IntroductionIngestion of foreign bodies are not uncommon, however enterohepatic migration of fish bones causing liver abscesses remains a rare phenomenon.Case ReportWe present the case of a 58-year-old female admitted with 11 days history of fever, rigors, shortness of breath and malaise associated with vomiting and diarrhoea. Her COVID-19 rapid antigen test was negative. She was tender in the left lower quadrant of her abdomen and inflammatory markers were markedly high so initial differential diagnosis included colitis and diverticulitis.Contrast Computed Tomography of the abdomen and pelvis showed an 8.1cm irregular hepatic lesion initially thought to be a multi-loculated abscess, malignancy or complex cyst. She was started on broad-spectrum antibiotics, escalated to Intensive Care Unit (ICU) and discussed at the hepato-biliary multi-disciplinary team (MDT) where magnetic resonance images demonstrated a perforated duodenum from a 2.5cm fish bone penetrating from the duodenal wall into the liver parenchyma causing a necrotic abscess.She underwent percutaneous drainage of the hepatic abscess. Endoscopic retrieval was then attempted; however, the fish bone was not visualised. Definitive management followed with laparoscopic removal of the fish bone and primary duodenal repair.DiscussionIdentification of the cause of the abscess during MDT discussion enabled prompt source control which was key in managing intra-abdominal sepsis – radiological drainage in the first instance prevented secondary peritonitis from a potentially ruptured abscess and enabled the patient to be de-escalated from ICU. Previous literature suggests endoscopic retrieval however, laparoscopic surgery remains safer for managing complications following removal of sharp foreign bodies.

Improvising in Endoscopy: Endoscopic Removal of Sharp Foreign Bodies in the Upper GI Tract, Using a Handmade Protective Device

Introduction. Foreign body ingestion is a common problem in large-volume endoscopic departments. Several techniques and devices have been described for the safe endoscopic removal of these objects. However, these devices may not be suitable in every clinical setting or—as in our case—they may not even be available. Case Presentation. We report the case of a 34-year-old patient, presenting with sharp foreign body ingestion. The foreign bodies were safely removed using a handmade protective hood due to lack of a commercial device. In our case, improvisation proved to be of great benefit for the patient as well as for the endoscopist. Discussion. Improvised interventions can be of special interest in the setting of insufficiently funded or equipped endoscopic departments.

1900 Crushing the Star: Esophageal Foreign Body Extraction Using Dormia Basket

INTRODUCTION: Sharp objects impacted in the esophagus require prompt endoscopic removal. Removal of sharp foreign bodies can be technically challenging and care should be taken to avoid inducing esophageal trauma during retrieval. CASE DESCRIPTION/METHODS: A 69-year-old female presented with sudden onset dysphagia and sharp chest pain for 1 day. While eating cake one day prior to arrival, she reported sudden, sharp, central chest pain followed by a sensation of food being stuck in her esophagus. Her physical examination was unremarkable with no abdominal tenderness. Her laboratory tests revealed normal complete blood count and chemistry. Chest x-ray revealed no acute abnormality. Upper endoscopy showed a sharp star-shaped foreign body (FB) approximately 2 cm in diameter (Figure 1). The FB was lodged in the distal esophagus, causing mucosal trauma. Due to the large size of the FB, insertion of an overtube was not considered to facilitate removal. An attempt was first made to extract the FB with rat-tooth forceps, but it could not be retrieved through the upper esophageal sphincter. Mucosal trauma was seen in the mid and proximal esophagus following this attempt. The FB was then advanced to the gastric antrum using a Roth net. Attempts to break the FB using argon plasma coagulation (APC) and a snare were unsuccessful due to the rigid nature of the FB. Subsequently, a 2T dual channel therapeutic gastroscope was inserted, and a Dormia stone retrieval basket was used to grasp the foreign body. Using the crushing power of the basket, the FB was successfully crushed and pulled inside the large therapeutic channel of the scope. The scope was withdrawn without additional mucosal trauma. The FB consisted of a star-shaped cake decoration with sharp edges (Figure 2). Following the procedure, the patient reported immediate improvement in her chest pain. DISCUSSION: This is a unique case wherein after the failure of conventional foreign body extraction devices, a Dormia stone retrieval basket was used to crush the object within the stomach allowing for safe retrieval. Gastroenterologists should consider this approach when retrieving irregularly-shaped, sharp, but pliable FBs. For the general public, care should be taken when eating food with non-edible decorations and toppers to avoid inadvertently swallowing or aspirating these objects.

