Foreign Body Retrieval Research Articles

Surgery for foreign body retrieval from airway after failed bronchoscopy intervention—a decade-long experience

Surgery for foreign body retrieval from airway after failed bronchoscopy intervention—a decade-long experience

Percutaneous ultrasound-guided anchor wire placement aids in the intraoperative localization of nonpalpable, superficial foreign bodies and abscesses in dogs.

To describe and evaluate the use of preoperative percutaneous ultrasound-guided anchor wire placement to aid intraoperative localization of superficial foreign bodies and abscesses in dogs. 11 dogs. In a retrospective observational study, the medical records of dogs that underwent surgical exploration of superficial abscesses, guided by anchor wire, between 2018 and 2023 were reviewed for clinical and histopathological findings and complications. Owners or veterinarians were contacted to collect long-term follow-up information. 11 dogs were included. Superficial swelling was the most common clinical presentation. Computed tomography and ultrasound revealed an abscess cavity and suspected foreign body in 9 dogs and an abscess cavity without evidence of a foreign body in 2 dogs. Anchor wires were placed in close proximity to the foreign body or inside the abscess. All documented foreign bodies were successfully located and retrieved. Two dogs suffered minor postoperative complications. No major intra- or postoperative complications were documented. One dog displayed recurrence of clinical signs, but no further surgical management was required. Preoperative percutaneous placement of an anchor wire via ultrasound guidance was successful in aiding intraoperative localization of nonpalpable abscesses and retrieval of foreign bodies. This technique may decrease surgical time, minimize the surgical approach required, and increase the likelihood of successful localization.

Foreign bodies in the ear and nose of the Australian paediatric population: A standardised approach.

Foreign bodies (FBs) in the ears and noseare common presentations among paediatric patients, necessitating prompt and appropriate management to avoid potential complications. This article presents a standardised approach for FB retrieval based on local clinical data from a tertiary paediatric centre, addressing the challenges of identifying patients requiring specialist referral. The approach involves a detailed initial consultation and succinct examination todetermine the most suitable retrieval method. Patient preparation and equipment availability are key to successful outcomes. A combination of microsuction and alligator forceps with adequate illumination is strongly recommended, along with various adjunct tools commonly available. Urgent referral to otorhinolaryngology is indicated for button batteries and previous failed attempts. This comprehensive approach seeks to achieve successful FB removal and optimise patient outcomes in both community and hospital settings.

Utility of Flexible Bronchoscopy as an Interventional Tool in Children: A Single-Center Cross-Sectional Study

AbstractThe aim of this study was to study the utility of pediatric flexible bronchoscopy as an interventional tool. This is a prospective study conducted in a tertiary care hospital. The studied patients underwent flexible bronchoscopy for various diagnostic and therapeutic reasons. The endpoint was to document the type of therapeutic procedure done in a patient, success rate, and any procedural complications encountered. During the 7-year period, a total of 824 different bronchoscopic procedures were conducted. The majority of procedures were for diagnostic reasons. A total of 68 therapeutic procedures were performed successfully, which included foreign body retrieval in 46 patients, bronchoscopic intubation in 5 patients, transbronchial needle aspiration (TBNA) in 4 patients, dilatation of tracheal stenosis in 4 patients, mucus plug removal in 3 patients for lung collapse, postoperative hydatid membrane removal in 3 patients, whole lung lavage in 2 patients, and transbronchial needle biopsy (TBNB) for suspected fibrosing mediastinitis in 1 patient. The 7-year audit of therapeutic role of flexible bronchoscopy (FB) in children revealed that the procedure is safe and can be utilized for many therapeutic procedures in children, including removal of aspirated foreign bodies, bronchoscopic intubation, dilatation of tracheal stenosis, treatment of atelectasis, and collection of biopsy specimens from the mediastinum. The procedure is safe and carried no major complication rate.

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

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

Flexible Endoscopic Management of Tracheo-oesophageal Magnet Foreign Bodies with Acquired Fistula in a Toddler.

