Foreign Body Retrieval Research Articles

Arthroscopic Removal of Metallic Foreign Body from the Talocrural Joint Using a Magnetic Retriever in a Horse

To report use of a magnetic retriever for arthroscopic removal of a metallic foreign body from the equine talocrural joint. Clinical report. A 2-year-old Warmblood stallion. A metallic foreign body was removed from a talocrural joint using a 10-mm magnetic retriever under arthroscopic guidance. Preoperative radiographs were used to locate the intra-articular position of the foreign body. Six months after surgery, the horse was no longer lame. A magnetic retriever can be used for arthroscopic removal of metallic foreign bodies from the equine talocrural joint. A magnetic retriever may be useful for arthroscopic retrieval of metallic foreign bodies from synovial cavities in horses, especially when direct observation is impeded by inflamed synovial villi and fibrin.

Pediatric airway foreign body retrieval: surgical and anesthetic perspectives

Airway foreign body aspiration most commonly occurs in young children and is associated with a high rate of airway distress, morbidity, and mortality. The presenting symptoms of foreign body aspiration range from none to severe airway obstruction, and may often be innocuous and nonspecific. In the absence of a choking or aspiration event, the diagnosis may be delayed for weeks to months and contribute to worsening lung disease. Radiography and high resolution CT scan may contribute to the eventual diagnosis. Bronchoscopy is used to confirm the diagnosis and retrieve the object. The safest method of removing an airway foreign body is by utilizing general anesthesia. Communication between anesthesiologist and surgeon is essential for optimal outcome. The choice between maintenance of spontaneous and controlled ventilation is often based on personal preference and does not appear to affect the outcome of the procedure. Complications are related to the actual obstruction and to the retrieval of the impacted object. The localized inflammation and irritation that result from the impacted object can lead to bronchitis, tracheitis, atelectasis, and pneumonia.

Intravascular foreign bodies: danger of unretrieved fragmented medical devices

A warning on the danger of unretrieved device fragments and recommendations to mitigate the danger were issued by the Food and Drug Administration in January 2008. The causes of intravascular foreign bodies are classified into three main categories: improper manipulation and usage, device defects, and others, such as patient and anatomical factors. Device failure after long-term use is rarely predicted at the time of approval, since device abnormality is rarely experienced in animal studies and clinical trials conducted during development of the device. Stent fracture due to metal fatigue is one example. Complex complications could occur from simultaneous use of two or more devices with diverse characteristics. The success rate of percutaneous retrieval of intravascular foreign bodies has improved with the advances in commercially available devices. However, the procedure is not always successful and sometimes surgical removal becomes necessary. Appropriate device selection and acquisition of experience in using the device are important. When an intravascular foreign body cannot be retrieved, the risk of complication could be high. Magnetic resonance imaging examination sometimes causes adverse events, including burns due to the heat generated by metal movement. Such information should be correctly recorded. Furthermore, it is necessary to provide patients with adequate information about the characteristics of implanted devices and unretrieved fragments. We reviewed the literature on unretrieved medical device fragments and include articles that describe the Japanese experience.

Endoscopic techniques for retrieving and manipulating ingested foreign bodies

Endoscopic foreign body retrieval refers to the removal of ingested objects from the oesophagus, stomach and duodenum by endoscopic techniques. It does not primarily involve surgery, but rather encompasses a variety of techniques for grasping the foreign bodies, manipulating them, and removing them while protecting the oesophagus and trachea. Careful patient selection aids in determining the method of choice. The chosen strategy depends on the type and location of the foreign body, the length of time it has been in the oesophagus, and degree of experience of the endoscopist. All endoscopy units need to be prepared for such an eventuality as prompt treatment of a patient with a suspected oesophageal foreign body is crucial because of the potential for severe complications. This article looks at some of the common foreign bodies ingested and focuses on the techniques and equipment used to retrieve or manipulate them. Finally, the article discusses the vital role of the nurse in such a procedure.