Delayed endoscopic removal of sharp foreign body in the esophagus increased clinical complications: An experience from multiple centers in China.

Foreign bodies impaction in the esophagus is a common clinical emergency. The aim of this study was to investigate the clinical features of foreign body ingestion, and to analyze the risk factors of complications during the endoscopic procedure.From 18 general hospitals in Zhejiang Province in China, 595 patients who underwent gastroscopic removal of ingested foreign bodies were prospectively recruited. Patient characteristics, clinical features, foreign body features, clinical outcomes, and complications were documented.The most common types of foreign body in the esophagus were sharp objects (75.9%), including fish bones (34.0%), chicken bones (22.1%), and fruit nuclei (17.1%). The remaining types were non-sharp objects (24.1%), including food bolus (14.6%). Most objects were lodged in the proximal esophagus (75.9%). Foreign body-related complications occurred in 63 patients (10.5%), including hemorrhage (5.0%), perforation and infection (5.5%). The complication rate was increased by 4.04- and 8.48- fold when endoscopic retrieval was performed after impacted for over 24 and 48 hours, respectively, after impaction, as compared with within 12 hours. Logistic regression analysis revealed that the patients with sharp objects developed more complications than those with non-sharp ones (odds ratio, 2.85; 95% confidence interval, 1.08-7.50; P = .034). However, complications were unrelated with the location in the esophagus or length of foreign bodies (P > .05).Sharp objects were the most frequently ingested foreign bodies in the esophagus in China. The prevalence of complications was increased in the patients with long foreign body retention time (>24 hours) and sharp objects. Sharp foreign bodies in the esophagus are recommended to be removed within 24 hours.

A Baby Feeding Nipple: Simple, Cost effective, and Safe Technique for Removal of Denture

Abstract Introduction: Denture ingestion occurs commonly in the elderly and frequently impacted in the esophagus due to the sharp edges. This can lead to serious complications such as perforation. We are describing here a simple, cost effective and safe technique for removal of dentures. Material and methods: We used a handmade hood protector made from baby feeding nipple with rat-toothed forceps to safely remove ingested denture in two middle aged patients. Both patients had subcutaneous emphysema. Results: Dentures were removed successfully in both patients. Following denture removal, endoscopic examination of the esophagus did not show any sign of mucosal damage, ulceration, bleeding, or perforation. Conclusion: We successfully and safely removed denture from the stomach using handmade hood designed from a baby feeding tube. It may be beneficial for wide visual field and safety. It is an easy, effective, and safe design for the removal of sharp foreign bodies like dentures.

Sharp Foreign Bodies of the Aero-Digestive Tract: Endoscopic Removal by the 'Kangaroo' Technique.

Removal of sharp foreign bodies in the aero-digestive tract may inflict iatrogenic damage to the esophagus, trachea or other vital structures in case of impalement. We describe the 'Kangaroo' technique for safe and effective removal of sharp objects from the upper aero-digestive tracts. Index Case 1: 1-year old boy presented to us with an open (un)safety-pin lodged in the upper esophagus. The technique of removal of the pin by the Kangaroo technique, along-with the mechanics of en-pouching the (un)safety-pin has been described. Index Case 2: 8years old boy presented with accidental aspiration of a razor blade. The removal of the blade from his trachea was executed by the Kangaroo technique. The Kangaroo technique is described for safe endoscopic extraction of sharp foreign body from the aero-digestive tract while protecting the surrounding tissues, to maintain control of the object during extraction and to avoid causing iatrogenic damage by enclosing the foreign body in a 'kangaroo pouch'. The advantages and limitations of the technique have been discussed. The Kangaroo technique is safe, effective and reproducible way to effect removal of sharp object from the aerodigestive tract while preventing iatrogenic injury to the surrounding organs.