Aerodigestive foreign bodies (FBs) aspiration is a common problem in children; however, simultaneous aerodigestive localisation is rare. Ingestion of multiple magnetic FBs can lead to serious complications, especially tracheo-oesophageal fistula and recurrent chest infections. These depend on the duration of foreign-body ingestion/aspiration, prompt intervention and adequate technique for foreign-body retrieval. A 1.8-year-old female child was found to have two magnetic FBs lodged simultaneously in the oesophagus and trachea. The magnetic FBs in the aerodigestive tract in children were removed in the same session using flexible endoscopes.

Preoperative and Intraoperative CT Imaging for Orbital Foreign Bodies Identification and Surgical Planning in Veterinary Medicine

Abstract The goal of this study was to evaluate sensitivity of intraoperative Computed Tomography (iCT) imaging for the detection of orbital foreign bodies (OFBs) in an in vitro model and evaluate iCT efficacy for surgical planning of OFB detection and removal in veterinary patients. Three canine patients were presented to our hospital for potential orbital foreign body removal. In vitro studies were conducted using a canine skull model with placement of various OFBs. Four different examiners utilized CT imaging to evaluate the detection of OFBs. A surgical navigation system was employed to assess the feasibility of stereotactic orbital foreign body retrieval in vitro. iCT imaging was applied for surgical planning and guidance of orbital surgery for the removal of OFBs in three clinical patients. In vitro experiments revealed a high detection rate for objects with high radiopacity such as metal and glass. The detection rate for organic foreign bodies such as wood was moderate, while for plastic foreign bodies ranged from moderate to low. Navigation was successfully used for OFB retrieval. iCT was effectively employed for detecting OFBs in clinical patients. However, porcupine quills were better detected using standard ultrasound imaging. The use of iCT potentially represents an evolving technological practice that enables real-time imaging to improve the precision of surgical procedures.

Unusual Airway Foreign Bodies in Children: Demographics and Management.

The aim is to study the demographics and management of unusual airway foreign bodies (UAFBs) in children. A retrospective observational study (2000-2020) of children with UAFBs, who underwent bronchoscopic removal. The demographics, types of foreign bodies, clinical and radiological features, management, and outcomes were collated and analyzed. Common foreign bodies, such as nuts, seeds, and vegetable aspirations, were excluded. Among 531 children who had bronchoscopic retrieval of airway foreign bodies, 74 (59 males/15 females) had unusual foreign bodies. These included pen caps, whistles, plastic objects, pins, coal piece, stones, clay, pencil, gold ornament, and glass bangle. Thirty-one children presented within 1 day of aspiration, 37 within 1 month and 6 till 6 months. Thirty-nine were below 5 years, and the rest were between 5 and 15 years. Cough, respiratory distress, fever, choking, and noisy breathing were common presentations. Others are stridor, whistling, cyanosis, loss, and change of voice. Chest X-ray showed ipsilateral hyperinflation (23), haziness (21), radio-opaque foreign body (17) and was normal in 14. The left main bronchus, followed by the right main bronchus and trachea, were the sites of impaction. Four children required additional procedures (tracheotomy and thoracotomy). There was one mortality in the study cohort. Aspiration of unusual foreign bodies is not uncommon in children. Most aspirations are witnessed and predominant in boys. The left bronchus is the common site of impaction, and X-ray clinches the diagnosis. Presentation is delayed, and bronchoscopic retrieval, though challenging, has favorable outcome.

Retrieval of an unusual fishhook foreign body from the esophagus in a buffalo

A four-year-old female buffalo was presented with a complaint of accidental ingestion of fishhook along with fodder. The owner tried to pull out the fishhook thread during ingestion, accidentally the thread broke and, the fishhook was ingested by the buffalo. The clinical examination revealed hypersalivation and the animal was anxious to observe. Radiography on a standing animal revealed fishhook shape metallic opacity just below the 4 to 5th cervical vertebrae within the esophagus. The fishhook was removed manually without any surgical intervention with the help of the right hand under deep sedation. Recovery was uneventful and soon after the intervention the animal was observed to be almost back to normalcy.