Percutaneous retrieval of intravascular and intracardiac foreign bodies with a dedicated three‐dimensional snare: A 3‐year single center experience

The presence of symptomatic or asymptomatic intravascular/intracardiac foreign body (FB) is under-reported in the literature, but it is more commonly encountered in clinical practice. The implantation of long-term venous catheters and the number of technical challenging endovascular procedures are both constantly increasing. Thus, the number of reported FBs will also increase, becoming a serious concern, especially once associated with a cardiovascular complication. We report the analysis of 22 patients in whom an intravascular/cardiac FBs retrieval was attempted. The details of the procedure have been discussed in depth emphasizing the technical aspects of the utilized dedicated three-dimensional snare device (Entrio snare). The technical feasibility, safety, and efficacy of the retrieval procedure were then analyzed. We divided our patients into two groups. Group 1 included 12 patients in whom the FB had already migrated in the right heart or in the pulmonary circulation. Group 2 included 10 patients with an intravascular FB (intravenous or intraarterial). Technical retrieval success rate was 95.5% (21/22), with a 35-min procedural mean time and no in-hospital procedural-related complications. Our data confirm that different kinds of FBs lodging in different sites of the cardiovascular system can safely and efficaciously be percutaneously retrieved by utilizing a dedicated three-dimensional snare device. This, therefore, suggests that this minimally invasive intervention should be rapidly attempted, thus anticipating several serious complications.

Estimating Radiation Doses to the Skin from Interventional Radiology Procedures for a Patient Population with Cancer

To estimate the peak radiation skin doses for interventional radiology cases performed at a cancer center, identify procedure types likely to result in skin doses exceeding the American College of Radiology's 3 Gy follow-up level, and determine a kerma area product (P(KA)) for use in monitoring. A single-center retrospective study was performed to estimate doses from consecutive procedures performed during 2006. Of 6,598 procedures, 3,925 (60%) had P(KA) recorded and were included. Forty-three procedure types are represented. The median estimated peak skin dose was 39 mGy (third quartile, 205 mGy). In 2.6% of the cases, the estimated skin dose exceeded 3 Gy. No procedures resulted in skin doses greater than 15 Gy, and 94% of the cases resulted in skin doses less than 1 Gy. Procedure types with instances of skin doses greater than 1 Gy included hepatic, portal, and other arterial embolizations; diagnostic arteriography; biliary drainages; stent placements and catheter exchanges; nephrostomy/nephroureterostomy; urinary catheter exchanges; inferior vena cava filters; foreign body retrieval; abscess drainage; catheter exchange; and fistulography. Hepatic embolizations, nonhepatic arterial embolizations, and biliary drain/stent procedures were most likely to result in skin doses greater than 1 Gy. Significant variations in skin dose were noted within the same procedure type. No patients were noted to have developed any sequelae from radiation. It is unlikely that typical cases in an oncologic interventional radiology practice would exceed the Joint Commission's "reviewable sentinel event" skin dose level of 15 Gy. A P(KA) trigger of 300 Gy cm(2) could be used in the authors' clinic to identify follow-up requirements.

Ventriculoperitoneal shunt migration into the pulmonary artery

Ventriculoperitoneal (VP) shunting is the most common form of treatment for hydrocephalus. Complications of VP shunts may occur anywhere along their course from the cerebral ventricle to the peritoneal cavity. Rare complications such as migration of the peritoneal catheter into the stomach, gallbladder, urinary bladder, vagina, liver, bowel, colon, and diaphragm have been described in the literature. In this review of the literature we discuss the rare but serious event of migration of the distal catheter of a ventriculoperitoneal shunt (VP shunt) into the pulmonary artery. We present an additional patient with a special emphasis on minimally invasive treatment. The patient's postoperative course was uneventful, and a postoperative plain X-ray of the chest and abdomen confirmed appropriate placement of the new distal catheter intraperitoneally. It is useful to consider alternative nonsurgical techniques for percutaneous intravascular foreign body retrieval. Many different percutaneous techniques have been described. Rare complications of percutaneous intravascular foreign body retrieval may include transient cardiac arrhythmia, fragmentation of the foreign body, or migration of the foreign body to a different location. A multidisciplinary discussion and approach is pivotal to treating this extraordinarily rare complication.

Comparison of Outcomes of Endoscopic Management of Gastrointestinal Foreign Bodies Among Prison Inmates to That of the General Population - A New York City Hospital Experience

Background: Few studies on endoscopic management of gastrointestinal (GI) foreign bodies (FB) in prison inmates (PI) have shown high failure rates and complications but there are no studies comparing the outcomes to that of the general population (GP). Aim: To analyze and compare the outcomes of endoscopic management of GI FB among PI to that of GP. Methods: On retrospective review of endoscopic reports and medical records collected from a single New York City Hospital there were 78 patients who underwent 99 endoscopic procedures for FB retrieval during 2000 to 2008.

