Foreign Body Retrieval Research Articles

Foreign Body Retrieval by Using Flexible Cryoprobe in Children.

Foreign body aspiration (FBA) can be a life-threatening emergency and the cause of significant morbidity and mortality in children. Although rigid bronchoscopy is considered as the treatment of choice for the retrieval of foreign bodies (FBs) among pediatrics, extraction with the flexible fiberoptic bronchoscope (FFB) has become increased in popularity over the last few years. Recently, though there have been some reports about the use of cryoprobes as tools for the removal of FBs in adults, there is a limited experience concerning pediatrics, especially during the infancy period. The aim of this study is to describe the characteristics of FBs and cryoextraction as the new method of treatment. This retrospective study was conducted on 50 pediatric patients with FBA who were managed by using the flexible cryoprobes to evaluate their outcomes between September 2013 and October 2018. A total of 50 children ranging in age from 7 months to 15 years underwent cryoextraction for the airway FBA retrieval with FFB using a cryoprobe. The main symptoms patients complained of were choking, cyanosis, cough, and noisy breathing. History, clinical examination, and finally radiologic examination were the diagnostic tools. The treatment consisted of FFB using cryoprobes under slight general anesthesia with maintaining the patient's spontaneous breathing. Using cryoextraction turned to be very useful. Using cryoextraction can be a reliable and preferred method with minimal complications for extracting airway FBs among children, especially those that have a friable texture.

Retrieval of Aspirated Teeth in an Adult Polytrauma Patient using Pediatric Flexible Fiberoptic Bronchoscopy Allied with Endoscopic Rat Tooth Alligator Jaw Grasping Forceps

Foreign body (FB) aspiration in maxillofacial injuries is a life-threatening event. A long-time interval between the aspiration and retrieval results in the formation of granulation tissue and mucosal inflammation around the FB, which could restrict the visual field of bronchoscopy and its retrieval. In addition, it can affect the lung structure with fatal complications. Herein, we present a case of unique FB retrieval (2 joined crown teeth – measuring 19 mm) within 8 h following aspiration in a 24-year-old male polytrauma victim. Further, we discuss our successful modified retrieval technique accordingly without resulting in any complications.

Endoscopic Transoral Image-Guided Retrieval of Infratemporal Fossa Foreign Bodies.

Removal of foreign bodies from the infratemporal fossa is surgically challenging and fraught with risks. This report describes our experience with a minimally invasive transoral technique, utilizing endoscopic and image guidance technology, for retrieval of infratemporal fossa foreign bodies in 6 patients. The technique was successfully applied in all cases with identification and retrieval of the foreign bodies, which included 4 hypodermic needles broken off during dental injections, a cottonoid surgical sponge lost during a facial fracture repair, and a maxillary molar displaced during attempted extraction. Complications were limited to transient postoperative lingual and inferior alveolar nerve sensory deficits in 1 patient.

Iatrogenic Intravascular Foreign Body Retrieval in a Neonate

AbstractThis is a short communication demonstrating a unique method of intravascular foreign body retrieval by grasp from inside technique in a neonate.

Unusual method in tracheo-bronchial foreign body aspiration management

Tracheo-bronchial foreign body aspiration could be a life-threatening condition that occurs mainly in children. Prompt diagnosis and intervention through foreign body retrieval are critical to prevent probable morbidity and mortality. The retrieval procedure could be difficult depending on the shape and consistency of the foreign body material. Surgeons can utilize special tools to help in the extraction of tracheo-bronchial foreign bodies. We present here a child patient who accidentally aspirated a plastic bead. He underwent successful retrieval of the foreign body using a Fogarty embolectomy catheter introduced through a rigid bronchoscope. Keywords: Foreign body; aspiration; tracheo-bronchial foreign body

Gastrointestinal Endoscopy in the Riverine Southwestern Ondo State of Nigeria: An Eight Year Review