Foreign bodies in adult upper digestive tract: a series of 30 cases

<p class="abstract"><strong>Background:</strong> Rigid endoscopy under general anaesthesia has traditionally been used by otolaryngologist for diagnosis and management of variety of disorders affecting the upper digestive tract including the removal of foreign body. Smooth foreign bodies does not pose much threat but may cause airway obstruction. Sharp foreign bodies, if not removed the earliest may penetrate oesophageal wall and cause complications.</p><p class="abstract"><strong>Methods:</strong> A Retrospective analysis was done for patients who underwent rigid oesophaghoscopy under general anaesthesia for 30 patients of foreign body ingestion at Upgraded Institute of Otorhinolaryngology, Madras Medical College, Chennai, between November 2016 – November 2017. The records of age, sex, co-morbidities, X-ray finding, complications were recorded. </p><p class="abstract"><strong>Results:</strong> Majority of adults in this group belonged to 40-50 years age. The most common foreign body impacted was chicken bone totalling 16. 2 patients of denture ingestion were referred for flexible endoscopy after failed attempt, 1 developed oesophageal perforation.</p><p><strong>Conclusions:</strong> Rigid endoscopy is the gold standard for removal of sharp foreign body as the sharp ends can be clasped and brought in to the endoscope there by preventing damage to the mucosa. Foreign body with multiple sharp ends which cannot be negotiated into rigid endoscope, should be pushed into the stomach and attempted removal by cutting sharp ends of foreign body or by gastrostomy, as pulling such foreign body will lead to full length tear of oesophagus leading to morbidity and mortality. </p>

The Management of Voluntary Ingestion of Razor Blades by Inmates

Ingestion of sharp objects is a rare event. We report our experience in the care of prisoners who ingested razor blades and the in-time evolution of our management. This is a descriptive study including all detainees ingesting a razor blade, transferred from the prison to Farhat Hached University Hospital of Sousse, from January 1, 2014 to December 31, 2015. Thus, we counted 19 cases of swallowed razor blades in 16 prisoners; indeed, 1 prisoner ingested a razor blade three times and another had ingested a blade twice. Our study includes 19 episodes of swallowed razor blades. In 2 cases, these events were secondary to suicide attempts. In the other cases, it was an expression of discontent and rejection of the situation in the prison. Three patients had a psychiatric history. The mean age of the patients is 24 years. The initial clinical examination had not objectified signs of gastrointestinal perforation. Thoraco-abdomino-pelvic computed tomography scans allowed specifying the blade location in all cases. It also objectified a pneumo-mediastinum in 2 cases. The blade location was esophageal in 1 case, gastric in 6 cases, and in the small bowel in the other cases. The first 4 patients had surgical removal of the blade. In subsequent cases, surgical abstention was the rule, and spontaneous blade expulsion was observed. The average time of expulsion was 4 days. In our experience, surgical removal of sharp foreign bodies should not be performed systematically without complications.

Pointing towards colonoscopy: sharp foreign body removal via colonoscopy

Removal of sharp foreign bodies via upper endoscopy is common; however, management in the setting of distal migration is not well-documented. We report two cases of objects beyond the ligament of Treitz, including successful extraction of a 4.4 cm sewing pin from the cecum using hot biopsy forceps with a protector hood to shield colonic mucosa, and in a separate case, a 3.4 cm glass shard from the ascending colon using a Roth Net retriever. We demonstrate that monitoring with serial radiographs and examination may allow for supervised passage of sharp objects into the colon, where removal can be performed safely via colonoscopy.