Current state of double balloon endoscopy: The latest approach to small intestinal diseases

Recent developments of capsule endoscopy and double balloon endoscopy (DBE) have made endoscopic examination of the entire small bowel practical, and changed the diagnostic algorithm for small bowel diseases. Double balloon endoscopy uses two balloons, one attached to the tip of the endoscope and another at the distal end of an overtube. By using these balloons to grip the intestinal wall, the endoscope can be inserted further without forming redundant loops of intestine. Total inspection by DBE is usually achieved by combination of sequential oral and anal intubations; success rates are reported to be 40-80%. Indications for DBE include scrutiny for obscure gastrointestinal bleeding, small bowel tumor, small bowel stricture and following up evaluation of previously diagnosed small bowel diseases. Because DBE has an accessory channel and good maneuverability in the distal small intestine, it enables endoscopic treatment, including hemostasis, balloon dilation, polypectomy, mucosal resection, retrieval of foreign bodies and endoscopic retrograde cholangiopancreatography (in the case of post-operative anastomoses). Double balloon endoscopy is also useful for cases of difficult colonoscopy, providing success rates of total colonoscopy between 88-100%. Although it has been a few years since its development, the usefulness of DBE is now well recognized. This challenging procedure has become popular rapidly and is currently used in many countries.

Simultaneous endoscopic removal of 5 coins from the stomach without causing mucosal injury using specially designed devices

Endoscopic retrieval of foreign bodies is sometimes a challenging task. We report a case of simultaneous removal of 5 coins from the stomach without causing mucosal injury using a specially-designed devices consisting of retrieval net, endoscopic attachment balloon and a disposable tip attachment. This technique has not been described before.

Retrieval of vascular foreign bodies using a self-made wire snare

Foreign bodies in the vascular system have a high potential to cause embolization, perforation, and infection. Therefore, numerous commercially available percutaneous retrieval devices have been developed. To evaluate the feasibility and efficacy of a self-made wire snare for the retrieval of foreign bodies in the vascular system. 16 consecutive patients, who underwent percutaneous foreign-body retrieval between 1997 and 2007, were included in this retrospective analysis. Percutaneous extraction was performed using an adjustable wire snare that was fabricated using a 5F diagnostic Headhunter or Multipurpose catheter and a 4-m-long 0.018-g/inch standard heavy-duty wire that was bent in the middle to create an eccentric loop. Percutaneous foreign-body retrieval was successful in all 16 cases. Intraluminal materials including partially fractured venous catheters, guidewires, a stent, and a vena cava filter were removed from various locations. In six cases, mobilization of the intraluminal material via a pigtail catheter was necessary before using the wire snare for removal. Successful retrieval was investigator independent. In no cases were surgical procedures required, and no relevant complications were encountered. This snare technique is an effective, feasible, and cost-effective method to retrieve intraluminal material. It is an alternative to commercially available retrieval devices.

Capsule endoscopy assisted by traditional upper endoscopy

Capsule endoscopy (CE) can be prevented by difficulties in swallowing the device and/or its gastric retention. In such cases, endoscopic delivery of the capsule to duodenum is very useful. We describe the indications and outcomes of cases in which traditional endoscopic techniques allowed placement of the capsule in duodenum. This is a retrospective, descriptive case series. All patients in the above conditions were identified and indications for CE, endoscopic-placement technique, complications and completeness of small bowel imaging were registered. Endoscopic-assisted delivery of the capsule was necessary in 13 patients (2.1% of all CE; 7 males; mean age--47.9 +/- 24.9 years, range 13 to 79 years). Indications for endoscopic delivery included: inability to swallow the capsule (7), gastric retention in previous exams (3), abnormal upper gastrointestinal anatomy (3). In eight patients, the capsule was introduced in GI tract with: foreign body retrieval net alone (3), retrieval net and a translucent cap (2), prototype delivery device (2) or a polypectomy snare (1). Five patients ingested the capsule that was then placed in duodenum with a polypectomy snare (3) or a retrieval net (2). No major complications occurred. Complete small bowel examination was possible in 10 patients (77%). Endoscopic placement of capsule endoscope in the duodenum is rarely needed. However it may be safely performed by different techniques avoiding some limitations of CE. The best methods for endoscopic delivery of the capsule in the duodenum seem to be retrieval net with a translucent cap when the patient is unable to swallow the device or a retrieval net only to capture the capsule in the stomach when the patients swallows it easily.