Gastrointestinal (GI) endoscopy is a notable advancement in the diagnosis of diseases in the digestive tract. It offers the advantage of biopsy and a range of cost-effective therapeutic options. The aim of this research was to study the range of GI endoscopy procedures, indications, spectrum of findings and outcome of GI endoscopy in a typical private specialist gastroenterology institution in a developing country. This was a cross sectional observational study of patients referred for GI endoscopy to a referral health facility in southern Ondo, Ondo state, Nigeria from February 2012 to February 2020. The variables studied were demographics of the patients, indication, the type of endoscopic procedure carried out and outcome. Statistical analysis was done using SPSS version 20 (SPSS, Chicago, IL, USA). Four hundred and ninety-six cases of endoscopy were performed during the study period comprising 313(63.1%) males and 183(36.1) females. The age range was 15 months - 86years (mean age of 48.9 ± 16.2 years). Upper and lower gastrointestinal bleeding were the commonest indications for endoscopy referral - 181 (36.5%). The range of procedures performed included oesophagogastroduodenoscopy 266 (52.8%) and colonoscopy 177 (35.9%); the therapeutic procedures carried out ranged from sclerotherapy 35(7.0%), polypectomy 24(5.0%), band ligation 6(1.0%), foreign body retrieval 6(1.0%) to a case of endoscopic mucosal resection EMR In our experience, the practice is safe with a high diagnostic yield and therapeutic achievement.

Foreign Bodies in Extraction Socket: An Outcome of Negligence and Proposal of a Classification with its Medico-legal Implications.

Removal of tooth is just a routine dental surgical practice, where negligence is a must avoidable contingence. Still, few complications may arise during or after the procedure. One of the rare complications is the breakage of surgical instrument or presence of any foreign body (FB) in extraction socket. This may be due to improper handling of a surgical instrument or using substandard tools, which may lead to breakage of the instrument or any negligence by the patient himself. This negligence can be on various levels, like professionals, manufacturers or patients. All these events may cause serious outcomes pertaining to the medicolegal issues. The aim of this study was to classify the negligence in oral surgery for legitimacy with possible management for the retrieval of the FB and discuss various Indian Penal Codes for Medical Negligence according to the Constitution of India and its implications. Diagnosis and surgical retrieval of FB associated with extraction socket were performed in three cases. Incision, flap reflection, identification of FB and successful retrieval followed by suturing under local anesthesia were achieved. Routine medications were prescribed. The FB were sent for stereomicroscopic examination. All the patients were followed up after a week, and no complications were observed. Suture removal was carried out, and oral hygiene instructions were given. The FB were found to be piece of lead, broken tip of a dental elevator and broken diamond round bur. The negligence can occur at any stage, and it has its medicolegal aspects. This negligence can be apprehended in front of the Indian Penal Code for Medical Negligence. Hence, a classification is required to understand and subdivide the negligence to find the legitimacy over the medicolegal implications.

Balloon-Assisted Enteroscopy for Retrieval of Small Intestinal Foreign Bodies: A KASID Multicenter Study.

Background and Aims Balloon-assisted enteroscopy (BAE) can be used to retrieve small intestinal foreign bodies (FBs). Here, we aimed at exploring the clinical usefulness of BAE for the retrieval of small intestinal FBs. Methods We retrospectively reviewed the medical records of 34 patients who underwent BAE to retrieve small intestinal FBs at 3 tertiary referral centers between April 2005 and June 2017. Results The retained materials included capsule endoscopes (CEs; n = 18 [52.9%]), self-expandable metal stents (SEMSs; n = 5 [14.7%]), biliary drainage catheters (n = 4 [11.8%]), gallstones (n = 3 [8.8%]), an embolization coil (2.9%), a needle, an intragastric bariatric balloon, and a razor blade. FBs were located or stuck in the ileum (n = 17 [50%]), jejunum (n = 16 [47.1%]), and an undetermined small intestinal segment (n = 1). Seventeen cases of FBs (50%; 7 CEs, 3 biliary drainage catheters, 3 SEMSs, 2 gallstones, 1 intragastric balloon, and 1 needle) were successfully retrieved enteroscopically. FBs of 4 asymptomatic patients (3 CEs and 1 razor blade) passed spontaneously. The remaining 13 patients underwent surgery for persistent or symptomatic FBs: 12 were successfully removed and 1 CE removal procedure failed due to severe peritoneal adhesions. The presence of symptoms was the only independent predictor of successful retrieval using BAE (odds ratio 13.40, 95% confidence interval 1.10–162.56, P = 0.042). BAE-related complications such as bowel perforation and acute pancreatitis occurred in 2 patients (5.9%). Conclusions BAE can be the first option for FB removal in the small intestine. The presence of symptoms was associated with successful enteroscopic retrieval.