Endoscopic retrieval of oesophageal foreign body in a dachshund

Four-year-old male Dachshund dog was presented to Madras Veterinary College and Teaching Hospital with the history of gradual weight loss and chronic vomiting for more than twenty days. Previously the dog was treated in several places with anti-emetics, proton pump inhibitors, H2 blockers, fluid therapy and antibiotics but there was no improvement. On clinical examination the dog was severely dehydrated, increased skin tenting time and increased capillary refill time. Hematobiochemical assessment revealed mild hypoproteinemia and hypoalbuminemia. Radiographic examination of thorax and abdomen revealed no radio-opaque foreign body in the gastrointestinal tract and ultrasound examination also confirmed the same. Contrast radiographic examination revealed absence of megaesophagus and foreign body in gastrointestinal tract. Hence upper gastrointestinal endoscopy was performed and which revealed presence of plastic thread twine along the esophagus from the level of pharynx to cardia and the foreign body was retrieved using endoscopic forceps. Further the animal was treated with fluid therapy along with other supportive therapy. The dog was shown the clinical improvement after third day.

Endoscopic retrieval of oesophageal foreign body in a Shih-tzu dog

A 9 month old, female Shih-tzu dog was presented with history of vomiting and anorexia for a period of 2 days following feeding with chicken bones. Deworming and vaccination were regular. Survey radiography revealed radio-opaque structures in the thoracic oesophagus close to the base of the heart. Endoscopy was performed to visualize and retrieve the bones. The foreign body was successfully recovered using laparoscopic forceps under the guidance of endoscope. The pup was treated for oesophagitis and pup had uneventful recovery.

Coin-cidence? Have cashless payments reduced the incidence of upper aerodigestive foreign body insertion? A study of UK Hospital Episode Statistics.

Insertions of nasal and oral foreign bodies (FB) are common presentations in the emergency department, with coins frequently implicated among paediatric populations. Contactless payments were first introduced in the UK in 2007, and cash payments significantly declined from 2012. This study aims to explore the potential implications of increasing contactless payments on FB ingestion. UK Hospital Episode Statistics (HES) were reviewed between 2000 and 2022. All FB retrieval procedures involving the alimentary tract, respiratory tract and nasal cavity were included. Regression analysis was performed to assess trends in the incidence of FB ingestion before and following the transition to cashless payments in 2012. Following the decline in cash payments in 2012, the frequency of alimentary tract FB removal procedures decreased significantly by 27.78 procedures per year (p < 0.001). Similarly, respiratory FB removal procedure decreased by 4.83 per year (p = 0.009) and nasal cavity FB removal procedures decreased by 52.82 per year (p < 0.001). This study suggests a statistically significant decline in the number of procedures for removal of FB performed in the UK from 2012. Although this relationship is multifactorial, our data suggest an association between the introduction of contactless payments and a reduction in the number of FB retrieval procedures from the of upper aerodigestive tract.

The extraordinary case of a welder: retrieval of foreign bodies via transcervical neck exploration

Penetrating foreign bodies in the neck can be challenging to locate, especially given the complex anatomy of neck and edematous tissue planes following injury. These foreign entities require prompt surgical exploration for their removal because of risk of migration. Retrieval of foreign bodies relies upon their size and surrounding anatomical tissues. We are reporting an uncommon instance in which an iron chip accidentally penetrated patient's neck, producing acute hoarseness of voice and agony. The foreign body was removed via transcervical neck exploration.

Hypoxaemia risk in pediatric flexible bronchoscopy for foreign body removal: a retrospective study

BackgroundHypoxemia represents the most prevalent adverse event during flexible bronchoscopy procedures aimed at foreign body retrieval in pediatric patients; if not expeditiously managed, it carries the potential for cardiac or respiratory arrest. The specific risk factors contributing to the occurrence of hypoxemia during foreign body FB removal via bronchoscopy have yet to be definitively established.MethodsThis retrospective study included a cohort of 266 pediatric subjects from January 1, 2015, to December 31, 2022, who underwent flexible bronchoscopy for the purpose of FB extraction. In this cohort, the supraglottic airway was used to connect the anesthesia apparatus during the removal procedure.ResultsIn total, 45 of the pediatric patients (16.9%) experienced episodes of hypoxemia during the FB removal procedure. Multivariate analysis revealed that the following factors were significantly associated with the occurrence of hypoxemia: an operation time exceeding 60 min (odds ratio [OR] 8.55; 95% confidence interval [CI] 3.82–19.13), a maximum diameter exceeding 7 mm (OR 5.03; 95% CI, 2.24–11.29), and the presence of radiological evidence indicating pneumonia (OR 2.69; 95% CI, 1.27–5.69).ConclusionDuring flexible bronchoscopy procedures aimed at FB removal in pediatric patients, there is an increased susceptibility to hypoxemia. Factors including extended operation duration, larger FB dimensions, and radiographic evidence suggestive of pneumonia significantly contribute to a heightened risk of hypoxemia.