Removal of a temporary pacemaker lead fragment with the use of biopsy forceps

The percutaneous retrieval of intravascular foreign bodies is a rather frequently applied technique, given the growing number of vascular procedures in daily clinical practice. Various types of devices have been used, such as gooseneck snares, Dormia baskets, tip deflectable wires, or biopsy forceps. A 75-year-old male was admitted to the Coronary …

Computed tomography as an aid to management of chronic oropharyngeal stick injury in the dog

To describe the use of computed tomography scanning in the management of dogs with chronic signs after oropharyngeal stick injury. Dogs with a final diagnosis of chronic oropharyngeal stick injury that underwent a computed tomography scan during their investigation were selected retrospectively from case files at the Royal Veterinary College, London. The six dogs were young (median age 3.1 years) and medium to large breed (19.0 to 42.0 kg). By the time of referral the most common clinical sign was cervical swelling (five dogs). Stick foreign bodies were apparent on the plain computed tomography images in all cases and appeared as well-demarcated, linear abnormalities. A ventral mid-line approach was used for foreign body retrieval, and the computed tomography findings corresponded well with the surgical findings, with stick foreign body length ranging from 1 to 7 cm. Closed suction drainage was used in five dogs, for two to four days. Clinical signs fully resolved postoperatively in all cases, although cervical swelling recurred three weeks after surgery in one case. This dog had the smallest foreign body, the greatest number of surgical interventions before referral (three) and the longest disease course before referral (eight months). Computed tomography scanning is accurate in identifying the presence and location of chronic stick foreign bodies. Recurrence of disease is possible despite successful retrieval of the wood fragments found by computed tomography scan.

S123 – New Approaches to Infratemporal Fossa Foreign Body Removal

Objectives 1) To understand indications for removal of foreign bodies (FB) from the head and neck. 2) To be able to describe the use of new surgical technologies for FB removal from the head and neck region. 3) To understand the clinical applications of a novel, minimally-invasive technique for removal of FB from the infratemporal fossa. Methods A retrospective review of 2 cases of infratemporal fossa foreign bodies, which were referred to a tertiary care facility for management utilizing a novel transoral, endoscopic, image-guided approach. Results Both patients presented with pain and trismus following failed attempts to retrieve foreign bodies–1 broken hypodermic needle and 1 torn cottonoid sponge-through open explorations. Use of endoscopic equipment for visualization and image-guidance system for precise localization enabled both objects to be removed through a transoral approach. Surgical removal resulted in improvement in pain and trismus in both patients who were discharged within 24 hours. Conclusions A new approach is now available for the minimally-invasive retrieval of radio-opaque foreign bodies in the infratemporal fossa, which avoids the need for extensive surgical dissection or an external incision.

Aortic Pseudoaneurysm Caused by Migration of a Swallowed Sewing Needle

A white 64-year-old woman who made dresses for her livelihood was admitted to the emergency department for evaluation of acute chest pain and respiratory distress. Physical examination was unremarkable except for low arterial blood pressure (90 mm Hg systolic, 65 mm Hg diastolic), whereas ECG showed left atrial enlargement, possible previous septal myocardial infarction, negative T waves in the inferior leads, and no evidence of acute ischemia (Figure 1). Myocardial enzyme levels, including Troponin I, were within normal values after serial determination. Figure 1. ECG shows sinusal rhythm with 98 bpm, left atrial enlargement, possible previous septal myocardial infarction, and negative T waves in inferior leads. Chest x-ray was performed and showed a thin radiopaque foreign body at the 5° body of the thoracic vertebra level, near the trachea (Figure 2). When questioned specifically, the patient mentioned the possible accidental ingestion of …

Percutaneous endovascular retrieval of an intravascular foreign body in five dogs, a goat, and a horse

CASE DESCRIPTION-5 Dogs, 1 goat, and 1 horse underwent percutaneous endovascular retrieval of intravascular foreign bodies between 2002 and 2007. CLINICAL FINDINGS-Foreign bodies were IV catheters in 4 dogs, the horse, and the goat and a piece of a balloon valvuloplasty catheter in 1 dog. Location of the foreign bodies included the main pulmonary artery (1 dog), a branch of a pulmonary artery (4 dogs), the right ventricle (the goat), and a jugular vein (the horse). TREATMENT AND OUTCOME-The procedure of percutaneous endovascular retrieval of the foreign body was easy to perform in all instances. One dog was euthanized 41 days after retrieval because of worsening of another disease process, and 1 dog had abnormal neurologic signs secondary to a brain mass. All other animals were clinically normal during the follow-up period (follow-up duration, 3 to 57 months). None of the animals developed long-term complications secondary to the foreign body retrieval procedure. CLINICAL RELEVANCE-Intravascular foreign bodies that result from catheters or devices used during minimally invasive techniques are rare but may cause substantial morbidity. Percutaneous endovascular retrieval of intravascular foreign bodies was easily and safely performed in the 7 animals reported here. Use of percutaneous endovascular retrieval techniques should be considered for treatment of animals with intravascular foreign bodies because morbidity can be substantially decreased; however, proper selection of patients for the procedure is necessary.