Removal of Orbital Metallic Foreign Bodies With Image-Guided Surgical Navigation.

To describe the use of an image-guided 3-dimensional surgical navigation system for the removal of metallic foreign bodies from the human intraorbital region. Between January 2016 and June 2019, 30 patients with metallic foreign bodies in the orbital area underwent image-guided 3-dimensional surgical navigational removal at the authors' center, and their data were retrospectively analyzed. Patients' age, gender, complaints, cause of initial injury, location, interval between injury, and surgery were recorded. Preoperative CT scans of the orbits were obtained and used for preoperative planning. The 3-dimensional navigation system was used for intraoperative navigation. In all 30 patients, the foreign bodies were removed by minimally invasive access without any severe complications. The intraoperative average depth of foreign bodies was 19.98 ± 11.47 mm which was consistent with the depth measured in preoperative planning. The mean length, width, and height of foreign bodies determined in preoperative planning were confirmed by postoperative measurements. There was no significant difference between preoperative and postoperative mean logarithm of Mininal Angle Resolution (logMAR) best-corrected visual acuity. According to the postoperative CT scan, all 30 patients' metallic foreign bodies were successfully removed by surgeries using the surgical navigation system. Most patients who presented with diplopia, eye movement pain, and paresthesia were improved after surgery. This study demonstrated that computer-assisted image-guided 3-dimensional surgical navigation had the advantages of accurate real-time localization of foreign bodies, minimizing collateral damage, determining the appropriate surgical path, and increasing the successful rate of foreign body retrieval.

Laparoscopic-assisted gastrotomy for foreign body retrieval in four dogs

Four dogs with gastric foreign bodies were treated by laparoscopic-assisted gastrotomy. Techniques included two-port technique (n=two dogs), single-port with Alexis wound retractor (one) and single-port GelSeal cap with three cannulae...

The Management of Retained Rectal Foreign Body.

PurposeBecause insertion of a foreign body (FB) into the anus is considered a taboo practice, patients with a retained rectal FB may hesitate to obtain medical care, and attending surgeons may lack experience with removing these FBs. We performed this study to evaluate the clinical characteristics of Korean patients with a retained rectal FB and propose management guideline for such cases based on our experience.MethodsWe retrospectively investigated 14 patients between January 2006 and December 2018. We assessed demographic features, mechanism of FB insertion, clinical course between diagnosis and management, and outcomes.ResultsAll patients were male (mean age, 43 years) and presented with low abdominal pain (n = 2), anal bleeding (n = 2), or concern about a retained rectal FB without symptoms (n = 10). FB insertion was most commonly associated with sexual gratification or anal eroticism (n = 11, 78.6%). All patients underwent general anesthesia for anal sphincter relaxation with the exception of 2 who underwent FB removal in the emergency department. FBs were retrieved transanally using a clamp (n = 2), myoma screw (n = 1), clamp application following abdominal wall compression (n = 2), or laparotomy followed by rectosigmoid colon milking (n = 2). Colotomy and primary repair were performed in four patients, and Hartmann operation was performed in one patient with fecal peritonitis. No morbidity or mortality was reported. All patients refused postextraction anorectal functional and anatomical evaluation and psychological counseling.ConclusionRetained rectal FB is rare; however, colorectal surgeons should be aware of the various methods that can be used for FB retrieval and the therapeutic algorithm applicable in such cases.