Beyond diagnosis: a narrative review of the evolving therapeutic role of medical thoracoscopy in the management of pleural diseases.

Medical thoracoscopy (MT) is an endoscopic technique performed by interventional pulmonologists with a favorable safety profile and few contraindications, providing diagnostic and therapeutic intervention in a single sitting. This narrative review was designed to summarize the therapeutic role of MT based on the latest results from the available literature. Pertinent literature published in English, relative to human studies, between 2010-2022 was searched in Medline/PubMed and Cochrane databases. Publications regarded as relevant were considered for inclusion in this review; additional references were added based on the authors' knowledge and judgment. The review considered population studies, meta-analyses, case series, and case reports. MT has mostly been described and is currently used globally in the diagnostic approach to exudative pleural effusion of undetermined origin. Carefully evaluating the literature, it is clear that there is initial evidence to support the use of MT in the therapeutic approach of malignant pleural effusion, pneumothorax, empyema, and less frequently hemothorax and foreign body retrieval. MT is an effective procedure for treating the clinical entities presented in this document; it must be carried out in selected patients, managed in centers with high procedural expertise. Further evidence is needed to assess the optimal indications and appropriate patients' profiles for therapeutic MT. The endpoints of length of hospital stay, surgical referral, complications and mortality will have to be considered in future studies to validate it as a therapeutic intervention to be applied globally.

Endoscopic Removal of Gastric Foreign Bodies with a Bottle Liner in 12 Dogs (2020-2023).

Endoscopy is widely used to remove gastric foreign bodies using grasping forceps and loop snares to manipulate and retrieve the foreign material. However, as not all foreign bodies can be removed using conventional endoscopic techniques, this case series describes the use of bottle liners for the removal of gastric foreign bodies in 12 dogs between 2020 and 2023. A 4 oz bottle liner (Drop-Ins) was placed at the end of the endoscope and pushed into the stomach. With the help of forceps introduced into the operating channel, the foreign body was pushed into the bottle liner. The bottle liner containing the foreign body was then extracted with the help of traction threads. The technique was used as the initial retrieval method in 5 dogs because of smooth (i.e., difficult to grasp) or sharp (i.e., that may damage the digestive tract mucosa during removal) foreign bodies and as a rescue procedure in 7 dogs. Foreign body retrieval was successful in all 12 dogs, with minor complications reported in 5 dogs (erosions and bleeding of the gastroesophageal sphincter). The use of a bottle liner represents an affordable alternative to gastrotomy when foreign bodies cannot be grasped with forceps or snares.

Small Bowel Perforation Due to an Unusual Foreign Body

Gastrointestinal perforation is one of the most common causes of acute abdomen presenting to the casualty. However, gastrointestinal perforation due to ingestion of foreign body is rare and is usually encountered in children, psychiatric patients and in alcoholics. Most of the foreign bodies pass through the GI tract without any complications. Only about 1% are known to cause complications such as perforation. Fish or chicken bones, dentures, toy parts, coins, toothpicks are the most commonly encountered foreign bodies. In this report, we present a case of a 60-year-old male who presented to the emergency department with acute abdomen secondary to ingestion of an unusual foreign body that lead to perforation and underwent exploratory laparotomy for removal of the foreign body.&#x0D; Gastrointestinal perforation is one of the most common causes of acute abdomen presenting to the casualty that needs a timely surgical intervention.[1] Important sites of gastrointestinal perforation are stomach, duodenum, small bowel (jejunum, small intestine), appendix, colon and rectum.&#x0D; The most common causes of gastrointestinal perforation include peptic ulcer disease, diverticulitis, carcinomas, IBD, ischemia of bowel wall and infrequently foreign bodies.[2]&#x0D; Foreign body ingestion as seen in children is unintentional and can be deliberate in psychiatric patients.[3] In general, many of these foreign bodies travel through the gastrointestinal tract without causing complications. Only about 1% cases of ingested foreign bodies cause complications such as hollow viscus obstruction and/ or perforation which are usually life threatening and have poorer outcomes if diagnosis is delayed.[4,5] CT is the imaging tool of choice. Such conditions require immediate surgical intervention such as exploratory laparotomy or laparoscopic or endoscopic removal can be attempted in case of stomach or duodenal foreign bodies.&#x0D; Here in the following case report, we present an atypical case who arrived at the emergency room with acute abdomen following a foreign body consumption and underwent exploratory laparotomy for retrieval of foreign body.