MO-E-332-02: Skin Doses in Interventional Radiology Procedures Associated with Oncology Diagnosis and Treatment - Are There Reviewable Sentinel Events?

Purpose: Fluoroscopic examinations with cumulative dose exceeding 15 Gy to a single field is now considered as a ‘reviewable sentinel event’ according to Joint Commission standards. Guidance from the FDA suggests that the potential for injury be recorded in the patient's record for cumulative absorbed dose of 1 Gy or more. The purpose of this study was to estimate the peak radiation skindoses for interventional radiology procedures performed at a high patient volume cancer center. Method and Materials: A single‐center, IRB‐approved retrospective study was performed using data from an oncologic interventional radiology section. Peak skindoses were estimated from consecutive procedures performed during 2006 in three different fluoroscopic suites equipped for these studies. Of 6598 consecutive procedures, 3966 (60%) had dose‐area‐product (DAP) measurements recorded and were included in the study. Results: The mean estimated peak skindose was 0.19 Gy (range 4.95 microGy to 8.65 Gy) with a maximum individual skindose of 8.65 Gy. No procedures resulted in skindoses >15 Gy and over 95% of the procedures resulted in skindoses 1 Gy included: embolization, biliary drain/stent, IVC filter, nephrostomy, arteriogram, abscess catheters, foreign body retrieval, catheter change, cholecystostomy, and gastronomy tube check. Embolizations, and biliary drain/stent procedures were most likely to result in skindoses >1 Gy. Significant variations in skindose were noted for various instances of the same procedure (e.g. range 0.6 mGy to 8.65 Gy for hepatic embolizations). Conclusion: Even when potential errors in methodology are considered, it is unlikely that any typical case performed in an oncologic interventional radiology practice would exceed the Joint Commission ‘reviewable sentinel event’ level of 15 Gy. Identifying procedures that could have peak skindoses greater than 1 Gy can be useful for informed consent and clinical followup.

Endovascular retrieval of embolized jugular catheter fragments in three dogs using a nitinol gooseneck snare

Two dogs were referred to the Kansas State University Veterinary Medical Teaching Hospital for pulmonary arterial embolization and one to Washington State University Veterinary Teaching Hospital for right heart embolization of jugular catheter fragments. Endovascular retrieval of foreign bodies was accomplished under general anesthesia in all three cases. Although the incidence of, and complications associated with catheter embolization in dogs are unknown, it appears that they can be safely and easily retrieved with a nitinol gooseneck snare.

Fluoroscopic Guidance of Retrograde Exchange of Ureteral Stents in Women

The purpose of this study was to review our experience with fluoroscopically guided retrograde exchange of ureteral stents in women. During a 48-month period, 28 women (age range, 38-76 years) were referred to our department for retrograde exchange of a ureteral stent. The causes of urinary obstruction were tumor compression in 26 patients and benign fibrotic stricture in two patients. A large-diameter snare catheter (25-mm single loop or 18- to 35-mm triple loop) or a foreign body retrieval forceps (opening width, 11.3 mm) was used to grasp the bladder end of the stent under fluoroscopic guidance. The technique entailed replacement of a patent or occluded ureteral stent with a 0.035- or 0.018-inch guidewire with or without the aid of advancement of an angiographic sheath. A total of 54 ureteral stents were exchanged with a snare catheter in 42 cases or a forceps in 12 cases. One stent misplaced too far up the ureter was replaced successfully through antegrade percutaneous nephrostomy. Ten occluded stents, including one single-J stent, were managed with a 0.018-inch guidewire in three cases, advancement of an angiographic sheath over the occluded stent into the ureter in five cases, and recannulation of the ureteral orifice with a guidewire in two cases. No complications of massive hemorrhage, ureter perforation, or infection were encountered. With proper selection of a snare or forceps catheter, retrograde exchange of ureteral stents in women can be easily performed under fluoroscopic guidance with high technical success and a low complication rate.