Comparative analysis of computed tomography scan and flexible bronchoscopy in the evaluation of suspected foreign body aspiration in children and the role of later in its removal

Background: Foreign body aspiration (FBA) in children is considered one of the most important diagnostic and therapeutic challenges for physicians. Often there is no history of aspiration of foreign body in this population and these children present with a wide range of nonspecific signs and symptoms. The objective of the study was to study the diagnostic utility of chest computed tomography (CT) scan in children with suspected FBA in comparison to flexible bronchoscopy (FB) and the role of later as a therapeutic tool in the removal of airway foreign bodies. Methods: This was a prospective observational study conducted from January 2015 to August 2019. Children admitted for persistent respiratory symptoms underwent CT chest and FB for confirmation of the diagnosis and retrieval of the foreign body if present. Results: A total of 101 patients of both genders were enrolled in the study. Fifty-three participants were boys and 48 were girls. FBA was diagnosed in 53 patients on chest CT. On FB, FBA was confirmed in 55 patients. The sensitivity and specificity of chest CT in our study were 85% and 87% respectively. In 25 of these patients, removal was successfully done by the FB. Conclusion: We conclude that a Chest CT scan is inferior to FB in the diagnosis of suspected trachea-bronchial foreign bodies in children. FB as a therapeutic tool has an excellent safety record in the retrieval of airway foreign bodies in this population.

Foreign body retrieval by rigid bronchoscopy in children - A comparative study of spontaneous ventilation Vs controlled ventilation

Foreign body retrieval by rigid bronchoscopy in children - A comparative study of spontaneous ventilation Vs controlled ventilation

Surgical Retrieval of Esophageal Foreign Body in a Dog - A Case Report

Surgical Retrieval of Esophageal Foreign Body in a Dog - A Case Report

Age based evaluation of nut aspiration risk

ObjectiveTo identify an age at which initiation of whole nut into the pediatric diet could be considered safe, by evaluating the age distribution of children undergoing bronchoscopy with removal of nut or seed material from the airway.MethodA retrospective chart review over a ten-year period identifying children age 0–18 that have undergone bronchoscopy with retrieval of airway foreign bodies. A statistical analysis of demographic data was carried out to identify age distribution of aspiration events.ResultsSixty-four cases of foreign body aspiration were identified, of which 43 (67%) were of organic origin, specifically nuts. A Fisher’s exact test was carried out on the cumulative percentage of organic foreign body aspirations to identify the age distribution of nut aspiration events. A statistically significant decrease in organic foreign body aspirations occurred at approximately 36 months of age (p = 0.004).ConclusionForeign body aspiration is a leading cause of accidental injury or death in children. Nut and other small organic foreign bodies account for a significant portion of accidental aspiration events, however, no guidelines exist regarding appropriate age of whole nut introduction into the diet. Our study suggests that 90% of pediatric nut aspiration events occur under the age of 36 months. We suggest supervised introduction of whole nuts between the ages of 3 and 4 years. Official guidelines regarding this should be considered by professional pediatric societies.Level of evidence4

Management of foreign body in the maxillofacial region – A retrospective study

Background: Foreign bodies (FBs) in the maxillofacial region are not rare due to increasing trends of accidents and interpersonal assaults. This leads due to a steady increase in facial injuries. The management of FB starts with the development of strong clinical suspicion of the presence of FB during the initial wound examination. Face being the most appealing and esthetic part of the body, early recognition and removal of FB decrease the patient's morbidity. Further, chronic infection and recurrent surgeries can be avoided. Objectives: This retrospective study gives the clinical experience of the management of FB in the maxillofacial region in most referred tertiary care government hospital in South India. Further, the intricacies and the sequence of effective management were discussed in detail. Materials and Methods: A retrospective study was conducted in the Department of Dentistry, Government Rajaji hospital, Madurai Medical College, Tamil Nadu, India, for 5 years from 2014 to 2019 on the management of FBs in the maxillofacial region. Patient's records were analyzed for demographic data, etiology, clinical presentation, investigation, type of FB, and management. Results: Thirty-five patients were treated in the period of 5 years. Out of 35 patients, males were predominantly treated for retrieval of FB; the most common etiology is renal tubular acidosis, most of them presented early; computed tomography is the diagnostic modality used to detect most of the FB; the most common type of FB is the glass followed by wood, and the removal of FB was predominantly done under General anaesthesia (GA). Conclusion: Early recognition of FB in the maxillofacial region is important. This hastens the removal along with the management of fractures, if any without additional investigations and surgery.