Condoms used to assist difficult endoscopic removal of impacted upper esophageal foreign bodies

Summary The use of a homemade balloon dilator and protector hood composed of condoms for assisting the removal of sharp foreign bodies lodged in the upper esophagus in difficult cases is reported. A conventional endoscopic method failed to remove two sharp bones and two press-through packages became impacted in the upper esophagus. A condom was used to make a balloon dilator that was attached to a flexible endoscope in an attempt to dilate the upper esophageal sphincter to dislodge the impacted sharp bones. This handmade condom balloon dilator succeeded in dislodging the two tightly impacted sharp bones and assisted in removing the impacted objects in the upper esophagus. Additionally, a condom was tied to the distal end of the scope to act as a protector hood to protect the esophageal mucosa when removing the sharp packages. The two impacted press-through packages were pushed into the lower esophagus or stomach and removed uneventfully using the condom protector hood. Subsequent endoscopy disclosed no relevant mucosal damage after the successful removal and the patients did well after discharge from the emergency department. In conclusion, condom-based endoscopic balloon dilatation is a simple and accessible method for assisting the endoscopic removal of tightly impacted, sharp foreign bodies in the upper esophagus. A condom can also be used as a protector hood to avoid mucosal injury when removing impacted, sharp press-through packages when a commercial protector hood is not available.

The Abdominal Smile Sign

A 72-year-old man status post cholecystectomy, prostatectomy with residual surgical clips (black arrow), and right hemicolectomy with suture ring (white arrow) presented to the emergency department after “choking on something” while taking his morning pills. He described no chest pain, abdominal pain, dysphagia or dyspnea, but could not find his dental bridgework. A KUB revealed partial dentures in his lower abdomen. By comparing the KUB with an unrelated abdominal CT scan, radiology determined that the dentures were no longer in the stomach. Indications for endoscopic removal of sharp foreign bodies, such as dentures, include location of the object in the esophagus or stomach. Swallowed objects that enter the stomach will typically pass without incident; however, complications have been noted in up to 35% of patients. Impaction, perforation, or obstruction most commonly occurs at areas of acute angulation, including the ileocecal valve. In cases where the object cannot be removed safely, patients should be monitored with daily radiographs. Surgery should be considered if the object does not progress through the gastrointestinal tract within three days. In this case, the patient returned for daily imaging and passed the dentures on day three without pain. After a thorough cleaning, the patient continues to wear his dentures, despite his wife’s protests.

Endoscopic Removal of Sharp Foreign Bodies in Neck Using Image Intensified Television

AbstractForeign body impaction in the neck poses life-threatening problems when it is deep and close to vital structures. We report two cases of sharp metallic foreign body impaction in the neck – one of them in the prevertebral space and the other in the intervertebral disk space. A neck exploration and surgical removal of these foreign bodies, as is usually practised in most centers, would have been life-threatening and associated with high morbidity. We removed these foreign bodies using rigid endoscope under image intensified television (IITV) guidance. The patients could be discharged the same day. We suggest that endoscopic removal under IITV fluoroscopy system should be the method of choice in the removal of foreign bodies located in these sites. We also propose a classification of neck into vertical segments which would be useful in the management decision of these cases.

The root and development of otorhinolaryngology in traditional Chinese medicine

There is an increasing trend in society to look beyond conventional medicine to find answers to problems in health. Traditional Chinese medicine (TCM) is one of the most popular alternative, complementary therapies worldwide. It is becoming a popular alternative in otorhinolaryngology where its use in the treatment of sinusitis, tinnitus, deafness and Meniere's disease is growing. Despite the general awareness of TCM, the literature relating specifically to otorhinolaryngology is relatively scarce. In this review, we have traced the origin and development of otorhinolaryngology with respect to TCM and have provided a few interesting insights into otorhinolaryngology, as it used to be practised. Archaeological sources have shown that diseases affecting the ear, nose and throat were of medical concern as early as the 18th century BC. The first practising otorhinolaryngologist can be traced back to the 5th century BC. Acupuncture, moxibustion, herbal therapy and massage were amongst his treatments. Otorhinolaryngology was recognised as a major specialty when formal medical education began in the 7th century AD. Therapeutic measures since then expanded to include exercise, food therapy and surgery. References to using oesophageal speech as a substitute voice generator, the use of copper wire to excise nasal polyps, procedures for removal of sharp foreign bodies in the oropharynx, repair of lacerated trachea and treatment of cancer of lips can be found in historical notes. In conclusion, from its primitive roots, TCM has developed into a distinct branch of health care system in China today that works alongside Western medicine.