A135 DEEPLY EMBEDDED ESOPHAGEAL FISHBONE REMOVED BY ENDOSCOPIC MUCOSAL DISSECTION: CASE REPORT AND LITERATURE REVIEW

Abstract Background Foreign body ingestion is frequently encountered in gastroenterology clinical practice. While most objects pass spontaneously, sharp objects, most commonly bony fragments in adults, have a tendency to become lodged in the esophagus. The European and American Society of Gastrointestinal Endoscopy both recommend emergent endoscopy for sharp objects or bones impacted in the esophagus. However, there is little guidance regarding management of deeply embedded foreign bodies, that may not be visible intra-luminally or that may have penetrated the submucosa or muscularis propria. Aims In this case report, we describe successful endoscopic retrieval of a deeply embedded fishbone in the distal esophagus. A literature review was also conducted to evaluate the current evidence surrounding the use of endoscopic ultrasound (EUS) and submucosal dissection (ESD) to localize and remove deeply embedded foreign bodies. Methods A literature search on EUS and ESD use in foreign body retrieval was performed via MEDLINE/PubMed (September 2023) using relevant keywords and MeSH terms. Results CASE DESCRIPTION A 50-year-old man presented to hospital with several hours of dysphagia after consuming fish. A fishbone deeply embedded through the submucosa into the muscularis propria was identified on CT scan and EUS. ESD was employed to free the bone and a fully covered metal stent was deployed to close the defect. The patient had no immediate complications and recovered well post-procedure. Our literature search revealed a total of 6 case reports detailing endoscopic management of penetrating foreign bodies. One case used EUS to localize an object which was subsequently removed surgically. The remaining 5 cases all used ESD to remove submucosal objects without any short or long-term complications. Conclusions Clinical history is critical to prompt diagnosis of foreign body ingestion, and it is crucial to be familiar with the radiologic characteristics of the suspected object. Fishbones are frequently encountered and are most commonly radiolucent on plain films. CT scans should be obtained in these patients. Rarely, these objects will be found to be deeply penetrating. There are emerging case reports supporting the use of EUS in the localization of some of these objects, particularly when they cannot be seen intraluminally. Upon review of the literature, there is a paucity of reports describing their removal. This case report adds to the sparse literature demonstrating that ESD has an emerging role in the management of deeply penetrating foreign bodies. Following multidisciplinary discussion and consultation with the appropriate surgical service, ESD may prevent the need for otherwise invasive and potentially morbid surgical intervention. Fishbone embedded in the distal esophagus. Removed by ESD, defect closed with metal stent. Funding Agencies None

Migrated oesophageal foreign body retrieval with trans cervical approach in a district general hospital of Sri Lanka

A 53-year-old previously healthy patient presentated with an impending airway obstruction due to a retropharyngeal and a para-oesophageal abscess caused by a delayed impacted foreign body,failed retrieval with rigid oesophagosopy. The patient was successfully managed by exploration of the neck with trance cervical approach in a district general hospital setting. Awareness and early referral from primary care setting could have prevented a potentially life threatening complication.

Fluoroscopy-guided metallic foreign body removal: A case report

A foreign body (FB) was detected in the right lower zone on the chest X-ray of a 24-year-old woman who presented to the OPD with a cough and sputum. With the help of virtual bronchoscopy, the FB was localized in the posterior segment of the right lower lobe. It was located with the help of a flexible bronchoscope and fluoroscopy and retrieved with the help of snare and endobronchial biopsy forceps. After ensuring clinical stability, the patient was discharged the next day. Bronchoscopic FB removal from segmental and subsegmental bronchi is difficult. Fluoroscopy permits the bronchoscopic retrieval of FB from these relatively inaccessible regions and of the lung and averts the need for thoracotomy.