Urethral Defect in Setting of Recurrent Urethral Foreign Body Insertion

We present a case of recurrent episodes of foreign body insertion into the urethra, ultimately resulting in urethral defect at the penoscrotal junction. We have decided against treating the urethral defect as it facilitates nonoperative retrieval of the urethral foreign bodies. We present our experience and rationale for the clinical management of this complex patient.

Transdiaphragmatic Gastrotomy for the Extraction of Distal Esophageal Foreign Bodies in 13 Dogs (1997-2016).

The records of 13 dogs with distal esophageal foreign body obstruction not amenable to endoscopic management that had transdiaphragmatic gastrotomy (TG) for the foreign body extraction were reviewed. West Highland white terriers were over-represented. Mean age of the dogs at presentation was 38.6 mo, and mean duration of clinical signs associated with esophageal foreign bodies was 5.8 days. A TG was performed via an eighth or ninth left intercostal thoracotomy, and clinical results were successful in 12 dogs. In 1 dog, gastrotomy failed to retrieve a foreign body and esophagotomy was performed. Foreign bodies that were removed included 3 fishhooks and 10 animal bones. Postoperatively, all dogs developed esophagitis, 1 dog showed esophageal stricture, and 1 dog died of pyothorax associated with esophageal perforation 1 day postsurgery. Overall, 12 dogs survived and were free of clinical signs after a median follow-up time of 17 mo. TG is an effective surgical technique for the retrieval of distal esophageal foreign bodies.

Endoscopic retrieval of gastric and oesophageal foreign bodies in 52 cats.

To assess the outcomes and major complications in cats that require oesophageal and gastric endoscopic foreign body removal. The medical records of 52 cats with oesophageal and gastric foreign bodies that underwent endoscopic foreign body retrieval during a 13-year period (2006 to 2018) were retrospectively reviewed to characterise the clinical and radiographic signs, endoscopic findings, outcomes and major complications. Endoscopic foreign body retrieval was successful in 49 of the 52 cats (94.2%). Radiographs confirmed the foreign material in 24 of the 50 cats (48%). Major complications occurred in eight of the 52 cats (15.4%) and included pleural effusion (n=2), aspiration pneumonia (n=2), unsuccessful removal of foreign material with endoscopy (n=3), oesophageal stricture formation (n=3) and cardiopulmonary arrest (n=1). Cats with oesophageal foreign bodies were more likely to experience major complications than those with gastric foreign bodies. Endoscopic foreign body removal in cats was associated with good overall outcomes and a low complication rate in this study sample. These results will help veterinarians better understand the outcomes of endoscopic foreign body removal in cats.

Endoscopic retrieval of magnetic foreign body ingestions with a nasal bridle: description of a novel technique (with video)

Accidental and intentional foreign body ingestions are common and frequently require endoscopic intervention. Sharp metallic objects pose a risk of perforation to the entire GI tract and are often difficult to visualize among food and other matter in the stomach. Three patients with histories of multiple ingestions are considered. Metallic foreign bodies can be easily removed using a nasal bridle. A snare and magnetic catheter are used as endoscopic tools to extract various metallic items. The bridle technique was used in 68 endoscopies in 3 patients who presented numerous times for foreign body ingestions. The technique was successful in 66 of the 68 procedures, with no adverse events. The bridle technique is an easy and effective way to remove metallic foreign bodies and has many advantages over traditional, mechanical modes of foreign body retrieval.