Removal of a triple-barbed fishhook from the hypopharynx with microlaryngoscopy

Objectives: To review the literature involving removal of sharp foreign bodies from the hypopharynx and to present a case of a triple-barbed fishhook removed from the hypopharynx with suspension microlaryngoscopy. Study Design: Literature review and case presentation. Methods: Review of the literature was done using a MEDLINE search with the keywords hypopharynx, foreign bodies, and laryngoscopy. Results: Review of the literature revealed no prior description of either foreign body removal using microlaryngoscopy or report of the removal of a triple-barbed fishhook from humans. Conclusion: Removal of sharp foreign bodies from the aerodigestive tract always presents a technical challenge, and this case of a hypopharyngeal triple-barbed fishhook introduces new operative techniques. By using microlaryngoscopy and bimanual instrumentation to manipulate and remove the fishhook, an open surgical procedure was avoided. (Am J Otolaryngol 2002;23:233-236. Copyright 2002, Elsevier Science (USA). All rights reserved.)

Endoscopic removal of sharp foreign bodies impacted in the esophagus.

Impacted sharp foreign bodies in the esophagus can be very difficult to manage. When attempts are made to remove such objects inappropriately, life-threatening complications such as perforation can occur. The aim of this study was to evaluate the safety and efficacy of endoscopic removal of impacted sharp foreign bodies in the esophagus using proximal dilatation with an oral side balloon or transparent cap. A total of 22 patients (10 men, 12 women) with impacted sharp foreign bodies in the esophagus underwent endoscopic extraction. The following technique was successfully performed at our hospital. An oral side balloon (Top Co., Japan) for esophageal variceal sclerotherapy was attached to the distal part of the endoscope. With the patient under local anesthesia, the endoscope was inserted as far as the proximal part of the esophageal foreign body. The oral side balloon was then gradually inflated. Dilatation of the proximal part of the esophagus made it possible to release the impacted sharp foreign body from the esophageal wall. A transparent cap was used for foreign bodies in the upper esophagus when there were difficulties with the oral side balloon. The types of foreign body removed were fish bones (n = 9), press-through packages (n = 8), chicken bones (n =3), dentures (n = 1), and a wrist watch (n = 1). Endoscopic removal was successful in all but one of the cases, in which a fish bone had to be extracted surgically. The proximal dilatation method using an oral side balloon or transparent cap is safe and effective in removing sharp foreign bodies from the esophagus, avoiding surgery and possible perforation.

A novel approach to the removal of sharp foreign bodies from the stomach using a combined endoscopic and laparoscopic technique

Ingestion of foreign bodies into the gastrointestinal tract is a common occurrence. Eighty percent to 90% of ingested foreign bodies pass spontaneously1 and the risk of perforation of the gastrointestinal tract is minimal.2-4 Although perforation occurs in only 1% of foreign body ingestions,5,6 sharp or pointed objects are reported to perforate in 15% to 35% of cases.6-8 Objects longer than 5 cm or wider than 2 cm will rarely pass the stomach.9 When perforation does occur, it may result in a variety of complications accounting for considerable morbidity and mortality.

A novel approach to the removal of sharp foreign bodies from the stomach using a combined endoscopic and laparoscopic technique

A novel approach to the removal of sharp foreign bodies from the stomach using a combined endoscopic and laparoscopic technique